Geriatric Hospital Research Articles

Nutritional status, dietary quality and eating disturbance issues among people with dementia in Vietnam: evidence of a cross-sectional study

BackgroundDue to cognitive impairments, people with dementia (PWD) often have difficulties in eating and drinking. This study aimed to assess the nutritional status, dietary quality and eating disturbance issues among PWD in Vietnam.MethodsWe conducted a cross-sectional study at the Vietnamese National Geriatric Hospital from April to December 2022. We used Mini-Mental State Exam (MMSE) to classify the severity levels of dementia. Mini Nutritional Assessment (MNA), 24-hour recall, eating disturbance questionnaires, and anthropometric indicators were used to evaluate the nutritional status, dietary quality, and eating disorders of study subjects.ResultsOverall, among 63 study participants, 74.6 per cent of PWD were at risk of or having malnutrition. By dementia classification according to MMSE scale, people with moderate and severe dementia accounted for 53.3 per cent of those who met the recommended energy levels, compared to 42.4 per cent of people with mild dementia and normal people. In the above two groups, around three per cent of participants reached the recommended amount of fibre. Calcium (50–70%), vitamin A (80–90%), and D (90%) were found to be the most severe deficiency forms of minerals and vitamins in both male and female participants. The majority of participants (90.5%) had at least one form of eating disorders with the most frequent issue being appetite changes (76.2%) and swallowing issues (50.8%).ConclusionsPWD in our sample frequently experienced malnutrition, a lack of essential nutrients, difficulties swallowing, changes in eating habits and appetite. It is neccesary to early screen and assess nutritional status and swallowing disturbance in PWD, and instruct their caregivers to prepare nutritious meals for them.

Sleep disturbances and associated factors in patients with Parkinson's disease

AimsThis study aimed to describe clinical characteristics and sleep quality of Parkinson’s Diseases (PD) patients and identify associated factors with sleep quality. MethodsA cross-sectional study was conducted at the National Geriatric Hospital, Hanoi, Vietnam, from December 2022 to April 2023. A total of 130 Parkinson's disease patients undergoing treatment at the hospital were invited. Demographic and clinical characteristics were obtained. The diagnosis of sleep disorders was based on the standards outlined in the DSM-V. A multivariate logistic regression model was employed. Results90.9 % experienced sleep disorder, with the significant types including insomnia (76.2 %) and restless legs syndrome (56.2 %). The majority of patients suffered two (33.1 %) and one kind of sleep disorder (32.3 %). Most patients experienced sleep disorders after diagnosis of PD (80.0 %). Only having shoulder and neck pain was positively associated with a likelihood of having sleep disturbances (OR=4.87, 95 %CI=1.18–20.15). ConclusionThis study found a high rate of sleep disorders among PD patients in our sample. Shoulder and neck pain was found to be associated with a risk of sleep disorders. Pain management should be performed to improve the sleep quality of PD patients.

Implementation and evaluation of a system for assessment of the quality of long-term management of patients at a geriatric hospital

BackgroundThe increasing aging population presents a significant challenge, accompanied by a shortage of professional caregivers, adding to the therapeutic burden. Clinical decision support systems, utilizing computerized clinical guidelines, can improve healthcare quality, reduce expenses, save time, and boost caregiver efficiency. Objectives1) Develop and evaluate an automated quality assessment (QA) system for retrospective longitudinal care quality analysis, focusing on clinical staff adherence to evidence-based guidelines (GLs). 2) Assess the system’s technical feasibility and functional capability for senior nurse use in geriatric pressure-ulcer management. MethodsA computational QA system using our Quality Assessment Temporal Patterns (QATP) methodology was designed and implemented. Our methodology transforms the GL’s procedural-knowledge into declarative-knowledge temporal-abstraction patterns representing the expected execution trace in the patient’s data for correct therapy application. Fuzzy temporal logic allows for partial compliance, reflecting individual and grouped action performance considering their values and temporal aspects. The system was tested using a pressure ulcer treatment GL and data from 100 geriatric patients’ Electronic Medical Records (EMR). After technical evaluation for accuracy and feasibility, an extensive functional evaluation was conducted by an experienced nurse, comparing QA scores with and without system support, and versus automated system scores. Time efficiency was also measured. ResultsQA scores from the geriatric nurse, with and without system’s support, did not significantly differ from those provided by the automated system (p < 0.05), demonstrating the effectiveness and reliability of both manual and automated methods. The system-supported manual QA process reduced scoring time by approximately two-thirds, from an average of 17.3 min per patient manually to about 5.9 min with the system’s assistance, highlighting the system’s efficiency potential in clinical practice. ConclusionThe QA system based on QATP, produces scores consistent with an experienced nurse’s assessment for complex care over extended periods. It enables quick and accurate quality care evaluation for multiple patients after brief training. Such automated QA systems may empower nursing staff, enabling them to manage more patients, accurately and consistently, while reducing costs due to saved time and effort, and enhanced compliance with evidence-based guidelines.

Comparison of the effectiveness of core genome multilocus sequence typing and polymerase chain reaction-based open reading frame typing in tracing nosocomial methicillin-resistant Staphylococcus aureus transmission

IntroductionA clonal shift from staphylococcal cassette chromosome mec (SCCmec) type II/ST5 methicillin-resistant Staphylococcus aureus (MRSA) to SCCmec type IV/clonal complex (CC)1 MRSA has occurred rapidly in Japan. Our previous research in a geriatric hospital found SCCmec type IV/CC1 MRSA prevalence in long-term care wards. Due to intensive personal care requirements, frequent contact with healthcare providers can potentially cause unintentional nosocomial MRSA transmission. We performed polymerase chain reaction-based open reading frame typing (POT) and core genome multilocus sequence typing (cgMLST) to investigate the occurrence of nosocomial transmission and to compare the results of these methods. MethodsPOT and whole genome sequencing were performed in 83 MRSA isolates. Commercial automated software (Ridom SeqSphere+) was used to perform cgMLST. MRSA isolates with 0–8 allelic differences were considered related, and medical records were consulted in these cases. ResultsSCCmec type IV/CC1 MRSA was the most frequently detected clone (n = 56, 67.5 %), which was divided into 14 POT types, followed by SCCmec type I/ST8 (n = 9) and SCCmec type IV/ST8 (n = 8). Identical POT types were found across 7 of 11 wards. However, cgMLST analysis identified only three cases (six strains) of high genetic similarity, indicating nosocomial transmission; only one involved SCCmec type IV/CC1 (two strains). The mean allelic difference in the core genomes between strains with identical POT types in the same ward was 55.3 ± 22.0. ConclusionsThe cgMLST method proved more effective for identifying nosocomial transmissions compared to POT, highlighting its utility in tracking MRSA spread in healthcare settings.

A Hierarchical Analysis Study of the Plan Structure According to the Type of Nursing Station in the Ward of A Geriatric Hospital

A Hierarchical Analysis Study of the Plan Structure According to the Type of Nursing Station in the Ward of A Geriatric Hospital

Association between dietary variety status and sarcopenia as defined by the Asian Working Group for Sarcopenia 2019 consensus in older outpatients at a hospital specializing in geriatric medicine: A cross‑sectional study with baseline data of prospective cohort study (JUSTICE‑TOKYO study).

To the best of our knowledge, little is known about the association between dietary variety status and sarcopenia in university-affiliated geriatric hospital in elderly. The present study aimed to investigate, in a multidisciplinary setting, the prevalence of sarcopenia and association between dietary variety status and sarcopenia in older outpatients at Juntendo Tokyo Koto Geriatric Medical Center (Tokyo, Japan). Between October 2020 and December 2021, a cross-sectional study of outpatients aged ≥65 years [458 male (44%) and 584 female (56%); mean age, 78.2±6.1 years] was conducted to assess prevalence of sarcopenia, according to Asian Working Group for Sarcopenia 2019 criteria, and the relationship between dietary variety status and sarcopenia. Patient profile, comorbidities, drug use, neuropsychological data, abdominal symptoms, pulmonary function and dietary variety status were collected. Of 1,042 subjects, there were 223 (21.4%) with [142 male (63.7%) and 81 female (36.3%); mean age, 80.6±6.3 years] and 819 (78.6%) without sarcopenia [316 male (38.6%) and 503 female (61.4%); mean age, 77.6±5.8]. In multivariate analysis, older age, male sex, low body mass index, high Brinkman Index and phase angle, low quality of life, history of daycare use, diabetes mellitus, osteoporosis and low Mini-Mental State Examination and Dietary Variety Score were related to sarcopenia. The prevalence of sarcopenia was higher in than in community-dwelling individuals. Dietary variety status was associated with sarcopenia.

Clinical value of Vitamin-D combined with budesonide/formoterol and theophylline sodium glycinate sustained-release tablets in the treatment of chronic obstructive pulmonary disease patients.

To explore the clinical value of Vitamin-D combined with budesonide/formoterol (BF) and theophylline sodium glycinate (TSG) sustained-release tablets in the treatment of patients with chronic obstructive pulmonary disease (COPD). Medical records of 114 patients with CODP, treated in Wenzhou Geriatric Hospital from October 2020 to February 2023, were retrospectively analyzed. Of them, 59 received treatment with Vitamin-D combined with BF and TSG sustained-release tablets (Group-A), and 55 patients received treatment with BF combined with TSG sustained-release tablets (Group-B). Lung function indicators, blood gas status, inflammatory factors, fractional exhaled nitric oxide (FeNO), and 25-hydroxyvitamin D [25(OH)D] levels before and after the treatment in both groups were collected. After the treatment, lung function indicators, blood gas status, inflammatory factors, FeNO, and 25 (OH) D levels in both groups were significantly improved compared to pretreatment levels, and were significantly better in the Group-A compared to Group-B (P<0.05). The combination of Vitamin-D, BF, and TSG sustained-release tablets can effectively regulate the blood gas status of patients with COPD, improve lung function, regulate FeNO and 25 (OH) D, and effectively downregulate the levels of inflammatory factors, thus reducing the degree of inflammatory response.

Nutritional status in older patient with osteoporosis

Objective: To evaluate of nutritional status of elderly patients with osteoporosis in hospital base. Methods: A cross-sectional study on older patients with osteoporosis, aged 60 years or older who were treated at The National Geriatric Hospital. The Mini Nutritional Assessment – Short Form (MNA- SF) was used to assess the nutritional status of the participants. Results: The average MNA score is 11.26 ± 2.43 near (range 8-11). 64 women were classified as undernourished/ at risk of undernutrition and 4 men were in the same group. Mean T-score of the femoral neck is: -1.51 ± 1.17 and the mean T-score lumbar spine is -3.32 ± 0.70. Conclusion: Overall, the nutritional status was poor in this group of patients. Assessment of nutritional status should be applied as a regular clinical practice for older osteoporosis patients.

Characteristic of fall in sarcopenic patients at the National Geriatric Hospital

Objective: to describe the characteristic of falls in sarcopenic patients at National Geriatric Hospital. Method: The study is a cross-sectional descriptive study. Inpatients and outpatients at National Geriatric Hospital excepted for Emergency and Stroke departments, Intensive care unit. The research was conducted from July to October 2022. Results: Mean age 75.68±8.20, 78.2% female. 64 (21.8%) participants reported at least 1 fall in the previous 12 months and 42.9% of participants had a high risk of fall. The majority of falls occurred at home and in the house or bedroom (40%). Conclusion: Patients with sarcopenia have a high prevalence of falls and a high risk of falls. Fall risk assessment and implementation of fall prevention should be carried out in everyday practice.

Association between geriatric characteristics and falls in older patients with overweight and obesity

Objectives: To assess geriatric characteristics and associations with falls among older people with overweight and obesity. Subjects and Methods: A cross- sectional study on 233 older patients with overweight and obesity examined and treated at National Geriatric Hospital from January to May 2023. Falls in the last 12 months and geriatric characteristics were collected by interviewing using a questionnaire. Results: Of the total 233 participants, the proportion of patients with falls in the last 12 months was 16.7%. The majority of study participants had 2 or more diseases, accounting for 94%. Prevalence of polypharmacy was 63.1%. The rate of ADL impairment was 17.6% and IADL impairment was 16.7%. There was 75.5% of study participants had a high likelihood of depression. The majority of study participants rated quality of life at a high and very high level. There is a statistically significant difference in the rate of falls in the last 12 months between the dependent group and the non-dependent group in activities daily living ADL and IADL (p&lt;0.05). Conclusion: Multi- comorbidities, polypharmacy and depression are the common geriatric syndromes in overweight and obese elderly people. Fall in the past 12 months associated with activities daily living ADL and IADL.

Health-related quality of life and associations with general characteristics among older patients with overweight and obesity

Objectives: To assess health-related quality of life (HRQoL) and associations with general characteristics among older people with overweight and obesity. Subjects and Methods: A cross-sectional study on 220 older patients with overweight and obesity examined and treated at National Geriatric Hospital from January to May 2023. HRQoL were assessed using the EQ–5D– 5L questionnaire. General information and classification of obesity were also collected. Results: Of the total 220 participants, the proportion of patients with difficulties in aspects such as mobility was 57.3%; self- care is 48.6%; usual activities is 55.5%; pain/ discomfort is 65% and anxiety/depression is 49.5%. The results showed that HRQoL in women was significantly lower than in men in terms of pain/discomfort and anxiety/ depression (p&lt;0.05). People living in urban areas have better HRQoL than those living in rural areas in terms of usual activities with p&lt;0.05. People living in rural areas have lower EQ-VAS health self-assessment scores than those living in urban areas, which is statistically significant with p&lt;0.05. Between groups with the different numbers of hospital stays in the past year, there was a significant difference in almost all aspects of HRQoL (p&lt;0.05) except for pain/discomfort. The more hospital stays, the lower the HRQoL, especially the lower the EQ - VAS score (p &lt; 0.001). Conclusion: About 50% of the participants self-rated as having problems with one of the aspects of HRQoL among older patients with overweight and obesity. Our results highlighted that aspects of quality of life EQ - 5D are related to gender, living area, and number of hospitalization in the past year among this population.

Health-related quality of life in osteoporosis patients

Objective: To assess the health-related quality of life in osteoporosis patients at the National Geriatric Hospital. Method: The study was a cross-sectional descriptive study. A sample of 141 patients with osteoporosis aged from 60 years. Health-related quality of life was collected using the EQ-5D-5L questionnaire. Results: The mean age of the patients was 73.12 ± 8.62 years, and 94.3% were female. The mean EQ-5D-5L total score was 18.30 ± 3.79. Conclusion: The proportion of patients with osteoporosis who have decreased quality of life is still increasing so the quality of life. It needs to be studied throughout the course of the disease, in order to develop counseling, support, and treatment interventions.

Associated factors with health-related quality of life in osteoporosis patients

Objective: To assess the association between health- related quality of life and related factors in osteoporosis patients at the National Geriatric Hospital. Method: The study is cross-sectional descriptive study. A total of 141 osteoporosis patients aged from 60 years was recruited. Data were collected using the EQ-5D-5L questionnaire, general information and geriatric syndromes. Results: The mean of quality of life were more likely to be higher in the patients who: lower age patient (p&lt;0.001), good marital status (p&lt;0.05), good sleep quality (p&lt;0.001) , minimal depression (p&lt;0.001), independence in function status (p&lt;0.001), normal nutrition status (p&lt;0.001) and low risk fall (p&lt;0.001). Conclusion: The proportion of patients with osteoporosis who have decreased quality of life is still increasing. Appropriate care aims to help patients develop effective strategies for accepting the disease and coping with it.

Characteristics of falls in older patients with overweight and obesity

Objectives: To assess characteristics of falls and associations with general characteristics among older people with overweight and obesity. Subjects and Methods: A cross-sectional study on 233 older patients with overweight and obesity examined and treated at National Geriatric Hospital from January to May 2023. Fall characteristics, general information and classification of obesity were collected by interviewing using a questionnaire. Results: Of the total 220 participants, the proportion of patients with falls in the last 12 months was 16.7%. 46.2% of participants have recurrent falls. The percentage of fall injury and fall that required hospitalization were 69.2% and 5.1%, respectively. Falls inside the house/ bedroom account for the highest rate at 12%. Slips and falls accounted for the highest proportion in the circumstances of falls (6.9%) and loss of balance (4.3%). The group of subjects ≥ 75 years old had a higher rate of falls (69.2%) compared with the group of subjects aged 65-74 years (30.8%) (p&lt;0.05). Conclusion: 1 out of 6 elderly people who are overweight or obese has had a fall in the past 12 months. Our results highlighted that falls are related to advanced age among this population.

Activity daily living and some related factors among older patients with osteoporosis

: To assess activities in daily living and some related factors among older people with osteoporosis examined and treated at National Geriatric Hospital. Subjects and Methods: A cross-sectional study on 141 older patients with osteoporosis examined and treated at National Geriatric Hospital from June to October 2022. Activities in daily living were assessed using Activities of Daily Living (ADL) and Instrument Activities of Daily Living (IADL). General information, characteristics of osteoporosis, and geriatric syndromes were collected. Results: Of the total 141 participants, the proportion of participants with functional impairment in ADLs and IADLs was the same, accounting for 34.8%. There were significant associations between impaired ADL and group aged ≥ 80 with OR=4.5; BMI &lt;18.5 (kg/m2) with OR=9.7; those who had diabetes with OR=2.9. There were significant associations between impaired ADL and geriatric syndromes: frailty syndromes (OR=20.8), low levels of physical activity (OR=10.8), cognitive impairment (OR=6.4), malnutrition (OR=4.5), risk of falls (OR=4.5), depression (OR=4.4), sleep disturbances (OR=2.9) and polypharmacy (OR=2.6). There was no statistically significant difference in the decline in daily functioning and some characteristics of osteoporosis. Conclusion: One in three elderly osteoporosis patients has impaired ADL or IADL. Our results highlighted that advanced age, BMI, diabetes, and geriatric syndrome were significantly associated with ADL in older patients with osteoporosis.

Factors associated with intrinsic capacity impairment in hospitalized older adults: a latent class analysis

BackgroundIntrinsic capacity (IC) is proposed by the World Health Organization (WHO) to promote healthy aging. Although some studies have examined the factors influencing IC, few studies have comprehensively confirmed lifestyle factors on IC, especially IC impairment patterns. The present study aimed to identify the patterns of IC impairment and explore the lifestyle and other factors associated with different patterns of IC impairment.MethodsThis cross-sectional study was conducted in a Chinese geriatric hospital. IC was evaluated in five domains according to the recommendations of WHO: cognition, locomotion, vitality, sensory and psychological domains. The sociodemographic and health-related characteristics of participants were assessed.The health promoting lifestyle was evaluated using the Health-Promoting Lifestyle Profile-II scale, including nutrition, health responsibility, interpersonal relationships, physical activity, spiritual growth and stress management. We applied latent class analysis to identify IC impairment patterns and compared basic activities of daily living, instrumental activities of daily living, frailty, quality of life and falls among different IC impairment patterns. Multinomial logistic regression analysis was conducted to identify factors influencing the IC impairment patterns.ResultsAmong 237 participants included, the latent class analysis identified three patterns of IC impairment: 44.7% high IC (Class 1), 31.2% intermediate IC mainly locomotor impairment (Class 2) and 24.1% low IC mainly cognitive impairment (Class 3). Older adults in class 1 had the best function ability and quality of life, while class 3 had the highest levels of disability and frailty, the poorest quality of life and a higher prevalence of falls. Compared with class 1, older adults with advanced age (OR = 22.046, 95%CI:1.735-280.149), osteoporosis (OR = 3.377, 95%CI:1.161–9.825), and lower scores in physical activity (OR = 0.842, 95%CI:0.749–0.945), stress management (OR = 0.762, 95%CI:0.585–0.993) and social support (OR = 0.897, 95%CI:0.833–0.965) were more likely to belong to the class 2. Simultaneously, compared with class 1, older adults with advanced age (OR = 104.435, 95%CI:6.038-1806.410), stroke (OR = 3.877, 95%CI:1.172–12.823) and lower scores in physical activity (OR = 0.784, 95%CI:0.667–0.922) and social support (OR = 0.909, 95%CI:0.828–0.998) were more likely to be class 3. In addition, compared with class 2, older adults with a lower score in nutrition (OR = 0.764, 95%CI:0.615–0.950) were more likely to belong to the class 3.ConclusionsThis study provides evidence that there are heterogeneous IC impairment patterns in older adults and identifies various associated factors in each pattern, including age, stroke, osteoporosis, social support and lifestyle behaviors such as nutrition, physical activity and stress management. It informs stakeholders on which modifiable factors should be targeted through public health policy or early intervention to promote IC and healthy aging in older adults.

Staff hebdomadaire qualité et gestion des risques en gériatrie: un outil d'appropriation de la démarche qualité pour le management des unités

The quality approach has become essential in geriatric hospital services, but also in the medico-social sector. This process is continuous and shared by all those in charge of the care units, to facilitate unit management and support caregivers in this approach. The weekly structured quality staff meeting is a relevant tool to facilitate the understanding and appropriation of this approach by the medical and nursing managers of the care units.

Assessment of mobility and related factors among older patients with osteoporosis

This cross-sectional study was conducted to assess mobility and related factors among older people with osteoporosis treated at the National Geriatric Hospital. Mobility was assessed using the Time Up and Go test (TUG test). The proportion of participants with mobility impairment was 22.0%. The mean time of the TUG test was 12.3 ± 3.9 (seconds). There were significant associations between impaired mobility and age ≥ 80 years old with OR=3.3, knee osteoarthritis with OR=3.5, and diabetes with OR=3.0. There were significant associations between impaired mobility and geriatric syndromes: frailty syndromes (OR=3.5), low levels of physical activity (OR=3.5), and high risk of falls (OR=3.0). In conclusion: one in five older osteoporosis patients has impaired mobility. Our results highlighted that advanced age, knee osteoarthritis, diabetes, and geriatric syndromes such as frailty, low physical activity level, and high risk of falls were significantly associated with mobility in older patients with osteoporosis.

Lower limb strength and associated factors among older patients with dementia

This cross-sectional study was conducted to assess lower limb strength and related factors among older people with dementia examined and treated at the National Geriatric Hospital. Lower limb strength was assessed using the 30-Second Chair Stand Test. The proportion of participants with impaired lower limb strength was 78.2%. There were significant associations between impaired lower limb strength and diabetic patients. There were significant associations between impaired lower limb strength and geriatric syndromes: malnutrition, high risk of falls, and dependence or partial dependence according to the Barthel Index. There was no significant difference between the type of dementia and the level of dementia with impaired lower limb strength. In conclusion: Three-quarters of older dementia patients have impaired lower limb strength. Our results highlighted that diabetes, and geriatric syndromes such as malnutrition, high fall risk, dependence, and partial dependence were significantly associated with lower limb strength in older patients with dementia.

Nutritional status in older patients with parkinson’s disease and associated factors

This study was conducted to assess factors related to the nutrition status among older patients with Parkinson’s disease (PD) in 2023. A cross-sectional study was conducted on participants aged over 60 years old having PD at the National Geriatric Hospital from February 2023 to October 2023. The nutritional status was assessed using Mini Nutritional Assessment Short Form (MNA – SF) questionnaires. A total of 200 study participants diagnosed for PD with the mean age of 68.7 ± 5.2 years old and the female/male ratio was approximately 1.5. The prevalence of malnourished and at risk of malnutrition were 7.5%, 41.5%, respectively. Multiple logistic regression analysis showed that female (OR = 2.34, 95% CI 1.18 – 4.63, p = 0.014), dopamine agonist (OR = 0.36, 95% CI 0.16 – 0.82, p = 0.009) and depressive symptom (OR = 2.11, 95% CI 1.02 - 4.40, p = 0.044) were risk factors for malnutrition in older patients with PD. Screening for malnutrition is necessary among older patients with PD, especially in female, using dopamine agonist, and having depressive symptoms.