Elderly Outpatients Research Articles

Characteristics of hearing loss in elderly outpatients over 60 years of age: an annual cross-sectional study

Background The prevention and treatment of presbycusis becomes a serious health challenge and socio-economic problem. Objectives We performed a cross-sectional analysis of the audiometry results of all elderly patients who visited our department throughout the year of 2018. Material and methods A total of 5520 people aged 60 and over were included and divided into three groups: young-old group (60–74 years old), old-old group (75–89 years old), and longevous group (over 90 years old). Pure-tone audiometry results of all patients were analyzed. Results Among the 5520 patients, there were 4445 cases in the young-old group, 1029 cases in the old-old group, and 46 cases in the longevous group, accounting for 80.53, 18.64, and 0.83%, respectively. In the young-old group, normal hearing and mild-moderate hearing loss were the most common, while moderate and severe hearing loss were more common among the old-old group and the longevous group. The hearing curve showed typical age-related hearing loss with a drop at high frequencies. Conclusions With an increase in age, patients tend to suffer from more serious hearing disorders. Presbycusis was associated with specific frequency and age characteristics. Understanding these characteristics is of great significance for the prevention and treatment of age-related hearing loss.

Knowledge, Attitudes and Beliefs of Adults and Elderly Outpatients Regarding Pneumococcal Vaccination at Taif Hospital Cluster

The whole world is invaded by many micro organisms which are not only killing people but also ruining the quality of life of the people worldwide. Vaccination against major micro-organism is the only way out to protect the people. Pneumonia and influenza are two leading causes of death especially the elderly within the globe.
 Objective of the Study: It was to assess knowledge, attitudes, and beliefs of adults and elderly outpatients regarding pneumococcal vaccination at the Taif hospital cluster and to understand the factors that may influence pneumococcal vaccination among the elderly and younger adults.
 Materials and Methods: It was a cross sectional questionnaire study where Self-administered Monkey surveys was administered to a cohort of elderly and younger adult participants. The study was conducted for 4 months. Age group of the participants were within 20 - >80 years and included both Saudi and Non Saudi individual. The collected data were subjected to descriptive analysis to obtain the frequencies of the different variables and the correlation between them using cross tabs, paired-sample T-test, and Pearson’s Chi-square. p-value < 0.05 was taken as significant.
 Results: Overall 301 people participated in the study (response rate 91%). A total of 32.56% responded that they had received the pneumococcal vaccine. From the respondents above 12.45% were between 20-40 years old, 10.72% between 41-60 years old, and 8.65% between 61-70 years and 2.07% between 71 to > 80 years of age, indicating lower rates of vaccination among the elderly. Vaccination depends on the patient's health conditions. Despite the positive knowledge, attitudes, and beliefs of the participants about the importance of the vaccine, yet they did not respond well to take the vaccine as recommended by the international health authorities.
 Conclusion: From the present study it can be concluded that gender has no statistically significant association with vaccination. More is the education more is the adherence to vaccination. Saudi nationals adhered more to vaccination as compared to non Saudi. The results from our study showed that healthcare guidance and recommendation significantly influenced vaccine uptake in both the elderly and younger adults.

Psychometric properties and diagnostic accuracy of the short form of the geriatric anxiety scale (GAS-10)

BackgroundAnxious symptoms have a negative impact on different aspects of the elderly’s quality of life, ranging from the adoption of unhealthy lifestyle behaviours to an increased functional impairment and a greater physical disability. Different brief assessment instruments have been developed as efficacy measures of geriatric anxiety in order to overcome psychometric weaknesses of its long form. Among these, the 10-item Geriatric Anxiety Scale (GAS-10) showed strong psychometric properties in community-dwelling samples. However, its diagnostic accuracy is still unexplored, as well as its discriminative power in clinical samples.MethodsIn the present study, we explored the psychometric performance of the GAS-10 in the elderly through Item Response Theory in a sample of 1200 Italian community-dwelling middle-aged and elderly adults (53.8% males, mean age = 65.21 ± 9.19 years). Concurrent validity, as well as diagnostic accuracy, was examined in a non-clinical sample (N = 229; 46.72% males) and clinical sample composed of 35 elderly outpatients (74.28% females) with Generalized Anxiety Disorder (GAD).ResultsThe GAS-10 displayed good internal construct validity, with unidimensional structure and no local dependency, good accuracy, and no signs of Differential Item Functioning (DIF) or measurement bias due to gender, but negligible due to the age. Differences in concurrent validity and diagnostic accuracy among the long form version of the GAS and the GAS-10 were not found significant. The GAS-10 may be more useful than the longer versions in many clinical and research applications, when time constraints or fatigue are issues.ConclusionUsing the ROC curve, the GAS-10 showed good discriminant validity in categorizing outpatients with GAD disorder, and high anxiety symptoms as measured by the GAS-SF cut-off. The stable cut-off point provided could enhance the clinical usefulness of the GAS-10, which seems to be a promising valid and reliable tool for maximize diagnostic accuracy of geriatric anxiety symptoms.

High Prevalence of Multimorbidity and Polypharmacy in Elderly Patients With Chronic Pain Receiving Home Care are Associated With Multiple Medication-Related Problems.

Aim: To measure the extent of polypharmacy, multimorbidity and potential medication-related problems in elderly patients with chronic pain receiving home care. Methods: Data of 355 patients aged ≥65 years affected by chronic pain in home care who were enrolled in the ACHE study in Berlin, Germany, were analyzed. History of chronic diseases, diagnoses, medications including self-medication were collected for all patients. Multimorbidity was defined as the presence of ≥2 chronic conditions and levels were classified by the Charlson-Comorbidity-Index. Polypharmacy was defined as the concomitant intake of ≥5 medications. Potentially clinically relevant drug interactions were identified and evaluated; underuse of potentially useful medications as well as overprescription were also assessed. Results: More than half of the patients (55.4%) had moderate to severe comorbidity levels. The median number of prescribed drugs was 9 (range 0–25) and polypharmacy was detected in 89.5% of the patients. Almost half of them (49.3%) were affected by excessive polypharmacy (≥10 prescribed drugs). Polypharmacy and excessive polypharmacy occurred at all levels of comorbidity. We detected 184 potentially relevant drug interactions in 120/353 (34.0%) patients and rated 57 (31.0%) of them as severe. Underprescription of oral anticoagulants was detected in 32.3% of patients with atrial fibrillation whereas potential overprescription of loop diuretics was observed in 15.5% of patients. Conclusion: Multimorbidity and polypharmacy are highly prevalent in elderly outpatients with chronic pain receiving home care. Medication-related problems that could impair safety of drug treatment in this population are resulting from potentially relevant drug interactions, overprescribing as well as underuse.

Risk factors for high fall risk in elderly patients with chronic kidney disease.

Patients with chronic kidney disease (CKD) usually represent an aging population, and both older age and CKD are associated with a higher risk of falling. Studies on risk factors among subjects with CKD are lacking. Records of outpatients from one geriatric clinic in Turkey were retrospectively reviewed. A result of ≥ 13.5 s on the timed up and go (TUG) test was accepted as a high risk of falls. Independent predictors of an increased risk of falls among subjects with CKD (estimated glomerular filtration rate of < 60 mL/min/1.73 m2) were identified using logistic regression models. Patients with CKD (n = 205), represented the 20.2% of the entire cohort and was identified as an independent predictor of increased fall risk (OR 2.59). Within the CKD cohort, serum folic acid levels and frailty were independent predictors of an increased risk of falls. The CKD/fall risk group was older, had a lower median years of education, lower vitamin D levels, and lower serum folic acid levels than the CKD/non-fall risk group. In addition to higher serum creatinine and potassium levels, the only significant difference between patients with CKD/fall risk and a matched non-CKD/fall risk was a lower median folic acid level in the former group. Frailty and low folic acid levels are independently associated with an increased risk of falls among elderly outpatients with CKD. Prevention of frailty may reduce the risk of falls in these subjects. Possible benefit of folic acid supplementation requires further studies.

Effectiveness of a 23-valent pneumococcal polysaccharide vaccine for the prevention of pneumococcal pneumonia in the elderly with chronic respiratory diseases: a case\u2013control study of a single center

BackgroundThe effectiveness of the 23-valent pneumococcal polysaccharide vaccine (PPSV23) in preventing pneumococcal pneumonia has been controversial.MethodsTo evaluate the effectiveness of the PPSV23 in elderly outpatients with chronic respiratory diseases, we carried out a case–control study, including 4128 outpatients aged ≥ 65 years, in the respiratory department.ResultsThere were 320 vaccinated patients, of which 164 were diagnosed with pneumococcal pneumonia. The adjusted odds ratio was 0.39 (95% confidence interval (CI), 0.17 to 0.89). In the subsets consisting of age groups ≥ 70 and ≥ 75 years, the adjusted odds ratio (95% CI) was respectively 0.16 (0.04 to 0.67) and 0.15 (0.02 to 1.12).ConclusionThis real-world study suggests that PPSV23 can be useful in preventing pneumococcal pneumonia in the elderly with chronic respiratory diseases.

How did we take care of our older cancer patients during the first COVID-19 wave? The French experience

BackgroundThe management of older cancer patients has been highly challenging for clinicians in a health-care system operating at maximum capacity during the COVID-19 pandemic.Patients and methodsWe analyzed data from 9 different institutions. The primary endpoint was to assess the prevalence of adapted patient care during the pandemic for elderly cancer patients. The secondary endpoint was to assess the incidence of hospitalization and mortality due to COVID-19. All patients were older than 65 years of age.ResultsWe analyzed data from 332 outpatients’ case files between 9th of March and 30th of April 2020. The median age was 75 years (range: 65–101) and 53% were male. Because of the COVID-19 pandemic, more than half of the outpatients received modified patient care, defined as postponement or cancellation of surgery, irradiation scheme adapted, systemic treatment or the use of telemedicine. Among patients with localized cancer, 60% had a change in management strategy due to the pandemic. Changes in management strategy were made for 53% of patients at the metastatic stage. GCSF was used , in 83% of patients, increasing considerably in the context of the pandemic. Sixty-nine percent of physicians used telemedicine. In the final analysis, only one patient was hospitalized for COVID-19 infection. No deaths due to COVID-19 were reported in elderly cancer patients during this time period.ConclusionOur study is the first to assess modification of patient care in elderly cancer outpatients during an epidemic. With this unprecedented crisis, our objective is to protect our patients from infection via protective barrier measures and social distancing, but also to guarantee the continuity of cancer care without overexposing this fragile population. Physicians were able to adapt their practice and used new forms of management, like telemedicine.

Analysis of potentially inappropriate medications (PIM) used in elderly outpatients in departments of internal medicine by using the Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (STOPP) criteria.

Potentially inappropriate medications (PIMs) are associated with increased adverse drug reactions (ADRs), admission rate, and mortality rate in elderly patients. Here, we assessed PIM use in elderly outpatients in the departments of internal medicine in our center by using the Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria. The clinical data of 13,221 outpatients aged ≥65 years in the departments of respiratory medicine, endocrinology, neurology, and cardiovascular medicine of a tertiary hospital from January 2016 to March 2016 were retrospectively analyzed. The incidence of PIM in these patients was assessed by using the STOPP criteria (2014 version). Multivariate logistic regression analysis was performed to identify risk factors for PIM use. It was found that 1,040 (7.87%) of 13,221 elderly patients had at least one STOPP-listed PIM, and a total of 1,785 PIMs were identified. The most commonly used PIMs were benzodiazepine, hypnotic Z-drugs (zolpidem), and antipsychotics. Multivariate logistic regression analysis revealed that age [odds ratio (OR) =1.032, 95% confidence interval (CI): 1.022, 1.042], gender (OR =0.783, 95% CI: 0.687, 0.892), number of prescribed medications (OR =1.134, 95% CI: 1.106, 1.163), and number of diagnoses (OR =1.450 95% CI: 1.391, 1.510) were significantly associated with PIM use. The incidence of PIM use was highest in the Department of Neurology (12.75%), followed by the Department of Cardiology (5.90%), Department of Endocrinology (4.94%), and Department of Respiratory Medicine (2.90%). The risk factors for PIMs varied among different departments: except that benzodiazepines and hypnotic Z-drugs (zolpidem) were 2 common PIMs in all departments, the remaining topranked PIMs were department-specific. PIM use in elderly patients in the outpatient departments of internal medicine is mainly related to age, gender, number of medications, and number of diagnoses. However, it varies among different departments, and the main PIM types are also department-specific. Thus, special attention should be paid to departments with a high incidence and a large number of PIMs, so as to promote rational use of medicines.

Individualized education focusing on self‐management improved the knowledge and self‐management behaviour of elderly people with atrial fibrillation: A randomized controlled trial

This study examined the effect of an individualized educational intervention on the knowledge, attitudes and self-management ability after 12weeks for outpatients with atrial fibrillation. A randomized control-group pretest-post-test experimental design was used. Elderly outpatients with atrial fibrillation aged over 65years were recruited from a university hospital in Korea. The experimental group received a 50-min individualized education on self-management, one telephone counselling after 8weeks and maintenance of a self-management diary for 12weeks. Data were collected from November 2017 to April 2018 and analysed using SPSS 22.0 for descriptive statistics and hypothesis testing. The participants' mean age was 71.9 (4.6)years. Compared to the control group (n=29), the experimental group (n=31) showed a significantly greater improvement in knowledge regarding atrial fibrillation and stroke prevention (t=-2.27, p=.027) and self-management behaviours (t=-8.02, p<.001). There were no significant group differences in attitudes towards atrial fibrillation. The findings suggest that education for elderly people with atrial fibrillation should be individualized, focusing on self-management in daily life to prevent cardiovascular complications. Future research is needed to confirm the long-term effects of such education programmes.

Impact of a Telephone Intervention on Bowel Preparation Quality for Colonoscopy in the Elderly.

Bowel preparation is the basis of colonoscopy, and adequate bowel preparation is essential to the success of colonoscopy. Studies have been reported that telephone intervention can improve the quality of bowel preparation, while it remains unclear regarding effectiveness with the elderly. The purpose of this study was to evaluate the effect of telephone intervention on the quality of bowel preparation for colonoscopy in elderly outpatients. In total, 162 outpatients older than 65 years were enrolled and randomly divided into a control group and a study group. Patients in the study group were re-educated through telephone by a specific nurse 2 days before colonoscopy, whereas participants in the control group received education only on the day of appointment. The Ottawa score was used to evaluate the quality of bowel preparation between the two groups. In this study, no significant differences were observed in age, gender, body mass index, educational level, smoking and/or alcohol drinking, waiting time to colonoscopy, reasons for colonoscopy, and colonoscopic findings between the control group and the study group. Participants in the study group had higher adequate bowel preparation and compliance than the control group (83.1% vs. 59.5%, p = .03; 96.4% vs. 74.7%, p < .001). Univariate analysis showed that only noncompliance with start time was significantly associated with satisfactory bowel preparation in elderly patients. In conclusion, telephone intervention 2 days before colonoscopy can improve the quality of bowel preparation in the elderly.

Comparing the Prevalence of Polypharmacy and Potential Drug-Drug Interactions in Nursing Homes and in the Community Dwelling Elderly of Emilia Romagna Region.

Backround: We aimed at assessing the prevalence of polypharmacy and potential drug-drug interactions (DDIs) with clinical relevance in elderly patient on Emilia Romagna area. Both outpatients and residents in nursing homes were assessed, with only partially overlapping strategies. Methods: We defined a list of 190 pairs of potentially interacting drugs, based on literature appraisal and availability of therapeutic alternatives. January-June 2018 data on drug use in patients over 65 years-old were collected from nine Local Health Authorities of Emilia Romagna: data on community-dwelling subjects were extracted from archives of reimbursed prescriptions, while drug use in a sample of nursing homes was recorded from clinical charts in one index day within the same semester. The frequency of polypharmacy (at least five or at least 10 concurrent drugs) and of each DDI was calculated. Results: In line with different rates of polypharmacy (80% vs 16%), the risk of exposure to at least one interaction was 53.7% in nursing homes and 26.4% in outpatients. Among DDIs, in nursing homes antidepressants—anxiolytics (11.9%) ranked first, followed by antidepressants—aspirin (7.4%). In outpatients, ACE-inhibitors—non-steroidal anti-inflammatory drugs (NSAIDs) reached 7.2% followed by the calcium channel blockers—α-blockers (2.4%). Discussion: Polypharmacy and risk of DDIs appeared very different in the two settings, due to both technical and clinical reasons. In order to reduce use of benzodiazepines, NSAIDs, antidepressants and relevant DDIs, 1) defining alternative options for pain relief in elderly outpatients, and 2) implementing non-pharmacological management of insomnia and anxiety in nursing homes should be prioritized.

Predictors of Health-Related Quality-of-Life Status Among Elderly Patients With Cardiovascular Diseases

ObjectivesQuality of life is an important patient-reported outcome in the care of older patients with chronic diseases owing to aging-associated limited physical activity and poor health status. The current study aimed to evaluate health-related quality of life and its predictors among elderly cardiac outpatients. MethodsA descriptive, nonexperimental, cross-sectional study was carried out from May 2018 to October 2018 in outpatient departments of a tertiary-care hospital. The population under study were patients aged ≥65 years with at least 1 cardiovascular condition. The EQ-5D-3L (Euro QOL) and Barthel index were used to measure the quality of life and performance of activities of daily living, respectively. Linear regression analysis was performed by using SPSS version 21. ResultsOf a total of 386 patients, 198 patients (51.3%) reported impairment in the mobility domain, and 70.5% (n = 272) of patients indicated impairment in the depression domain. Mann-Whitney tests revealed EQ-5D scores, and visual analogue scale scores significantly differed by hospital admissions (P = .001), fall history (P < 0.001), and activities of daily living (P < .001). Kruskal-Wallis analysis revealed that EQ-5D index value and visual analogue scale score were significantly lower among patients who had comorbidities and who were exposed to polypharmacy (5-9 medications) (P < .001). In multivariate linear regression analysis, self-reported health (P = .006) and performance of activities of daily living (P < .001) were reported as influencing factors on health-related quality of life. ConclusionFindings indicated poor quality of life among older patients with cardiovascular diseaese or heart diseases in Pakistan. Measures should be taken to improve patients’ perception and to enhance awareness regarding the importance of doing daily living activities as a predictor of good quality of life.

Expressive Flexibility and Dispositional Optimism Contribute to the Elderly's Resilience and Health-Related Quality of Life during the COVID-19 Pandemic.

The COVID-19 outbreak had a negative impact on psychological status among elderly subjects, negatively affecting their health-related quality of life (HRQoL). Psychological factors that promote resilience might beneficially contribute also to promoting a better HRQoL among elderly subjects. The main purpose of the present study was to investigate the contribution of dispositional optimism and expressive flexibility on the HRQoL of elderly outpatients during the COVID-19 outbreak. The outpatients were recruited from October 2018 to October 2019, and then followed-up during April 2020, by evaluating their HRQoL. The baseline sample consisted of 141 elderly outpatients (mean age 80.31 ± 6.84 years); the final number of outpatients included in the follow-up evaluation was 104 (mean age 80.26 ± 6.39). Univariate and multivariate linear regressions were developed to explore significant associations with the physical and mental component of HRQoL. Baseline dispositional optimism was a predictor of the mental component of HRQoL at follow-up; the flexible suppression of emotional expression was a predictor of the physical component of HRQoL at follow-up. From a psychogeriatric perspective, the accurate assessment of psychological factors, such as dispositional optimism and expressive flexibility, might help physicians and psychologists to recognize additional patients’ vulnerabilities during the current emergency.

2011～2019年の間に当院が施行した65歳以上の高齢者に対する歯科訪問診療の概要 ―高齢者の外来診療との比較―

2011～2019年の間に当院が施行した65歳以上の高齢者に対する歯科訪問診療の概要 ―高齢者の外来診療との比較―

Relationship between the swallowing function, nutritional status, and sarcopenia in elderly outpatients

It is important to prevent sarcopenia in community-dwelling elderly adults. Thus, we investigated the relationship between the swallowing function, nutritional status, and physical function in elderly outpatients. A total of 90 elderly outpatients (77.2±8.3 years) participated in the study. The investigation items included the Seirei dysphagia screening questionnaire, 20 masticable foods questionnaire, tongue pressure, grip strength, the skeletal muscle mass index (SMI), the questionnaire for sarcopenia screening (SARC-F), and the Mini Nutritional Assessment-Short Form (MNA-SF). The odds ratio for the swallowing function and six items was determined by a logistic regression analysis. About 83.3% of the participants were at risk of dysphagia. The questions that detected the symptom in ≥30% of the participants were, "Do you cough during a meal?", "Have you become slower at eating?", and "Has it become more difficult to eat hard food?". The 20 masticable foods questionnaire, SARC-F, and MNA-SF were correlated with the Seirei dysphagia screening questionnaire. The results of the logistic regression analysis indicated that SARC-F was a significant predictor for a loss of the swallowing function. Because elderly outpatients have a decreased oral function, including chewing, they are at an increased risk of dysphagia. This study suggested that the swallowing function in elderly outpatients is related to the chewing ability, nutritional status, and sarcopenia. The swallowing function can thus be used to detect sarcopenia in elderly outpatients at an early stage and is important for preventing dysphagia.

Gait analysis in the elderly patients with lumbar spinal stenosis.

This study aims to analyze the gait characteristics of the elderly patients with lumbar spinal stenosis by an intelligent device for energy expenditure and activity (IDEEA) to assist clinical work. A total of 98 subjects were included in this study from January 2017 to December 2018. A total of 49 elderly outpatients with symptomatic lumbar spinal stenosis in unilateral lower extremity were included as the experimental group, and another 49 healthy subjects matched with gender, age, and body mass index (BMI) were analyzed as the control group. The gait data of the subjects (including single support, double support, SLS/DLS, swing duration, step duration, cycle duration, pulling accel, swing power, ground impact, foot fall, foot off, push off, speed, cadence, step length, and stride length) were collected to compare between the experience group and control group, the affected leg and the healthy leg in experimental group. The results of this study presented that small intermittent claudication occurred in all patients. The time of single support was significantly increased (p < 0.05). Double support, step duration, and pulling accel were increased (p < 0.05), and the Push off, speed, step length, and Stride length were decreased (p < 0.05) in the experimental group compared with the control group. Small intermittent claudication was the basic gait composition of the elderly patients with lumbar spinal stenosis that can reflect the abnormal gait characteristics by IDEEA.

Dispositional Optimism and Context Sensitivity: Psychological Contributors to Frailty Status Among Elderly Outpatients.

The association of resilience-related factors with frailty is a recent research topic. Dispositional optimism and context sensitivity are two psychological factors that differently contribute to individual resilience. This study aimed at investigating whether dispositional optimism and context sensitivity might contribute to a multifactorial model of frailty, together with established relevant factors such as cognitive and physical factors. This cross-sectional study involved 141 elderly outpatients (42 males and 99 females) aged ≥65 years, who were referred to the Geriatrics and Multidimensional Evaluation Clinic of the University Hospital of Messina. We used the following measures: the Mini-Mental State Examination (MMSE) to screen for global cognitive functioning; 4-m gait speed and handgrip strength to measure physical performance; a 35-item Frailty Index (FI) to evaluate patients’ frailty status; the revised Life Orientation Test (LOT-R) to gauge dispositional optimism; and the Context Sensitivity Index (CSI) to measure context sensitivity. We found that LOT-R (β = −0.190, p = 0.038), CSI (β = −0.191, p = 0.035), and MMSE (β = −0.466, p < 0.001) were all significantly associated with FI. Gait speed was only marginally associated with FI (β = −0.184, p = 0.053). The present study showed a novel association of dispositional optimism and context sensitivity with frailty among elderly outpatients. These preliminary findings support a multidimensional approach to frailty in which even peculiar psychological features might provide a significant contribution.

Prevalence, Factors and Cost Comparison due to Potentially Inappropriate Medications (PIMs) of Elderly Outpatients in a State Hospital in Malaysia.

Introduction: Malaysia will be a full aging nation by 2030. The elderly (aged &gt;65 years old) population often has multiple comorbidities, which increases the risk of polypharmacy and potentially inappropriate medications (PIMs). This study aims to investigate the prevalence, factors associated with PIMs among elderly outpatients, and its burden of direct pharmacotherapy cost to the Ministry of Health Malaysia. Materials and method: A cross-sectional study involving clinic prescriptions among the elderly with more than one-month prescribing duration received from a tertiary hospital specialist clinic pharmacy from March to April 2017. Patient identifiers were screened using the Pharmacy Information System (PhIS) by including prescriptions from other clinics while excluding multiple visits and duplicate prescriptions. Patients were categorised as PIM group and non-PIM groups using Beers Criteria 2015. Logistic regression analysis was conducted to examine the factors associated with PIMs. The median monthly prescription cost was compared between PIM and non-PIM groups by Mann-Whitney test. Results: Among 472 patients, 39.4% of patients had at least one PIM while 60.6% of patients did not receive any PIM. The number of medications prescribed was an independent risk factor contributing to PIMs (OR:2.04; 95% CI:1.40, 2.97). The median monthly prescription cost for the PIM group was MYR 29.50 (?USD 7.53) which was not statistically significant (p=0.735) compared with the non-PIM group which was MYR 28.50 (USD 7.28). Conclusion: PIM was frequently prescribed in our setting with the number of medications as the only factor. However, the prescribing of PIM did not add nor reduce the direct cost of pharmacotherapy.

Prevalence, Factors and Cost Comparison due to Potentially Inappropriate Medications(PIMs) of Elderly Outpatients in a State Hospital in Malaysia

Prevalence, Factors and Cost Comparison due to Potentially Inappropriate Medications(PIMs) of Elderly Outpatients in a State Hospital in Malaysia

Efficacy of malnutrition screening tools in China for elderly outpatients.

Malnutrition in elderly individuals is extremely common. In China, Nutritional Risk Screening 2002 (NRS-2002) is often used to assess malnutrition in hospitalized elderly patients, although a gold standard for elderly outpatients is lacking. The Nutrition Screening Initiative Checklist (NSI) and Malnutrition Screening Tool (MST) have seldom been validated in elderly outpatients. This open, parallel, multi-center, cross-sectional study evaluated the performance of NRS-2002, the NSI, and the MST in estimating malnutrition risk in elderly outpatients. This study included 986 elderly outpatients, with 53.2% being women, from five clinical teaching hospitals in Beijing. The sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) of the tools were estimated using a body mass index (BMI) of <18.5 kg/m2 as a reference. The mean (range) age of the patients was 69.6±6.8 (60-100) years. Overall, 4.3% had BMI <18.5 kg/m2, 16.8% scored ≥3 points in NRS-2002, 9.8% scored ≥2 points in the MST, and 37.0% scored ≥3 points in the NSI. NRS-2002 had the highest sensitivity and the best AUC (0.934 vs. 0.642 for the NSI and 0.660 for the MST, p<0.05), and the MST had the highest specificity. The sensitivity and specificity of the NSI were 0.64 and 0.64, respectively. NRS-2002 had the highest validity, and the MST had the highest specificity in estimating the risk of malnutrition in elderly outpatients. However, the accuracy of the NSI should be further verified with large samples.