Elderly Patients In Taiwan Research Articles

The Prevalence of Anticholinergic Drugs and Correlation with Pneumonia in Elderly Patients: A Population-Based Study in Taiwan

Anticholinergic drugs may increase the risk of serious respiratory infection, especially in the elderly. The study aims to investigate the prevalence of anticholinergic drugs and the correlation of incident pneumonia associated with the use of anticholinergic drugs among the elderly in Taiwan. The study population was 275,005 elderly patients aged ≥65 years old, selected from the longitudinal health insurance database (LHID) in 2016. Among all the elderly patients, about 60% had received anticholinergic medication at least once. Furthermore, the study selected elderly patients who had not been diagnosed with pneumonia and had not received any anticholinergic drugs in the past year in order to evaluate the correlation between pneumonia and anticholinergic drugs. The study excluded elderly patients who died or had received related drugs of incident pneumonia during the study period and selected elderly patients receiving anticholinergic drugs as the case group. Propensity score matching (PSM) on a 1:1 scale was used to match elderly patients that were not receiving any anticholinergic drugs as the control group, resulting in a final sample of 32,215 patients receiving anticholinergic drugs and 32,215 patients not receiving any anticholinergic drugs. Conditional logistic regression was used to estimate the association between anticholinergic drugs and pneumonia after controlling for potential confounders. Compared with patients not receiving anticholinergic drugs, the adjusted odds ratio of patients receiving anticholinergic drugs was 1.33 (95% confidence interval: 1.18 to 1.49). Anticholinergic medication is common among elderly patients in Taiwan. Elderly patients receiving anticholinergic drugs may increase their risk of incident pneumonia. The safety of anticholinergic drugs in the elderly should be of concern in Taiwan.

Relationship between Potentially Inappropriate Anticholinergic Drugs (PIADs) and Adverse Outcomes among Elderly Patients in Taiwan

The Beers' criteria indicate that some anticholinergic drugs are inappropriate for treating elderly patients, but those most frequently used anticholinergic drugs in previous studies. This study was aimed to explore the association between the potentially inappropriate anticholinergic drugs (PIADs) and adverse outcomes among elderly people in Taiwan. A retrospective cohort study was conducted by analyzing the Longitudinal Health Insurance Database (LHID2005) of the National Health Insurance Research Database (NHIRD) from 2007 to 2008 to investigate all prescriptions for elderly people above the age of 65. The anticholinergic risk scale (ARS) constituted the criteria for PIADs. Adverse outcomes included emergency visits, hospitalization, and adverse drug reactions (ADRs) such as constipation, delirium, cardiac arrhythmia, and cognitive impairment. The prevalence of PIADs was 18.67% in outpatient prescriptions. Approximately 75.65% of outpatients have received at least one PIAD. After adjusting for age, gender, the number of drug items, and CCI, patients, who have received PIADs, had higher risks of emergency visits, hospitalization, constipation, delirium, and cardiac dysrhythmia (odds ratio [OR] = 1.85, 1.07, 1.87, 1.51 and 1.16) than those who have never received PIADs. This study suggests that physicians should be cautious when prescribing anticholinergic drugs for elderly patients to reduce the risk of adverse outcomes and improve the safety of medicating elderly people.

Dynamic changes of soluble ST2 levels predicted fatality and were involved in coagulopathy in dengue fever in the elderly.

BackgroundSevere dengue virus (DENV) infection involves plasma leakage and vascular collapse, and leads to significant morbidity and death. Serum soluble ST2 (sST2 [interleukin (IL)-1 receptor like-1 protein: IL-1-RL-1]) levels are high in pediatric cases of DENV infection, and the disease progresses. However, the correlation between serum sST2 levels and the outcomes of DENV infection in the elderly (≥65 years) is unclear. We thus explored the mechanisms of serial sST2 level changes involved in the coagulopathy and bloodstream infections of elderly patients in Taiwan’s 2015 DENV outbreak.MethodsThis retrospective study was done in a tertiary medical center in southern Taiwan during the outbreak. All DENV-infected patients who, between July 1, 2015, and December 31, 2015, provided a written informed consent for at least two blood sample analyses were enrolled and reviewed. The serum levels of sST2 were quantified. ΔsST2 is defined as the “changes of sST2 levels in serially paired samples”. Receiver operating characteristic (ROC) curve and area under the ROC curve (AUC) analyses were used to evaluate the prognostic ability of ΔsST2.ResultsForty-three patients with DENV infection were enrolled. Mean patient age was 75.0 ± 12.2 years and the case fatality rate was 44.2% (19/43). Significantly more non-survivors than survivors had increased ST2 level (78.9% vs. 12.5%, p < 0.001). The AUC value for serum ΔsST2 level was 0.857 for predicting DENV fatality. Moreover, patients given frozen fresh plasma (FFP) transfusions were significantly (p = 0.025) more likely to have higher serum ST2 level changes than were those who had not. DENV-infected patients with early bloodstream infections (BSIs) seemed to have higher ST2 levels than those who did not have BSIs.ConclusionsSerum ST2 levels increased in the elderly (≥ 65 years of age) with DENV infection. The changes in serum sST2 levels might be a critical indicator of DENV infection severity for the elderly; sST2 is an important modulator of coagulopathy in severe DENV infections.

Leading Comorbidity associated with 30-day post-anesthetic mortality in geriatric surgical patients in Taiwan: a retrospective study from the health insurance data

BackgroundElderly patients with aged physical status and increased underlying disease suffered from more postoperative complication and mortality. We design this retrospective cohort study to investigate the relationship between existing comorbidity of elder patients and 30 day post-anesthetic mortality by using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) from Health Insurance Database.MethodsPatients aged above 65 years old who received anesthesia between 2000 and 2010 were included from 1 million Longitudinal Health Insurance Database in (LHID) 2005 in Taiwan. We use age, sex, type of surgery to calculate propensity score and match death group and survival one with 1:4 ratio (death: survival = 1401: 5823). Multivariate logistic model with stepwise variable selection was employed to investigate the factors affecting death 30 days after anesthesia.ResultsThirty seven comorbidities can independently predict the post-anesthetic mortality. In our study, the leading comorbidities predict post-anesthetic mortality is chronic renal disease (OR = 2.806), acute myocardial infarction (OR = 4.58), and intracranial hemorrhage (OR = 3.758).ConclusionsIn this study, we present the leading comorbidity contributing to the postoperative mortality in elderly patients in Taiwan from National Health Insurance Database. Chronic renal failure is the leading contributing comorbidity of 30 days mortality after anesthesia in Taiwan which can be explained by the great number of hemodialysis and prolong life span under National Taiwan Health Insurance. Large scale database can offer enormous information which can help to improve quality of medical care.

Information Reception and Expectations Among Hospitalized Elderly Patients in Taiwan: A Pilot Study.

Communicating with patients, especially geriatric patients, is a challenge for medical professionals. Medical message receiving and expectations among hospitalized elderly patients have not been studied. The aim of this study was to explore medical message receiving and expectations concerning medical information among hospitalized elderly patients in Taiwan. A descriptive study design was used. Convenience sampling was applied, and the research was conducted in a geriatric ward in a medical center in southern Taiwan. Patients were recruited who were 65 years or older and capable of verbal communication. Data were collected using a self-developed semistructured questionnaire. For each participant, data were collected in one regular ward round. The messages of the physician were recorded. During the first and fourth hours after the ward round, the researcher collected the medical messages that were conveyed by the physician in the ward round and that could be repeated by the patients. Open-ended questions were used to collect data about patient expectations of medical messages during the first hour after the ward round. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed using content analysis. Thirty patients participated in this study. All of the participants remembered the visit of the physician. Seventeen participants (56.6%), however, could not repeat the messages, and the total message repetition rate was 17.8% at the first hour after the ward round. By the fourth hour, the message repetition rate fell to 8.9%. Furthermore, three participants (10%) reported messages incorrectly. Participants reported the importance and necessity of physicians conveying medical messages. "Desire to know the reasons for discomfort" and "discharge date" were the messages most expected by the participants. This study suggests that most hospitalized elderly patients cannot repeat medical messages that are conveyed by their physicians. Written materials and the involvement of principal caregivers in the medical informing process may be necessary. Besides, before providing medical information, medical professionals should be cognizant of the key concerns of their patients.

Economic outcomes of pharmacist-physician medication therapy management for polypharmacy elderly: A prospective, randomized, controlled trial.

With an increasing geriatric population, the need for effective management of chronic conditions and medication use in the elderly is growing. Medication use in the elderly presents significant challenges due to changes in pharmacodynamic and pharmacokinetic profiles. We aimed to examine the impact of a collaborative physician-pharmacist medication therapy management (MTM) program for polypharmacy elderly patients. Elderly patients with multiple chronic conditions on polypharmacy were enrolled in this prospective, randomized, and controlled study over 16 months of implementation. The intervention group consisted of patients randomized to a collaborative pharmacist-physician MTM program. They were monitored continuously by a clinical pharmacist, while patients in the control group received only usual care with follow-up assessment. Primary outcome was economic differences, measured in total medical expenditure. Secondary outcomes of clinical and humanistic effects were compared between the two groups. The total number of enrolled patients was 87 and 91 in the MTM and usual groups, respectively. The difference-in-difference estimate on medical expenditure during the 16-month implementation period was $3,758,373 New Taiwan Dollars ($127,015 US Dollars) less than the usually care group. Impact was also seen in humanistic outcomes while lipid profiles and mortality trended toward improvement. The pharmacist-physician collaborative MTM program for polypharmacy elderly had significant cost savings and improvement in humanistic measures, demonstrating the importance of clinical pharmacists and MTM programs for elderly patients in Taiwan. The results suggest the possibility of clinical benefits, but the study was not substantially powered to find a statistical difference.

Validation of the Patient Health Questionnaire for Depression Screening Among the Elderly Patients in Taiwan

Summary Background This study aimed to assess the reliability, validity, and factor structure of the Patient Health Questionnaire-9 (PHQ-9) and its two subscales (PHQ-2, PHQ-1) for screening major depression disorder (MDD) in primary care elderly patients in Taiwan. Method A total of 634 participants aged ≥60 years were enrolled from the primary care settings. They completed PHQ-9, and Short Form of Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q-SF). After that, they were interviewed by using Schedule for Clinical Assessments in Neuropsychiatry (SCAN) and 17-item of Hamilton Rating Scale (HAMD-17). Result The PHQ-9 demonstrated acceptable internal consistency (α = 0.77), test-retest reliability (intraclass correlation coefficient = 0.79), and concurrent validity with HAMD-17 ( r = 0.66; p r range −0.47 to −0.53, all p s Conclusion The Chinese versions of the PHQ-9 and its two subscales (PHQ-2 and PHQ-1) are valid and reliable to screen MDD in primary care elderly patients in Taiwan and could be proper alternatives to Geriatric Depression Scale 15-item version.

Prognostic Factors of Fournier's Gangrene in the Elderly: Experiences of a Medical Center in Southern Taiwan

Summary Background Prognoses of Fournier's gangrene in the elderly are rarely discussed. This study aims to investigate the clinical characteristics and prognosis of Fournier's gangrene in a series of elderly patients in Taiwan. Methods The medical records of 90 patients with Fournier's gangrene were reviewed between January 01, 1995 and December 31, 2009. Univariate and logistic regression analyses were used to analyze the data. Results Among 90 patients (83 males and 7 females) with a mean age of 76.4 years, 78.9% were alive and 21.1% died. The mean duration of hospitalization was 32.14 days. Diabetes mellitus (50%) was the leading predisposing factor. Escherichia coli , Klebsiella pneumoniae , and Proteus spp. were the three most common isolated pathogens. In total, 296 operations and 244 debridements were performed. Significant variables related to mortality in the univariate analysis were a serum albumin level of Proteus spp., polymicrobial wound infection, bacteremia, acute renal failure, septic shock, and respiratory failure requiring intubation. The logistic regression analysis showed that the mortality rate in patients with individual factors, including polymicrobial wound infection, fewer operations ( Conclusion The core principles to manage Fournier's gangrene in geriatric patients are early diagnoses, aggressive resuscitations, use of broad-spectrum antibiotics, and prompt and repeated surgical intervention. Medical teams can save their lives by applying aggressive treatment with longer hospitalization.

Association Between Tooth Loss, Body Mass Index, and All-Cause Mortality Among Elderly Patients in Taiwan.

To date, the effect of tooth loss on all-cause mortality among elderly patients with a different weight group has not been assessed. This retrospective cohort study evaluated the data obtained from a government-sponsored, annual physical examination program for elderly citizens residing in Taipei City during 2005 to 2007, and follow-up to December 31, 2010. We recruited 55,651 eligible citizens of Taipei City aged ≥65 years, including 29,572 men and 26,079 women, in our study. Their mortality data were ascertained based on the national death files. The number of missing teeth was used as a representative of oral health status. We used multivariate Cox proportional hazards regression analysis to determine the association between tooth loss and all-cause mortality. After adjustment for all confounders, the hazard ratios (HRs) of all-cause mortality in participants with no teeth, 1 to 9 teeth, and 10 to 19 teeth were 1.36 [95% confidence interval (CI): 1.15–1.61], 1.24 (95% CI: 1.08–1.42), and 1.19 (95% CI: 1.09–1.31), respectively, compared with participants with 20 or more teeth. A significant positive correlation of body mass index (BMI) with all-cause mortality was found in underweight and overweight elderly patients and was represented as a U-shaped curve. Subgroup analysis revealed a significant positive correlation in underweight (no teeth: HR = 1.49, 95% CI: 1.21–1.83; 1–9 teeth: HR = 1.23, 95% CI: 1.03–1.47; 10–19 teeth: HR = 1.20, 95% CI: 1.06–1.36) and overweight participants (no teeth: HR = 1.37, 95% CI: 1.05–1.79; 1–9 teeth: HR = 1.27, 95% CI: 1.07–1.52). The number of teeth lost is associated with an increased risk of all-cause mortality, particularly for participants with underweight and overweight.

An Analysis of Emergency Treatment-seeking Characteristics in Elderly Patients in Taiwan in 2010

The aim of this study was to understand the differences in demographic data and emergency department (ED) diagnosis between different age groups of patients. This study is based on data from the 2010 National Health Insurance Research Database published by the Taiwan National Health Research Institutes. We used descriptive statistics and bivariate statistical analysis to obtain the number of emergency visits in 2010. The main variables for analysis included demographic data and treatment-seeking characteristics, such as age, sex, marital status, International Classification of Diseases diagnostic code (International Classification of Diseases, 9th Revision, Clinical Modification), and medical institutions. Data from the cohort sample of the 200,000 random samples taken from the health insurance beneficiary files of the National Health Insurance Research Database found a total 277,384 ED visits during 2010 after exclusion of unusual frequent ED users (hemophilia B or schizophrenia), 58,014(20.91%) of which were attributed to elderly patients. Female patients were predominantly in the elderly ED visits. The average cost of emergency medical expenses, number of ED visits, and subsequent hospitalization are significantly higher in elderly ED patients.

Frequencies and prescription patterns of traditional Chinese medicine use among elderly patients in Taiwan: A population-based study

Ethnopharmacological relevanceTraditional Chinese medicine (TCM), one of the most commonly used complementary and alternative medicines, has been receiving increasing attention among elderly patients. However, epidemiological reports and prescription patterns of geriatric TCM users are few. The aim of this study is to use data from a nationwide cohort database to analyze TCM use by the geriatric population in Taiwan from 2005 to 2009. Materials and methodsTCM outpatient claims data was obtained from the Taiwan National Health Insurance database. Data for elderly patients aged 65 years and older were included in the analysis during the study period. The demographic data, disease distributions, and frequencies and prescription patterns of TCM use by the geriatric population were analyzed. ResultsThe geriatric cohort included 97,210 patients, in which 46,883 patients (48%) had used TCM at least once, with a total of 723,478 TCM outpatient visits. Of these, 175,857 visits (24.3%) were prompted by “diseases of the musculoskeletal system and connective tissue”; more than half of patients with such diseases were treated using acupuncture and traumatology manipulative therapies. Overall, among the 552,835 visits during which Chinese herbal products (CHP) were prescribed, Shu-Jing-Huo-Xie-Tang and Dan Shen (Radix Salvia Miltiorrhizae) were the most frequently prescribed herbal formula and single herb, respectively, for elderly patients. In addition, Shu-Jing-Huo-Xie-Tang was also the most prescribed herbal formula for the most common disease categories of “diseases of the musculoskeletal system and connective tissue” among TCM elderly patients, followed by Du-Huo-Ji-Sheng-Tang, and Shao-Yao-Gan-Cao-Tang. ConclusionThis study elucidated the TCM utilization patterns of the geriatric population. However, additional studies are warranted to determine the safety and efficacy of these CHPs for use by elderly patients in further clinical trials.

Validated Chinese Translation of the Fresno Test for Evidence-based Health Care Training

To elevate quality of care for the ever-increasing number of elderly patients in Taiwan, staff in geriatric medicine frequently attend training to promote evidence-based health care. However, such training programs must be effective. Evaluation of evidence-based health care training requires a valid instrument to assess learners' competence. The Fresno test has robust psychometric properties, but there is no validated Chinese translation of this tool yet available. The English Fresno test was translated into Chinese and then back-translated to English to ensure equivalence of concepts and semantics. First-year postgraduate physician trainees (novices) recruited from an evidence-based medical training program completed the Chinese Fresno test prior to and after the program. Experienced instructors (experts) in the program also completed the test for comparison. The correlation and consistency of the Chinese version were analyzed and validated. Forty (20 experts and 20 novices) completed the tests. The inter-rater correlation ranged from 0.65 to 0.98. Internal consistency was good (Cronbach's α = 0.98). Item difficulty ranged from 23% to 72%. Item discrimination indices ranged from 0.40 to 0.90. Experts scored significantly higher than novices (experts = 165, novices = 93; p < 0.001). Test–retest correlation 2 weeks after the first test was 0.98 ( p < 0.001). This Chinese version of the Fresno test is a reliable and valid instrument for evaluating evidence-based health care knowledge and skills.

The medical autonomy of elderly in Taiwan

The elderly population is increasing rapidly in Taiwan. With the average life expectancy on the rise, the elderly have become major consumers of healthcare products and services. Factors that influence respect for autonomy, a core value of medical ethics, may be related to family, society, and the medical culture. Especially in patients who are already elderly, aging causes declines in physical, mental and societal capacities. Practicing a respect for patient autonomy is particularly challenging for healthcare professionals in Taiwan due the unique culture background of elderly Taiwanese patients. This article reviews and integrates the literature related to the issue of patient autonomy and elaborates on medical decision-making among elderly patients in Taiwan in the contexts of: the disadvantages faced by the elderly, the background of Chinese culture, and the current medical decision-making environment. A few suggestions are proposed to help preserve the medical-decision-making autonomy of elderly patients in Taiwan.

Statin use and incident dementia: A nationwide cohort study of Taiwan

BackgroundStatins are widely used in clinical treatment. However, an U.S. Food and Drug Administration issued health alert has raised concerns for the adverse effects of statin-associated confusion and memory loss in the elderly people. It is necessary to clarify the relationship between statin use and risk of incident dementia as well as whether class effects exist. MethodsIn this population-based retrospective cohort study, total 33,398 patients aged≥60years were selected from a subset of the Taiwan National Health Insurance Research Databases and followed up for tracking the occurrence of any type of dementia from 2000 to 2010. The Cox proportional hazards models were used. ResultsCompared to nonusers, statin users had a significantly lower risk of incident dementia (hazard ratio [HR], 0.78; 95% CI, 0.72–0.85, p<0.001). The potency and the cumulative duration of statin utilized were associated with the reducing risk of dementia. After stratifying by gender, the risk of incident dementia was lower in female statin users (HR, 0.76; 95% CI, 0.68–0.85, p<0.001) than in male statin users (HR, 0.86; 95% CI, 0.75–0.98, p=0.024). Higher potency and longer cumulative duration of statin use were required for reducing the risk of incident dementia in male patients than in female patients. ConclusionStatin use was associated with a significantly lower risk of dementia in the elderly patients in Taiwan. The potency and the cumulative duration of statin utilized played critical roles.

Listeriosis among elderly patients in Taiwan

Listeriosis among elderly patients in Taiwan

Prevalence of Asymptomatic Peripheral Arterial Disease and Related Risk Factors in Younger and Elderly Patients in Taiwan

We determined the prevalence of asymptomatic peripheral arterial disease (PAD) and cardiovascular risk factors in Taiwan. Ambulatory participants (n = 1915) without symptoms of PAD were enrolled (mean age of 61.2 years). The ankle-brachial index (ABI) was used to detect the PAD (ABI < 0.90). The overall prevalence of asymptomatic PAD was 5.4% (2.8% in the younger participants [<65 years of age, n = 1021] and 8.4% in the elderly participants [≥65 years of age, n = 894]). Younger participants with asymptomatic PAD had a significantly higher rate of hypertension (55.2% vs 30%) and obesity (31% vs 13.3%) than those without asymptomatic PAD (P < .05). Elderly participants with asymptomatic PAD had a significantly higher rate of diabetes mellitus (36% vs 21.2%) and hypertension (69.3% vs 55.4%) than those without asymptomatic PAD (P < .05). Asymptomatic PAD is prevalent among elderly Taiwanese individuals. Overall, age was the strongest risk factor for the development of asymptomatic PAD.

Factors Affecting CPAP Acceptance in Elderly Patients With Obstructive Sleep Apnea in Taiwan

The prevalence of obstructive sleep apnea (OSA) increases with age. Treatment often includes CPAP. CPAP adherence is correlated with disease severity and symptoms. We hypothesized that CPAP acceptance rates in elderly patients with OSA would be lower than in younger patients with OSA, and examined factors associated with CPAP acceptance. We reviewed the charts of 315 subjects with OSA (apnea-hypopnea index ≥ 5 events/h) who were treated at our hospital from 2008 to 2011 with CPAP therapy. All underwent CPAP titration testing before CPAP prescription. Subjects were grouped by age: young (25-40 y, n = 35), middle-age (41-65 y, n = 169), and elderly (> 65 y, n = 111). Demographic variables, excessive daytime sleepiness, overnight polysomnography study variables, CPAP acceptance, and CPAP adherence were compared. Regression analysis was performed to identify factors associated with acceptance. The elderly subjects had less excessive daytime sleepiness and less pronounced alterations in overnight polysomnography variables than the subjects in the other groups, but had more cardiovascular comorbidities. The CPAP acceptance rate (overall 125/315, 39.7%) was significantly lower in the elderly group, compared with the younger group (31.5% vs 60%, P = .01). CPAP acceptance was associated with fewer comorbidities, higher excessive daytime sleepiness, and higher apnea-hypopnea index, but not age. CPAP adherence was not associated with age. CPAP acceptance is low in elderly patients in Taiwan. CPAP acceptance, instead of CPAP adherence, is the critical issue with elderly patients with OSA.

Determinants of emergency medical utilization among the elderly population in Taiwan: A national longitudinal cohort study

The aim of this study was to evaluate the potential determinants for emergency medical utilization by elderly patients in Taiwan. The data were drawn from the ‘Survey of Health and Living Status of the Elderly in Taiwan’, a population-based, longitudinal study of a nationally representative random sample of older adults aged 60 years and older, which was conducted from 1989 to 2007. Face-to-face interviews were conducted at the respondents’ homes by trained interviewers accompanied by local health workers. The Andersen Behavioral Model helped us to evaluate the potential determinants for emergency medical utilization that included predisposing factors, enabling factors, and need factors. The measurements of determinants were repeated five times in the period of this study, and the longitudinal data were analyzed through the generalized estimating equation (GEE) by SPSS 17.0 software. The eligibility criteria were that respondents had to be more than 65 years old at baseline in 1993, and then they had to be enrolled in a 14-year follow-up period from 1993 to 2007. At the beginning of this study in 1993, there were 2961 eligible respondents in total, and in 2007, there were 1136 survivors. The loss in follow-up was mainly due to death. The results demonstrated that the significant determinants of emergency medical utilization by the elderly population were gender, age, education, self-ranked health status, chronic disease, and medical accessibility. The GEE model provides a suitable method to predict the long-term trend of emergency medical utilization by the elderly.

Integration of fuzzy set theory and TOPSIS into HFMEA to improve outpatient service for elderly patients in Taiwan

BackgroundTaiwan became a World Health Organization–defined aging country in 1993, and it is estimated to become an aged country by 2017, surpassing Japan as the fastest aging country in the world. However, healthcare services in Taiwan need a wide range of improvements to cope with the challenges of population aging. MethodsHealthcare failure mode and effects analysis (HFMEA) developed by the Department of Veterans Affairs' National Center for Patient Safety (NCPS) was used to evaluate the inconvenience of outpatient registration process for elderly patients. Also, fuzzy set theory was used along with technique for order preference by similarity to ideal solution (TOPSIS) method in multiple criteria decision making (MCDM) to rank the failure risks in the HFMEA. ResultsThe top three failure modes ranked by the TOPSIS method were “short consultation time,” “possible complications of the checkup or treatment were not told,” and “opinions and feelings of patients and relatives were not respected.” Based on those failure modes, improvements were proposed and results were feedback to hospitals. A random sample of 40 elderly patients was selected for interview at the outpatient department of a tertiary medical center in Taiwan. Thirty-seven out of the 40 elderly patients (92.5%) agreed with the executive expert team. This meant the improvement proposals were effective. ConclusionIn this study, HFMEA was extended to explore the impacts of geriatric outpatient service process failures on elderly patients. Using fuzzy set theory and the TOPSIS method in multiple criteria decision making to rank the severity of the failure modes, the risk assessment of the geriatric outpatient service process was more objective when analyzed with quantitative data.

Using published criteria to develop a list of potentially inappropriate medications for elderly patients in Taiwan

Explicit criteria for potentially inappropriate medications (PIMs) developed from other regions were often difficult to apply to a specific territory without significant modifications. To describe a process of developing a country-specific explicit PIM criteria from quality review of several published PIM criteria, followed by consensus among regional experts in Taiwan. After a review of the literature, we selected seven sets of published PIM criteria. Medications/medication classes listed in at least three of the seven sets of criteria were selected as preliminary core PIMs. We asked a group of 21 experts from various specialties to rate how appropriate they found inclusion of each medication/medication class in final PIM criteria after two rounds of modified Delphi methods. Table 1 of the instrument included 24 medication/medication classes to be generally avoided in older adults irrespective of co-morbidities, and Table 2 included 12 chronic conditions with six medication/medication classes that patients with these conditions should avoid. The Taiwan criteria contained only half the number of statements that were included in the Beers criteria (36 vs 68 statements) but detected nearly 70-75% as many PIMs in older patients with polypharmacy in a secondary data analysis. Features included straightforward statement arrangements, suggestions of alternatives, and clear definitions of long-acting benzodiazepine and anticholinergic drugs for Table 1 PIMs. A user-friendly instrument was developed to detect PIMs for Taiwanese older adults. Further prospective studies are needed to validate its use in clinical and research settings.