Geriatric Outpatients Research Articles

Physical rehabilitation in the frailty syndrome among the elderly

Frail elderly are those who have intrinsic vulnerability to develop disabilities and adverse events related to health. The prevalence of frailty increases with age. The American Medical Association estimates that 40% of those over 80 years old are fragile. Objective: To demonstrate the results obtained with the rehabilitation protocol for the frailty syndrome at Vila Mariana Geriatric Outpatient Unit of the Israelita Albert Einstein Hospital. Method: Series of cases study, descriptive and retrospective of 12 elderly who have accomplish the physical rehabilitation program at Vila Mariana geriatric outpatient unit in the Israelita Albert Einstein Hospital. Results: The average age was 77 years, 75% of the participants were female with an average of 7,5 diagnoses. There was improvement in all areas evaluated: balance (p = 0.02), gait speed (p < 0.01), lower limb strength (p < 0.01) and grip strength (p < 0.01). Those who aged 80 or more showed improvement of 83% while those with less than 80 years old, showed an improvement of 41%. It was found that 8 of 10 seniors who met on the track at high risk for disability, hospitalization and death (SPPB equal or less than 9) was able to leave the risk range. It was showed improvement in at least one domain. No deterioration or complication was observed. Conclusion: The rehabilitation protocol for the frailty syndrome that was used at Vila Mariana geriatric outpatient unit was able to improve the balance, gait speed, lower limb strength and grip strength in the population studied.

Medication Reconciliation in an Outpatient Geriatrics Clinic: Does Accuracy Improve If Patients “Brown Bag” Their Medications for Appointments?

Medication Reconciliation in an Outpatient Geriatrics Clinic: Does Accuracy Improve If Patients “Brown Bag” Their Medications for Appointments?

Renal function in geriatric psychiatry patients compared to non-psychiatric older adults: effects of lithium use and other factors

Objectives: Chronic renal failure is very common, affecting 30%–40% of community-dwelling elderly. We wished to verify whether geriatric psychiatry patients are at increased risk of renal dysfunction compared to elderly controls, as well as whether lithium exposure and other factors are important predictors of risk.Method: This is a four-year retrospective cohort and nested case-control study at a Canadian tertiary-care hospital using data from March 2007 to March 2011. We compared 82 geriatric psychiatry outpatients and 200 psychotropic-naïve family medicine controls aged ≥65. Our main continuous measure of renal outcome was change in estimated glomerular filtration rate (eGFR). Multivariate analyses were performed to determine potential risk factors for renal dysfunction in geriatric psychiatry patients, including age, hypertension, diabetes mellitus, diuretics, and lithium duration.Results: Clinically important decreases in eGFR (>8 mL/min/1.73 m2) were found in 40.2% of geriatric psychiatry patients compared to 29.5% of controls (p = 0.040). Multivariate analyses found that lithium duration was independently associated with adverse renal outcome in patients with eGFR < 60 mL/min/1.73 m2. In this sub-population, lithium users had clinically important decreases in eGFR when compared to non-lithium users: 10.3 vs. 0.40 mL/min/1.73 m2 (p = 0.017).Conclusion: Geriatric psychiatry patients are at a greater risk for clinically important decreases of renal function than similarly aged controls. Lithium appears to be an important risk factor for renal dysfunction when eGFR is <60 mL/min/1.73 m2. However, in the majority of older adults who have normal kidney function, lithium use appears to be safe.

Correlations between the Signal Complexity of Cerebral and Cardiac Electrical Activity: A Multiscale Entropy Analysis

The heart begins to beat before the brain is formed. Whether conventional hierarchical central commands sent by the brain to the heart alone explain all the interplay between these two organs should be reconsidered. Here, we demonstrate correlations between the signal complexity of brain and cardiac activity. Eighty-seven geriatric outpatients with healthy hearts and varied cognitive abilities each provided a 24-hour electrocardiography (ECG) and a 19-channel eye-closed routine electroencephalography (EEG). Multiscale entropy (MSE) analysis was applied to three epochs (resting-awake state, photic stimulation of fast frequencies (fast-PS), and photic stimulation of slow frequencies (slow-PS)) of EEG in the 1–58 Hz frequency range, and three RR interval (RRI) time series (awake-state, sleep and that concomitant with the EEG) for each subject. The low-to-high frequency power (LF/HF) ratio of RRI was calculated to represent sympatho-vagal balance. With statistics after Bonferroni corrections, we found that: (a) the summed MSE value on coarse scales of the awake RRI (scales 11–20, RRI-MSE-coarse) were inversely correlated with the summed MSE value on coarse scales of the resting-awake EEG (scales 6–20, EEG-MSE-coarse) at Fp2, C4, T6 and T4; (b) the awake RRI-MSE-coarse was inversely correlated with the fast-PS EEG-MSE-coarse at O1, O2 and C4; (c) the sleep RRI-MSE-coarse was inversely correlated with the slow-PS EEG-MSE-coarse at Fp2; (d) the RRI-MSE-coarse and LF/HF ratio of the awake RRI were correlated positively to each other; (e) the EEG-MSE-coarse at F8 was proportional to the cognitive test score; (f) the results conform to the cholinergic hypothesis which states that cognitive impairment causes reduction in vagal cardiac modulation; (g) fast-PS significantly lowered the EEG-MSE-coarse globally. Whether these heart-brain correlations could be fully explained by the central autonomic network is unknown and needs further exploration.

Physical rehabilitation in the frailty syndrome among the elderly

Frail elderly are those who have intrinsic vulnerability to develop disabilities and adverse events related to health. The prevalence of frailty increases with age. The American Medical Association estimates that 40% of those over 80 years old are fragile. Objective: To demonstrate the results obtained with the rehabilitation protocol for the frailty syndrome at Vila Mariana Geriatric Outpatient Unit of the Israelita Albert Einstein Hospital. Method: Series of cases study, descriptive and retrospective of 12 elderly who have accomplish the physical rehabilitation program at Vila Mariana geriatric outpatient unit in the Israelita Albert Einstein Hospital. Results: The average age was 77 years, 75% of the participants were female with an average of 7,5 diagnoses. There was improvement in all areas evaluated: balance (p = 0.02), gait speed (p &lt; 0.01), lower limb strength (p &lt; 0.01) and grip strength (p &lt; 0.01). Those who aged 80 or more showed improvement of 83% while those with less than 80 years old, showed an improvement of 41%. It was found that 8 of 10 seniors who met on the track at high risk for disability, hospitalization and death (SPPB equal or less than 9) was able to leave the risk range. It was showed improvement in at least one domain. No deterioration or complication was observed. Conclusion: The rehabilitation protocol for the frailty syndrome that was used at Vila Mariana geriatric outpatient unit was able to improve the balance, gait speed, lower limb strength and grip strength in the population studied.

Prevalence of Xerostomia and Its Relationship with Underlying Diseases, Medication, and Nutrition: A Descriptive Observational Study

Introduction.– We examined the prevalence of xerostomia and other mouthcomplaints in 223 geriatric outpatients in the Slotervaart Hospital in the Netherlands, and the possible relationship between xerostomia on the one hand andmedication, comorbidity and malnutrition on the other. Methods.– The prevalence of xerostomia and oral symptoms was measured in geriatric outpatients using a questionnaire and the GOHAI (Geriatric Oral Health Assessment Index). Malnutrition was assessedwith theMNA (MiniNutritional Assessment).Medications and comorbidity were recorded. Multiple regression analysis was used to determine the possible causes of xerostomia. Results.– The prevalence of xerostomia and oral symptoms is 45% and 61%, respectively. Xerostomia is associated with the use of benzodiazepines (P0.015) andantidepressants (P0.031).No significant relationshipwas found between xerostomia andmalnutrition. Malnutrition, though,was frequentlyobserved.Geriatric specialists reported oral symptoms in only 4.5% of the patients. Conclusion.– Oral symptoms and xerostomia occur frequently, but are not often recognised. There is a significant correlation between the use of benzodiazepines and antidepressants and the risk of xerostomia. We did not find any relationship between xerostomia and underlying diseases or between xerostomia and malnutrition. We recommend that geriatric patients should be asked whether they have oral symptoms, such as xerostomia and other oral symptoms. Medication, particularly antidepressants and benzodiazepines, should be reviewed and a thorough oral examination should be performed.

The usefulness of Kihon Checklist (KCL) to predict adverse outcomes in geriatric outpatients with chronic diseases

Results.– Mean appendicular skeletal muscle mass index (ASMI) was 6.61±0.64kg/m2, and 14 had sarcopenia diagnosed with European Working Group on Sarcopenia in Older People (EWGSOP) algorithm; 4/43: reduced gait speed, 11/39: low handgrip strength, 2: severe sarcopenia, 23: pre-sarcopenia; 16: obesity, 11: sarcopenic-obesity (Baumgartner’s criteria).With Fried’s frailty criteria, seven were classified as frail, 23 as pre-frail, and 13 as robust. All of six male frail patients were diagnosed as sarcopenia. All of eight sarcopenic patients without diagnosis of frailty were classified as pre-frail. Gait speed was associated with BODE index and parameters of HrQOL, nutrition, mood, and physical activity. Conclusions.– Sarcopenia was a highly prevalent condition and might play an etiological role in the frailty in elder PR patients with COPD.

Optimizing drug treatment among older people in residential care facilities in Helsinki – A randomized, controlled trial

Introduction.– We examined the prevalence of xerostomia and other mouthcomplaints in 223 geriatric outpatients in the Slotervaart Hospital in the Netherlands, and the possible relationship between xerostomia on the one hand andmedication, comorbidity and malnutrition on the other. Methods.– The prevalence of xerostomia and oral symptoms was measured in geriatric outpatients using a questionnaire and the GOHAI (Geriatric Oral Health Assessment Index). Malnutrition was assessedwith theMNA (MiniNutritional Assessment).Medications and comorbidity were recorded. Multiple regression analysis was used to determine the possible causes of xerostomia. Results.– The prevalence of xerostomia and oral symptoms is 45% and 61%, respectively. Xerostomia is associated with the use of benzodiazepines (P0.015) andantidepressants (P0.031).No significant relationshipwas found between xerostomia andmalnutrition. Malnutrition, though,was frequentlyobserved.Geriatric specialists reported oral symptoms in only 4.5% of the patients. Conclusion.– Oral symptoms and xerostomia occur frequently, but are not often recognised. There is a significant correlation between the use of benzodiazepines and antidepressants and the risk of xerostomia. We did not find any relationship between xerostomia and underlying diseases or between xerostomia and malnutrition. We recommend that geriatric patients should be asked whether they have oral symptoms, such as xerostomia and other oral symptoms. Medication, particularly antidepressants and benzodiazepines, should be reviewed and a thorough oral examination should be performed.

Are patients assessed for falls in a general geriatric outpatient clinic different from other geriatric outpatients?

Are patients assessed for falls in a general geriatric outpatient clinic different from other geriatric outpatients?

Association with and predictive capacity of self-perceived risk of falling in recurrent falls in older people: a prospective study

Given the impact of recurrent falls in older people, risk evaluation for falling is an important part of geriatric assessment. Available clinical tools usually do not include patients' self-perceived risk of falling. The objective of this study was to evaluate association with and predictive capacity of self-perceived risk of falling in recurrent falls. Prospective cohort study. Patients attending a geriatric outpatients' clinic were recruited (Pfeiffer score <5). A baseline assessment and follow-up over 14 months was scheduled for each patient. Self-perceived risk of falling was assessed through four questions. Association with falls was evaluated through relative risk, survival curves (Kaplan-Meier), and Cox regression (recurrent falls as outcome variables). Predictive capacity was evaluated through sensitivity, specificity, and predictive values. 52 participants answered all 4 questions, and 15 participants (27.2 %) presented recurrent falls. Question 1 (Do you think you may fall in the next few months?) was associated with the occurrence of recurrent falls according to relative risk [3.88 (CI95 %:1.48-10.09)] and survival curves (log Rank, p 0.004). Such relationship is maintained over time. Cox-regression also showed significant difference in relation to the answer for question 1 and recurrent falls [hazard ratio 4.044 (CI: 1.410-11.597); p 0.009]. Sensitivity, specificity, positive and negative predictive values (question 1) were 53.3 % (CI95 %:28.1-78.6), 84.2 % (CI95 %:72.6-95.8), 57.1 % (CI95 %:31.2-83.1), and 82.1 % (CI95 %:70.0-94.1), respectively. Patients' self-perceived risk of falling is related to recurrent falls amongst people with a high risk of falling and this parameter might be useful in falling risk evaluation.

Factors Associated with Undertreatment of Atrial Fibrillation in Geriatric Outpatients with Alzheimer Disease

According to international recommendations [from the American College of Cardiology/American Heart Association/European Society of Cardiology] and those of the Haute Autorité de Santé (HAS) in France, treatment with a vitamin K antagonist is recommended in patients with atrial fibrillation (AF) in the presence of a high thromboembolic risk factor [history of stroke, transient ischemic attack, systemic embolism, or valvular heart disease, or presence of a mechanical heart valve prosthesis] or at least two moderate risk factors (age ≥75years, hypertension, congestive heart failure, or diabetes). In patients with a major contraindication, the vitamin K antagonist can be replaced by an antiplatelet agent (APA). These recommendations are not systematically observed in patients with Alzheimer disease (AD). The aim of our study was to determine the factors associated with undertreatment of AF in geriatric outpatients with AD. Use of oral anticoagulants or APAs was studied in 66 patients with AF who were included in the French Network on Alzheimer Disease (REAL.FR) cohort, consisting of 686 outpatients living at home, supported by an informal caregiver, and suffering from Alzheimer-type dementia, with a Mini Mental Status Examination (MMSE) score between 10 and 26. First, demographic characteristics (age, sex, body mass index [BMI], living arrangements, educational level), medical conditions (comorbidity, number of medications), disability (activities of daily living [ADL], instrumental activities of daily living [IADL]), risk of falls (one-leg balance test), cognitive status (according to MMSE, Alzheimer's Disease Assessment Scale-Cognitive Subscale [ADAS-Cog], and Clinical Dementia Rating [CDR] scores), risk factors for stroke (hypertension, history of stroke, congestive heart failure, diabetes, or age ≥75years) and potential contraindications to oral anticoagulants (OACs) or APAs (polypharmacy, risk of falls, renal failure, gastrointestinal diseases) of patients receiving OACs were compared with those of patients receiving APAs and those of patients receiving no treatment for AF. Then the same characteristics were compared between patients receiving no treatment for AF and those receiving OACs or APAs. Only 56% (n=37) of patients with AF were receiving OACs or APAs at the baseline visit, of whom 18 (49%) were receiving OACs and 19 (51%) were receiving APAs. Bivariate analysis showed that patients receiving OACs or APAs were significantly more likely to have a history of cardiovascular disease (p=0.005)-in particular, hypertension (p=0.037)-less likely to be living alone and unaided (p=0.038), and less likely to be taking nonsteroidal anti-inflammatory drugs [NSAIDs] (p=0.001). Despite the national and international recommendations, nearly half of AD patients with AF do not receive OACs or APAs. A history of cardiovascular disease-in particular, hypertension-improves access to treatment, but use of NSAIDs and living alone without home care seem to be the main factors associated with non-prescription of OACs or APAs.

Prevalence and determinants for malnutrition in geriatric outpatients

Few data is available on the nutritional status of geriatric outpatients. The aim of this study is to describe the nutritional status and its clinical correlates of independently living geriatric older individuals visiting a geriatric outpatient department. From 2005 to 2010, all consecutive patients visiting a geriatric outpatient department in the Netherlands were screened for malnutrition. Nutritional status was assessed by the Mini Nutritional Assessment (MNA). Determinants of malnutrition were categorized into somatic factors (medicine use, comorbidity, walking aid, falls, urinary incontinence), psychological factors (GDS-15 depression scale, MMSE cognition scale), functional status (Activities of Daily Life (ADL), Instrumental ADL (IADL)), social factors (children, marital status), and life style factors (smoking, alcohol use). Univariate and multivariate logistic regression analyses, adjusted for age and sex and all other risk factors were performed to identify correlates of malnutrition (MNA < 17). Included were 448 outpatients, mean (SD) age was 80 (7) years and 38% was men. Prevalence of malnutrition and risk for malnutrition were 17% and 58%. Depression, being IADL dependent, and smoking were independently associated with an increased risk of malnutrition with OR's (95%CI) of 2.6 (1.3-5.3), 2.8 (1.3-6.4), 5.5 (1.9-16.4) respectively. Alcohol use was associated with a decreased risk (OR 0.4 (0.2-0.9)). Malnutrition is highly prevalent among geriatric outpatients and is independently associated with depressive symptoms, poor functional status, and life style factors. Our results emphasize the importance of integrating nutritional assessment within a comprehensive geriatric assessment. Future longitudinal studies should be performed to examine the effects of causal relationships and multifactorial interventions.

Do Antidepressants Lower the Prevalence of Lithium-Associated Hypernatremia and Symptomatic Polyuria in the Elderly?

BackgroundClinically important measures of lithium-induced nephrogenic diabetes insipidus (NDI) such as hypernatremia have not been well-studied. This is especially relevant for the elderly who, in comparison to younger adults, may become symptomatic and require hospitalization with relatively small elevations in sodium levels. We hypothesized that antidepressant use, which has been associated with the syndrome of inappropriate antidiuretic hormone secretion, has a protective effect against lithium-associated hypernatremia in the elderly.MethodsRetrospective cohort study of 55 geriatric psychiatry outpatients followed at tertiary-care hospitals. Patients using lithium and antidepressants were compared with those using lithium alone for prevalence rates of hypernatremia during a 15-year observational period.ResultsThe prevalence of hypernatremia was less in patients who had concurrent use of lithium and antidepressants, as compared to lithium alone 3/35 (8.6%) vs. 8/20 (40%), OR 0.14, p = .011.ConclusionsOur results suggest that elderly lithium patients are less likely to develop hypernatremia if they are taking antidepressants concurrently. Whether antidepressants may be useful in the prevention of lithium-associated hypernatremia should be assessed in future prospective observational or treatment studies.

Escherichia coli antimicrobial resistance increased faster among geriatric outpatients compared with adult outpatients in the USA, 2000-10

Few studies have examined Escherichia coli antimicrobial resistance across age groups over time. The objective of this study was to compare urinary E. coli antimicrobial resistance trends among adult and geriatric outpatients from 2000 to 2010. Antimicrobial susceptibility results for E. coli urine isolates from adult (aged 16-64 years) and geriatric (aged ≥65 years) outpatients were analysed using data from The Surveillance Network Database-USA. Susceptibility test results from adult (n = 6 412 025) and geriatric (n = 3 395 297) outpatients showed that E. coli antimicrobial resistance increased faster among geriatric outpatients for all agents studied. The greatest increases in resistance over the study time period were for ciprofloxacin (9.4% and 23.5% increases among adult and geriatric individuals, respectively), trimethoprim/sulfamethoxazole (4.3% and 10.5%) and ampicillin (2.0% and 13.6%). Urinary E. coli antimicrobial resistance increased faster among geriatric outpatients than adult outpatients in the USA. Rising antimicrobial resistance disproportionately affects geriatric populations and presents a threat to public health.

Nutritional status of geriatric outpatients with systolic heart failure and its prognostic value regarding death or hospitalization, biomarkers and quality of life.

The prevalence of malnutrition in ambulatory patients with heart failure is difficult to determine, depending on the timing and methodology. To determine the nutritional status of outpatients with systolic heart failure with the Mini Nutritional Assessment (MNA) full and short-form versions, and evaluate its relationship with the short-term prognosis, biomarkers and quality of life. Fifty consecutive (70% male), geriatric (74.3+ 6.2years old) stable outpatient with heart failure (NYHA class II 68%, III 32%) and left ventricular ejection fraction of 26.7 +11.5% were included and followed during 12 months. At a routine visit to the heart failure clinic, the MNA, the Minnesota Living with Heart Failure questionnaire (MLHFQ) were applied. According to the MNA screening score the nutritional status was classified using the MNA full (MNA-F) and the short-form (MNA-F) versions of the questionnaire. The recorded events were death and hospitalization. The survival and hospitalizations curves were evaluated with the Log-Rank test and Cox Regression analysis. The association between parameters was analyzed with the Pearson and Spearmann correlation coefficient. (1) The mortality and hospitalization rates were 12% and 42%, respectively. (2) With the MNA-SF 7.6% of the patients had malnutrition and 20% were at risk of malnutrition. There was a good agreement (90%) between the MNA-SF and the MNA-F classifications. (3) There was a significant relationship between the MNA screening score and the MLHFQ (rs= -0.592 p<0.001), Nt-ProBNP (rs= -0.49 p<0.001) and total plasma protein (r= 0.672 p=0.006); (3) The MNA-SF nutritional classification was associated with the 12 months survival (Log-Rank p=0.044) and hospitalization (Log-Rank p=0.005) curves. (4) Those patients with malnutrition by the MNA-SF were at greater risk of death (HR= 8.0 p=0.059) and hospitalization (HR 8.1 p=0.008). The MNA is useful for the evaluation of the nutritional status of elderly outpatients with systolic heart failure. It is a good predictor of the short-term outcome and is also associated with the quality of life and Nt-ProBNP.

The Effect of Serum Lithium Levels on Renal Function in Geriatric Outpatients: A Retrospective Longitudinal Study

Lithium remains an important treatment for bipolar disorder; however, whether elevated lithium levels lead to long-term renal problems is unknown. Previous consensus opinion was that levels should be kept below 0.6 mmol/L in geriatric patients to minimize renal toxicity. We hypothesized that elevated serum lithium levels correlate with decreased renal function [estimated glomerular filtration rate (eGFR)] in geriatric psychiatry outpatients. This was a 4-year retrospective cohort study (2007-2011). We performed this study in three Canadian university-affiliated tertiary care clinics. Data from 42 lithium-using geriatric psychiatry outpatients was used. INTERVENTION/EXPOSURE: Our main exposure of interest was mean serum lithium level between 2007 and 2011. Our primary outcome was change in eGFR between 2007 and 2011 (hypothesis formulated before data collection). Lithium levels did not correlate significantly with change in eGFR at 2- or 4-year follow-up (r < 0.12, p > 0.57). There were no significant predictors of change in eGFR in a multiple linear regression model including hypertension, diabetes, baseline eGFR, lithium duration, and lithium levels. Lithium levels do not correlate strongly (ρ > 0.5) with decreased eGFR at 2- and 4-year follow-up in geriatric outpatients. These results are not reliably generalizable when treating patients at mean lithium levels greater than 0.8 mEq/L, especially at 4-year follow-up, and larger studies will be necessary to examine the possibility of a smaller correlation. Nonetheless, these data and the existing literature suggest that lithium levels up to 0.8 mmol/L are safe for use in the long-term treatment of geriatric patients with mood disorders without pre-existing chronic renal failure.

Limitations for Interpreting Failure on Individual Subtests of the Montreal Cognitive Assessment

The Montreal Cognitive Assessment (MoCA) is sensitive to mild forms of cognitive impairment in geriatric populations and asks questions under the subheadings visuospatial/executive, naming, attention, language, abstraction, delayed recall, and orientation. This study examined the extent to which these subsets of MoCA items evaluate their intended cognitive domains. Clinical data from 185 geriatric memory clinic outpatients who underwent cognitive screening and subsequent neuropsychological assessment were analyzed. Factor analysis of their neuropsychological test scores identified 5 cognitive domains memory, language, visuospatial ability, attention/processing speed, and cognitive control. Scores on MoCA subtests were examined for their correlations with individual factor scores and for their sensitivity and specificity in predicting impairment within each domain. The MoCA subtest scores correlated significantly but modestly with neuropsychological test factor scores in their corresponding domains, for example, the correlation between 5-word recall and the memory factor was 0.46. However, subtest scores were poor predictors of impaired performance on the tests contributing to each cognitive domain. The best predictive accuracy was seen for the visuospatial/executive subtest that showed fair accuracy at predicting impairment on tests in the visuospatial domain. Other subtests showed unacceptably poor levels of accuracy when predicting impaired scores in their respective domains (60%-67%). In a sample of geriatric outpatients referred for cognitive assessment, performance on individual items and subtests of the MoCA yields insufficient information to draw conclusions about impairment in specific cognitive domains as determined by neuropsychological testing.

Should we screen for heart failure in the elderly?

Should we screen for heart failure in the elderly?

The Use of GDS-15 in Detecting MDD: A Comparison Between Residents in a Thai Long-Term Care Home and Geriatric Outpatients

BackgroundTo assess the psychometric properties of the Thai version of the 15-item Geriatric Depression Scale (TGDS-15) when screening for major depression (MDD) among geriatric outpatients (GOs) and long-term care (LTC) home residents in Thailand.MethodsThis was a cross-sectional study of 156 geriatric outpatients and 81 LTC home residents. All 237 participants were given a Mini-Mental State Examination, a MDD diagnosis according to the Mini-International Neuropsychiatric Interview, and completed a TGDS-15 questionnaire. Sensitivity, specificity, overall accuracy, and positive and negative predictive values were calculated. A comparison between the two groups was carried out. Differential Item Functioning (DIF) using logistic regression and factor analytic study were also applied.ResultsOverall, 38.4% of the participants were found to have MDD. The TGDS-15 was found to perform better when used with the GOs than with the LTC home residents, revealing a sensitivity of 0.92 and a specificity of 0.87 in the GOs (cut-off score of ≥ 5), but a sensitivity of 100% and a specificity of 49% with the LTC home group (cut-off score of ≥ 8), when comparing only cognitively intact subjects. The negative predictive value (NPV) was very good for both groups, but the positive predictive value (PPV) for the GO group was much better than for those in the LTC group (83.3% vs. 31.2%). Seven uniform DIF items were found - 2 by gender and 4 by age. Cronbach’s alpha was higher for the GO group than for the LTC home residents. Factor analysis supported a two-factor solution, using the ‘depressed mood’ and ‘positive mood’ factors, which accounted for 46.55% of the total variance.ConclusionsThe TGDS-15 scale was effective at screening for MDD in elderly cognitively intact Thais, those in both GO and LTC settings, as the sensitivity and NPV were shown to be very good in both groups. However, in the LTC setting, the low specificity and PPV found leads to the need for a further assessment to be carried among the potentially depressed individuals, based on the GDS results. Taking the factor analytic study into account, a more suitable version of the GDS should be developed.

Effectiveness of the medication safety review clinics for older adults prescribed multiple medications

Polypharmacy is common among Taiwanese older adults. We aim to determine the effectiveness of the medication safety review clinics (MSRCs) for solving drug-related problems (DRPs) among older adults prescribed multiple medications. This prospective case-series intervention study was conducted at the outpatient department of the National Taiwan University Hospital and its BeiHu Branch. Older adults (≥65 years) who either had been prescribed ≥8 chronic medications (drugs prescribed for ≥28 days) or had visited ≥3 different physicians during the 3-month screening period were enrolled (N=193). DRPs were identified after baseline assessments from a team of geriatricians and pharmacists. Prescribers were contacted with proposed interventions to be administered within 12 weeks. Problem-solving rates (PSRs) at both Week 12 and Week 24 visits were recorded. Stepwise multivariate logistic regression was applied to identify correlates of having at least one unsolved DRP at 24 weeks. Participants (N=139) who completed four visits to the MSRCs were analyzed. The mean age was 75.6±6.1 years and 56% of them were men. The mean chronic medication per patient was 9.0±3.1, and the mean DRP per patient was 2.1±1.5. ThePSR was 76% at Week 12 and 87% at Week 24. Thirty-two patients (22%) had at least one unsolved DRP. Correlates of the unsolved DRP included a higher geriatric depression scale, a higher chronic medication per patient, and a higher DRP per patient. The mean chronic medication per patient (9.0 vs. 8.6, p<0.05) decreased, and the number of participants rating good or better health status improved from 22% to 38% in 24 weeks (p<0.001). Participants were highly satisfied (96% at all times) with the service. DRPs were common in geriatric outpatients taking multiple medications and most were solved with appropriate interventions. The MSRC service may improve prescription quality in Taiwan if widely available.