Background/Purpose: People are living longer. However, the aging process, coupled with lifestyle and health conditions, may lead to what is known as frailty syndrome. There is a consensus among researchers in the field that frailty is associated with adverse health outcomes, such as functional decline, dependency, recurrent falls, fractures, institutionalization, hospitalization and death. The aim of the present study was to analyze the relationship between frailty and mortality in a population of older people living in a Brazilian community. Methods: A prospective cohort study was conducted through two assessments in the city of Ribeirão Preto, state of São Paulo, with a mean follow-up period of 5.6 years. The sample was made up of 515 (75.37±7.28) older adults who were assessed in 2007/2008, and 262 (79.31±6.34) who were assessed in 2013. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) 22.0; the Wilcoxon test, Cox regression and Kaplan-Meier survival analysis were also used. Results: We verified that most older people were considered non-frail in 2007/2008 (59.5%); 22.9% were identified as apparently vulnerable, and 17.6% were frail. In 2013, 28.7% were considered non-frail, 20.9% apparently vulnerable; and 50.4% were frail (an increase of 186%). A total of 24.7% died during the follow-up period; 45.7% were considered frail according to the Edmonton Frail Scale. The survival analysis showed that frail older people were more likely to die. Conclusion: Frailty developed during the period under study, in association with mortality: a greater proportion of non-frail older people were among the survivors. In the present study, frailty was considered an important predictor of mortality. 2210-8335/Copyright © 2018, Asia Pacific League of Clinical Gerontology & Geriatrics. Published by Full Universe Integrated Marketing Limited.
Background/Objective: The aim of this study was to investigate the fall diagnostic accuracy of performance oriented mobility assessment (POMA), a widely used clinical measure for balance, gait and risk of fall, in inactive/low physically active and sufficiently physically active older adults. Methods: One hundred and forty three community-dwelling older adults aged 60 years and older were divided into two groups: inactive/low physically active; and sufficiently physically active. History of fall in the past year was recorded, and balance and gait were evaluated by POMA. Different cut-off points of POMA in the two groups were studied regarding specificity and sensitivity. Results: The POMA scores showed significant differences between inactive/low physically active and sufficiently physically active older adults (p < 0.001). The best cut-off point in inactive/low physically active and sufficiently physically active older adults was 19 (sensitivity 86% and specificity 86%). Conclusion: The POMA was a proper measure with sufficient sensitivity and specificity for diagnosing fall history in inactive/low physically active older adults. 2210-8335/Copyright (C) 2018, Asia Pacific League of Clinical Gerontology & Geriatrics. Published by Full Universe Integrated Marketing Limited.
Background/Purpose: The aim of this study is to identify the risk factors for readmission to acute hospital from convalescence care and compare the differences between early and late readmission and evaluate the impact of readmission on patients' outcome. Methods: Cases transferred from acute hospital to a convalescent care unit during the period of 1st July 2016 to 30th June 2017 were retrieved. Inclusion criteria were age >65 with unplanned readmission back to the index acute hospital. Primary outcome was early readmission (0-7 days after transferal) compare with late readmission (8-30 days after transferal) on basic demographic variables, principal diagnosis for transferal, comorbidity and length of acute hospital stay. Secondary outcomes were discharge destination, 30 and 90 days readmission and mortality. Results: Among the 5,447 admission episodes, 286 elderly subjects with a mean age of 81 (SD 9) have at least 1 unplanned hospital readmission. Patients with early readmission were mainly referred from medical unit with shorter acute hospital length of stay (4 vs. 12 days, p <0.001). There was high in-hospital mortality (34.7% vs. 35.7%) although there was no between group difference. There was no difference between early and late readmission on discharge destination, 30 and 90 days readmission and mortality. Conclusion: Shorter acute length of stay is a risk factor for early readmission and medical patients are more likely to be transferred back. Interventions which focus on acute inpatient management with better transitional care processes help to ensure better patient management and readiness for convalescence and rehabilitation care. 2210-8335/Copyright (C) 2018, Asia Pacific League of Clinical Gerontology & Geriatrics. Published by Full Universe Integrated Marketing Limited.
We report a 65-year-old Singaporean Chinese woman with Adult-Onset Still's Disease (AOSD) who presented with fever of unknown origin after multiple trauma who was successfully treated with prednisolone and methotrexate. The incidence of AOSD is extremely rare in the elderly population. Elderly patients with AOSD may also have atypical presentations and hence lead to a delay in diagnosis. In elderly patients with fever of unknown origin, particularly in Asians, the diagnosis of AOSD should be considered. 2210-8335/Copyright (c) 2018, Asia Pacific League of Clinical Gerontology & Geriatrics. Published by Full Universe Integrated Marketing Limited.
Background/Objective: Dementia is a chronic and incurable disease. To prevent a nursing home premature admission, the diagnosis should be made as earlier as possible. In 2003, our group found that primary care services had an insufficient identification and referral rate to secondary care of depression and dementia cases in the elderly population. Our hypothesis was that day center population was the most at risk of dementia (nursing homes/residential care homes being already with moderate to severe dementia and in local parish councils only with mild cognitive impairment), being the population which an early intervention would have a major impact. Methods: We did a selective cognitive screening study in the community. It consisted in a brief clinical interview and the application of Mini-Mental State Examination, Clock-Draw Test and Geriatric Depression Scale, creating a composite referral criterion. Individuals were referred and secondary analysis were done. Results: The screenings were done in 18 day centers (DC), 2 local parish councils (LPC) and 7 nursing homes (NH) in individuals without previous psychiatric/neurologic diagnosis. Five hundred and seventy-nine users were identified, 74% females. Referral criteria was met in 81% of NH, 56.8% in DC and 22.1% in LPC. Single individuals were significantly associated with lower cognitive score and married individuals with a higher score. Conclusion: There were a significant amount of people with cognitive impairment without a current diagnosis or adequate treatment plan. All individuals in DC should be assessed and prevention interventions should be implemented in LPC. Psychosocial network and daily social interactions should be further studied. 2210-8335/Copyright (C) 2018, Asia Pacific League of Clinical Gerontology & Geriatrics. Published by Full Universe Integrated Marketing Limited.
This paper refers to a 67-year-old male dilated cardiomyopathy (DCM) patient who received the left-ventricular assist device (LVAD) implant. However, having been affected by heart failure for many years, the patient had sustained long-term fatigue and weakness, and hence was in a depressed mood. The patient also experienced decreased muscle strength and muscle mass due to aging, which also led to a lack of endurance after the surgery. During the post-surgery recovery phase, the author worked with the patient, his family, physical therapists and heart-failure case-managers to implement an individually tailored recovery regime. As a result, the patient achieved an activity level of 1.0-3.0 metabolic equivalents (METs) in the cardiac care unit after surgery, which effectively improved his lack of endurance for activities. In addition, the patient performed daily living activities independently and regained his confidence. This case demonstrates the importance of cardiac rehabilitation and timing of cardiac rehabilitation. 2210-8335/Copyright (c) 2018, Asia Pacific League of Clinical Gerontology & Geriatrics. Published by Full Universe Integrated Marketing Limited.
Background/Objective: As people age the quest for maintaining good health becomes increasingly important. Since students' intention to work with older adults can be used as a valid proxy measure for their future behavior, therefore, a valid and reliable instrument to measure intention is essential for educational intuitions. The present study aimed to develop and validate a scale to measure medical sciences students' willingness to work with older adults. Methods: A cross-sectional design study was conducted on a sample of Iranian medical sciences students in 2017. The self-administered technique was employed to collect data in the respective departments. The items for the Willingness to Work with Elderly People Scale (WEPS) were developed through a systematic and critical review of the existing literature on willingness to work with older adults using Theory of Planned Behavior (TPB) as a theoretical framework. Data analysis was conducted using SPSS 23.0 for Windows (IBM SPSS Statistics 23.0) and AMOS 23.0 (Analysis of Moment Structure). Results: Out of 583 students surveyed, 56.4% were male and mean age was 21.98 (standard deviation, SD=3.63) years, ranging from 18 to 48. Internal consistency using Cronbach's alpha for the scale was found to be 0.81. The results provide support for the convergent and concurrent validity of the WEPS. The results from AMOS revealed that final model's CMIN/df (2.646), GFI (0.930), CFI (0.916) and RMSEA (0.053) fit statistics, indicated satisfactory model fit. Conclusion: The findings from the current study provided the initial evidence that the WEPS produced a reliable and valid scale for measuring the willingness to work with older adults. Future prospective research is needed to determine whether these attitudes and beliefs predict actual work with older adults among students. 2210-8335/Copyright (C) 2018, Asia Pacific League of Clinical Gerontology & Geriatrics. Published by Full Universe Integrated Marketing Limited.
Background/Objective: To study the effects of meditation on physical functions and quality of life in the elderly. Methods: This study compared the effects of meditation on physical health and quality of life in the elderly subjects. The meditation group (MG) received a meditation program consisting of 60-minute meditation sessions, 3 times a week for 8 weeks, while the control group (CG) received general health education. The outcomes that were measured included blood pressure, heart rate, six-minute walk distance test (6MWT) scores, five times sit to stand test (FTSST) scores, timed up and go test (TUGT) scores, functional reach test (FRT) scores and the results of a quality of life (QoL) assessment. Results: The 42 subjects eligible to participate in the study were divided into two groups: the MG and the CG (21 subjects each). The median ages of the MG and CG were 73 and 71 years, respectively. After the eight-week period, two outcomes, TUGT and FRT, differed significantly between the MG and CG. The TUGT score was significantly lower in the MG than CG (6.4 vs. 8.3 sec; p value <0.01), while the FRT score was significantly higher in the MG than CG (26.0 vs. 21.0 cm; p value <0.01). The other outcomes were comparable between both groups including those of the 6MWT, FTSST, and QoL assessment. Conclusion: The eight-week course of meditation significantly improved mobility, balance, and stability in healthy elderly subjects. 2210-8335/Copyright (c) 2018, Asia Pacific League of Clinical Gerontology & Geriatrics. Published by Full Universe Integrated Marketing Limited.
Development of lung cancer may develop in patients with pulmonary non-tuberculous mycobacterial (NTM) infection. Pulmonary NTM infection may present as mass-like consolidations mimicking lung cancer. Recent improvement in imaging modalities may enable correct diagnosis of lung cancer in these patients. We show herein an elderly patient developed in his clinical course of pulmonary NTM. Two sputum cultures were positive for acid-fast bacilli and the result polymerase chain reaction of his sputum showed a positive for Mycobacterium intracellulare. Lung cancer was detected in a follow-up chest computed tomography (CT) scan and PET/CT scan demonstrated significantly high the maximum standardized uptake values (SUVmax) of 34.5, and pulmonary NTM lesions showed SUVmax up to 4.9. The patient developed carcinomatous pleuritis, and cytological examination using the specimen obtained from pleural fluid proved to be adenocarcinoma. Although very rare, chest physicians and thoracic surgeons would be alert to the possibility of development of lung cancer in patients with pulmonary NTM infection. FDG-PET/CT scanning and a pathological approach provide important information to clarify the possibility of such a rare condition. 2210-8335/Copyright (C) 2018, Asia Pacific League of Clinical Gerontology & Geriatrics. Published by Full Universe Integrated Marketing Limited.
Background/Objective: We aimed to identify and compare factors associated with 30-day readmission and visit to Emergency Department (ED) post-discharge among elderly patients. Methods: This was a retrospective cohort study of patients >= 65 years old who were admitted to a regional acute hospital in Singapore in 2011-2015. Data on demographics, admission and discharge details, comorbidity and functional status were extracted from the hospital's electronic clinical records and linked to data on emergency visits and death. The outcomes were (1) unplanned inpatient readmissions within 30 days of inpatient discharge, and (2) visit to ED within 30 days of inpatient discharge. Backward stepwise multivariable logistic regression was used to examine the association between patient characteristics and outcomes. Results: There were 45,349 admissions for the analysis. Overall, 19.2% were readmitted and 22.2% visited ED post-30 day discharge. Several factors associated with 30-day readmissions and ED visits were shared, including males, functional impairment, higher number of hospital admissions, time of discharge, discharge to nursing home, Charlson cormorbidity index, length of stay and congestive heart failure. Conclusion: The outcomes were predicted by multiple risk factors, some of which were shared and modifiable. Identification of these factors could aid in tailoring of prevention strategies and intensification of efforts at this growing group. 2210-8335/Copyright (C) 2018, Asia Pacific League of Clinical Gerontology & Geriatrics. Published by Full Universe Integrated Marketing Limited.
Background/Objective: Aging causes a loss of functional fitness, which reduces the ability of the elderly to accomplish their daily life activities, affecting their quality of life. To overcome this scenario, exercise is indicated. It is important to know which training environment promotes greater quality of life and functional fitness. The aim of the present study was to compare the quality of life and functional fitness of elderly practitioners of water-based (WB) and land-based (LB) physical training. Methods: This study is characterized as observational of comparative cross-sectional design. Sample consisted of 14 individuals practitioners of LB (69.24 +/- 6.61 years) and 14 practitioners of WB (67.28 +/- 6.03 years). LB had weekly frequency from three to four sessions, in which aerobic and resistance training were performed, without clear structuring (control and progression of volume and intensity) of training. WB had two weekly sessions of deep water running aerobic training, with clear structuring of training. Results: Quality of life was similar between the groups, except in environment domain, in which WB showed greater values (LB: 66.07 +/- 7.34, WB: 75.67 +/- 12.98). WB presented better performance in the dynamic balance test (LB: 6.83 +/- 1.03s; WB: 5.74 +/- 0.78s), as well as greater upper limb strength (LB: 19 +/- 5 repetitions; WB: 28 +/- 8 repetitions), lower limb strength (LB: 13 +/- 4 repetitions; WB: 21 +/- 4 repetitions) and flexibility levels (LB: -10.21 +/- 12.85 repetitions; WB: 1.71 +/- 9.74 repetitions). Conclusion: Elderly practitioners of a periodized water-based training have the same quality of life, however, greater strength, dynamic balance and flexibility in comparison to practitioners of a non-periodized training on land environment. 2210-8335/Copyright (C) 2018, Asia Pacific League of Clinical Gerontology & Geriatrics. Published by Full Universe Integrated Marketing Limited.
This paper provides a description of the needs of people with dementia and their family caregivers based on clinical experience of the experts and compare the difference between literature and real clinical experience. We found that the needs of people with dementia include medical treatment, a safe environment, mental support, and dignity, which is consistent with previous research. We also found that the needs of the dementia people's family include physical, mental, bsocial, and economic aspects, which is in keeping with previous research. In addition to what is seen in the existing literature, we found that the primary caregiver generally insists on taking care of the people with dementia until the patient dies, although, at times, the caregiver dies first. Although caregivers become weary of looking after people with dementia, they are not comfortable putting them in a long-term care facility. This finding is different from that of Western research and can be attributed to filial piety or the traditional role of women in Chinese culture. 2210-8335/Copyright (c) 2018, Asia Pacific League of Clinical Gerontology & Geriatrics. Published by Full Universe Integrated Marketing Limited.
Background/Purpose: Elderly patients with heart failure suffer from many daily activity problems and mental adaptation; however, exercising as a non-medical intervention is not usually recommended by the treatment team. The purpose of the present study was to determine the effects of an aerobic and resistance exercise program on physiological-psychological adaptation in elderly with heart failure. Methods: This study is a randomized, clinical trial design. The study population comprised elderly with heart failure. Sixty male elders were selected using convenience sampling and randomly assigned into intervention and control groups. The group-based aerobic and resistance exercise program was conducted for three months. The psychological health questionnaire was completed both in the pre- and post-intervention period while the 6-Minute Walking Test was assessed in four time intervals. Results: The results showed a significant statistical difference between the two groups' 6-Minute Walking Test and psychological adaptation mean scores (p < 0.001). The aerobic and resistance exercise programs improved physiological and psychological adaptation, and diminished "psychological stress" (p < 0.001) among the elderlies with heart failure. Conclusion: The findings suggest that a group-based aerobic and resistance exercise program for elderlies with heart failure may contribute to improving their quality of life by improving their physiological capabilities and psychological adaptation. The study's results provide support for the safety and efficacy of group-based aerobic and resistance exercises for elderly patients with heart failure. 2210-8335/Copyright (c) 2018, Asia Pacific League of Clinical Gerontology & Geriatrics. Published by Full Universe Integrated Marketing Limited.
Background/Purpose: Aging is a natural, unavoidable process, associated with a reduction in physical, physiological, social and psychological activities of a person. Aging is adversely affecting nutritional as well as mental health status of the elderly population. The objective of the study to assess nutritional, pain and mental health status of elderly living in unban Delhi. Methods: The community-based study was conducted at the geriatric urban population of Delhi, North India. Predesigned and pretested questionnaires such as Mini nutritional assessment (MNA), McGill pain questionnaire (MPQ), Hamilton depression rating (HAM-D) and Hamilton anxiety rating scale (HAM-A) were used for nutrition, pain, depression, and anxiety respectively. Results: MNA based results showed that 37% of participants were malnourished, 39% at risk of malnutrition and 24% had a normal nutritional level. MPQ tool depicted 13% of the elderly population having mild pain, 80% as moderate and 7% having severe pain condition. The depression level was found to be 23% mild depression, 38% mild to moderate, 22% moderate to severe and 17% severe depression symptoms on HAD scale. Based on HAR scale, anxiety level was observed as 46% mild, 30% mild to moderate, 14% moderate to severe and 10% severe anxiety conditions. Conclusion: The results suggest a high prevalence of malnutrition, pain, depression, and anxiety in the elderly living in Delhi. The questionnaires have proven their potential as useful tools in the identification of malnutrition, pain, depression, and anxiety. Thus, trends observed in various health parameters can be utilized for the formulation of further detailed studies in the development of elderly related health policies. 2210-8335/Copyright (C) 2018, Asia Pacific League of Clinical Gerontology & Geriatrics. Published by Full Universe Integrated Marketing Limited.
Background/Purpose: To explore the factors associated with low physical performance among older inpatients. Methods: This cross-sectional study included 167 older inpatients aged 65 years and above (median: 83 years, women: 50.9%). We assessed physical performance using the Short Physical Performance Battery (SPPB). Low physical performance was identified by a SPPB score of four or lower. Measured variables included muscle strength, kyphosis, joint range of motion (ROM), and clinical characteristics. Separate stepwise logistic regression analysis between genders was performed to assess the relationship between low physical performance and the measured variables. Results: In men, knee-extensor muscle strength was associated with low physical performance. The odds ratio (OR) with a 95% confidence interval (CI) for knee-extensor muscle strength (per 0.1 Nm/kg) and low physical performance was 0.59 (0.45-0.77). In women, knee-extensor muscle strength, handgrip strength (per 1.0 kgf), and hip-extension ROM (per 5 degrees) were associated with low physical performance. The OR of knee-extensor muscle strength, handgrip strength, and hip-extension ROM for the low physical performance were 0.73 (0.54-0.99), 0.83 (0.69-0.99), and 0.26 (0.13-0.53), respectively. Conclusions: Factors associated with low physical performance in women were knee-extensor muscle strength, handgrip strength, and hip-extension ROM; and knee-extensor muscle strength in men. 2210-8335/Copyright (c) 2018, Asia Pacific League of Clinical Gerontology & Geriatrics. Published by Full Universe Integrated Marketing Limited.
Background/Purpose: Geriatric medicine is a new medical sub-specialty in Brunei. Information on co-morbidities and health care needs of older inpatients is essential for service planning. Methods: Retrospective review of electronic records for geriatric inpatients for three months. Pre-admission function, co-morbidities and input from allied health professionals were reviewed. Days of hospital stay were classified as medical treatment, rehabilitation, discharge planning and others. Outcome measures such as length of stay, mortality and readmission rates were assessed. Results: The 76 admissions consisted of 63 patients, equal gender proportions. Median age 85 years. Katz Index of Independence scores classified 67% with severe functional impairment and 26% as independent. More than a third had dementia. Only one-fifth were independent with mobility. Almost half were bed bound or transfers only. Sixty percent were referred for physiotherapy, 25% occupational therapy, 60% dietetics and 30% for speech language therapist input. Median length of stay was 8 days. Distribution of bed days in hospital were: medical treatment 32%, rehabilitation 19%, discharge planning 19%, admission under other teams 25% and others 6%. Inpatient mortality rate was 12%. There was a 5% 30-day mortality and 20% readmissions within a month. Conclusion: Older patients admitted under geriatric medicine in RIPAS Hospital have a high burden of co-morbidities, dementia, and poor functional status. Inpatient treatment required much medical and allied health input. A dedicated geriatrics ward is warranted to strengthen comprehensive geriatric assessment and multidisciplinary intervention to improve function outcomes. Community support services should also be developed to manage dependent patients after discharge. 2210-8335/Copyright (c) 2018, Asia Pacific League of Clinical Gerontology & Geriatrics. Published by Full Universe Integrated Marketing Limited.
Background/Objectives: Walking speed is known as a useful index for assessing health status and functioning in older individuals. However, the optimal walkway length for measuring walking speed has not been clarified, and measurements have been made using a variety of lengths. This study examined the agreement between two walking speeds collected using different walkway lengths, shorter than in previous studies, for older individuals. Methods: Participants comprised 206 community-living participants >= 65 years old who were able to perform activities of daily living independently. Comfortable and maximum walking speeds were measured using 5- and 2.4-m walkways. Agreements between 5- and 2.4-m walking speeds under each condition (comfortable and maximum) were investigated using Bland-Altman analysis. Results: Intraclass correlation coefficients (ICCs) between 5- and 2.4-m walking speeds under conditions of comfortable and maximum pace were 0.945 (95% confidence interval (CI), 0.928 similar to 0.958; p < 0.001) and 0.923 (95% CI, 0.899 similar to 0.941; p < 0.001), respectively. Mean differences between 5- and 2.4-m walking speeds under conditions of comfortable and maximum pace were -0.01 +/- 0.07 m/s (5 m: 1.44 +/- 0.20 m/s; 2.4 m: 1.45 +/- 0.20 m/s) and -0.02 +/- 0.09 m/s (5 m: 1.86 +/- 0.23 m/s; 2.4 m: 1.88 +/- 0.23 m/s), respectively. No proportional bias for differences between 5- and 2.4-m walking speeds was found under both comfortable and maximum pace conditions. Conclusion: Agreement between 5- and 2.4-m walking speeds was close to excellent in older individuals. The 2.4-m walking speed was slightly faster than 5- m walking speed, but the mean difference was extremely small and ignorable. Walking speed measured on a short walkway may be reliable and useful. 2210-8335/Copyright (C) 2018, Asia Pacific League of Clinical Gerontology & Geriatrics. Published by Full Universe Integrated Marketing Limited.
