National Geriatric Hospital Research Articles

Effectiveness of multifaceted interventions including motivational interviewing and home-based rehabilitation program for improving mental and physical health in stroke patients: A randomized controlled trial

BackgroundIn Vietnam, early screening and intervention for post-stroke mental health are limited, with rising demand for home-based rehabilitation due to the scarcity of inpatient programs. ObjectivesWe aimed to evaluate the effectiveness of multifaceted interventions, including Motivational Interviewing and home-based rehabilitation, in improving the mental and physical health of stroke patients. DesignA randomized controlled trial at the Vietnam National Geriatric Hospital assessed a multi-intervention approach for stroke survivors from 2021 to 2022. Ninety-two participants (aged over 45 with a stroke diagnosis) were randomly assigned to an intervention group (Motivational Interviewing and home-based rehabilitation) or a control group (standard care), with 46 participants in each group. Outcomes for mental health (Patient Health Questionnaire-9, Fatigue Severity Scale, Mini-Mental State Examination) and physical health (Barthel Index) were measured at baseline and after 1, 3, and 6 months. Statistical analyses used t-tests, Cohen's d, and repeated measures ANOVA. ResultsOver 6 months, 37 participants completed the intervention program. Baseline characteristics were similar except for age, lesion locations, and National Institutes of Health Stroke Scale scores. The intervention group showed significant improvements in mental health and physical function. Patient Health Questionnaire-9 scores decreased from 9.1 to 1.8, and Fatigue Severity Scale scores dropped from 28.5 to 17.8, while Barthel Index scores improved from 58.8 to 68.8 (p < 0.001). ConclusionsWe found that participants who underwent Motivational Interviewing therapy and home-based rehabilitation were more likely than those receiving standard care to experience substantial improvements in both mental and physical health metrics. RegistrationThe research protocol was registered on ClinicalTrials.gov on August 1, 2021 (Identifier: NCT04941482, link: https://clinicaltrials.gov/study/NCT04941482).

Ứng dụng của test chọc tháo dịch não tủy trong chẩn đoán và điều trị giãn não thất áp lực bình thường nguyên phát: ca lâm sàng

Normal Pressure Hydrocephalus (NPH) is a clinical syndrome characterized by gait disturbance, cognitive decline, and urinary incontinence accompanied by ventricular enlargement without increased intracranial pressure. NPH is a diagnosis of particular note as it differs from other neurodegenerative disorders such as Alzheimer’s and Lewy body disease. Symptoms may improve if diagnosed and treated promptly. Clinical symptoms of the disease were first described by Salomon Hakim and R.D. Adam in 1965, though they are common but not specific enough. Additionally, age-related ventricular enlargement and periventricular white matter damage are found in various conditions, both in normal individuals and in other cognitive decline disorders (vascular cognitive impairment, Alzheimer’s), making early diagnosis challenging. Treatment of NPH mainly relies on surgical intervention with ventriculoperitoneal shunting, with accurate preoperative diagnosis being crucial for success.Lumbar puncture (LP) can be considered the most important procedure to demonstrate the underlying pathophysiology of NPH, which is normal pressure hydrocephalus. High-volume lumbar tap test (LTT) is a relatively simple and effective method when clinical-radiological suspicion is present: it helps to distinguish NPH from other conditions with ventricular enlargement and aids in predicting the success of ventriculoperitoneal shunting surgery. The clinical case presented below illustrates the value of LTT in the definitive diagnosis of NPH at the Department of Neurology and Alzheimer’s Disease - National Geriatric Hospital.

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.

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.

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.

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.

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.

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.

Gánh nặng chăm sócbệnh nhân Parkinson có sa sút trí tuệ

Objective: Description of clinical features and assess the caregiver burden of patients with Parkinson’s disease dementia.Methods: Cross-sectional study on 50 patients diagnosed with Parkinson’s disease (PD) with dementia at the National Geriatric Hospital. PD patients were evaluated using Mini-Mental State Evaluation (MMSE), Barthel index, Parkinson’s Disease Questionnaire (PDQ-39), and Neuropsychiatric Inventory (NPI); Caregivers were evaluated using Depression Anxiety and Stress Scales (DASS21), and Parkinson’s Disease Carer Questionnaire (PDQ-carer). The study was statistically processed with SPSS 16.0 software.Results: 50 Parkinson’s patients with dementia and their main caregivers. The mean age of the study group was 74,48 ± 8,195, with a male/female ratio of ≈ 1/1,6. The mean duration of illness was 9,26 ± 4,24. The mean MMSE score of patients with dementia was 19,92 ± 4,45. There are 46 Parkinson’s patients with dementia (92%) with at least one of the behavioral and mental disorders or more. The functional ability of Parkinson’s patients with dementia according to the Barthel scale is 42,00 ± 29,71. Quality of life in Parkinson’s patients with dementia according to PDQ-39 is 49,50 ± 31,52. The prevalence of depression - anxiety - stress according to the DASS21 scale of primary caregivers for Parkinson’s patients with dementia is 67%, 70%, and 37%, respectively. The mean PDQ-carer score of primary caregivers was 74,44 ± 33,72.Conclusion: The caregiver burden for Parkinson’s patients was increased in Parkinson’s patients with dementia.

EVALUATION OF SOME COMMON GERIATRIC SYNDROMES AND THEIR RELATIONSHIP WITH THE QUALITY OF LIFE AMONG OLDER PATIENTS WITH KNEE OSTEOARTHRITIS

Objectives: To evaluate some common geriatric syndromes and their associations with health-related quality of life (HRQoL) among older people with knee osteoarthritis (OA). Methods: A cross-sectional descriptive study on 184 older patients with knee OA treated at National Geriatric Hospital from May to August 2022. HRQoL was assessed using the EQ-5D-5L questionnaire. Geriatric syndromes were assessed. Results: Some common geriatric syndromes in elderly knee OA patients were sleep disorders (72.3%), polypharmacy (54.3%), depression (48.4%), high risk of falls (45.1%), malnutrition and at risk of malnutrition (45.1%), IADL impairment (35.9%), and ADL impairment (32.6%). Cognitive impairment accounted for the lowest proportion (20.7%). There are significant associations between HRQoL and geriatric syndromes (malnutrition, ADL and IADL impairment, high fall risk, cognitive impairment, depression, and sleep disturbance). Patients with the presence of these geriatric syndromes have a poorer quality of life (QoL), in most aspects of HRQoL such as mobility, self-care, usual activities, pain/discomfort, and anxiety/depression). Conclusion: There was a high prevalence of geriatric syndromes in older people with knee OA. Most of these geriatric syndromes were related to the aspects of the patients’ QoL.

SOME FACTORS RELATED TO FATIGUE STATUS IN ELDERLY POST-STROKE PATIENTS

Objectives: To identify factors related to fatigue status in elderly post-stroke patients. Methods: A cross-sectional study on 157 patients those ages ≥ 60, diagnosed with stroke (according to the World Health Organization - WHO) and examined or treated as inpatients and outpatients at the National Geriatric Hospital, from July to November 2021. Data were collected using designed tools including characteristics of these patients. Entered data on Redcap and used SPSS version 22.0 for analysis. Results: Relevant factors affecting fatigue in elderly patients after stroke were physical activity daily living, cognitive impairment by Mini-Mental State Examination (MMSE), sleep disturbance by Pittsburgh Sleep Quality Index (PSQI), depression, and malnutrition. Factors that increased the risk of fatigue were age ≥ 60, using medication total, and cognitive decline. Conclusion: Early detection by performing the Fatigue Severity Scale (FSS) test to screen for fatigue in elderly post-stroke patients can provide appropriate treatment that helps improve treatment effectiveness as well as patients' quality of life.

Impact of COVID-19 on patterns of drug utilization: A case study at national hospital.

The Coronavirus disease of 2019 (COVID-19) pandemic and the corresponding mitigation measures have had a discernible impact on drug utilization among outpatients. However, limited research exists on the prescription trends in the elderly population during the pandemic period in Viet Nam. This study aims to analyze the effects of COVID-19 on outpatient drug utilization patterns at a national geriatric hospital in Ho Chi Minh City before and after the early onset of the pandemic. Data was collected from the prescriptions and administration claims, encompassing the period from January 2016 to December 2022. The dataset was divided into two periods: Period 1: January 2016 to December 2020 and Period 2: January 2021 to December 2022. The drug utilization was measured using DDD/1000P (defined daily doses-DDD per 1000 prescriptions) on a monthly basis. The analysis employed interrupted time series using Autoregressive Integrated Moving Average (ARIMA) to detect changes in drug use levels and rates. A total of 1,060,507 and 644,944 outpatient prescriptions from Thong Nhat Hospital were included in Period 1 and Period 2, respectively. The median age of the patients were 58 in Period 1 and 67 years old in Period 2. The most common comorbidities were dyslipidemia, hypertension, and diabetes mellitus. In terms of medication utilization, cardiovascular drugs were the most frequently prescribed, followed by drugs active on the digestive and hormonal systems. The study observed significant surges in the number of prescriptions and the average number of drugs per prescription. However, there were no significant changes in the overall consumption of all drugs. Among the drug groups related to the cardiovascular system, three subgroups experienced a sudden and significant increase: cardiac therapy, beta-blocking agents, and antihypertensives, with increasing consumption levels of 1,177.73 [CI 95%: 79.29; 2,276.16], 73.32 [CI 95%: 28.18; 118.46], and 36.70 [CI 95%: 6.74; 66.66] DDD/1000P, respectively. On the other hand, there was a significant monthly decrease of -31.36 [CI 95%: -57.02; -5.70] DDD/1000P in the consumption of anti-inflammatory and antirheumatic products. Interestingly, there was a significant increase of 74.62 [CI 95%: -0.36; 149.60] DDD/1000P in the use of antigout preparations. COVID-19 resulted in a sudden, non-significant increase in overall drug consumption levels among outpatients. Notably, our findings highlight significant increases in the utilization of three drug groups related to the cardiovascular system, specifically cardiac therapy, beta-blocking agents, and antihypertensives. Intriguingly, there was a statistically significant increase in the consumption of antigout preparations, despite a decline in the monthly consumption rate of non-steroidal anti-flammatory drugs (NSAIDs). Further studies in the following years are necessary to provide a more comprehensive understanding of the impact of COVID-19 on outpatient drug utilization patterns.

Associated factors with domains of comprehensive geriatric assessment among older post-stroke patients

This is a cross-sectional study conducted on 137 post-stroke patients aged ≥ 60 years old treated at the National Geriatric Hospital to explore some factors related to domains of comprehensive geriatric assessment (CGA). The components of CGA assessed were medical status (nutrition; urinary incontinence, frailty, visual and hearing ability), functional status (Barthel index, instrumental activity daily living, risk of fall) and neuropsychological status (cognition and depression). Patients ≥ 70 years old had a prevalence of malnutrition/risk of malnutrition, cognitive impairment, urinary incontinence, and frailty syndrome significantly higher than patients under 70 years old (p&lt;0.05). Post-stroke patients with hemiplegia had significantly higher dependency, cognitive impairment, depression, urinary incontinence, frailty syndrome, and hearing loss than patients without hemiplegia (p&lt;0.05). There was no statistically significant difference between gender, stroke classification, post-stroke duration, and the number of strokes and domains of CGA in older post-stroke patients. In summary, this study showed that advanced age and hemiplegia were significantly associated with some CGA domains.