Association between falls and high-risk medication use in hospitalized Asian elderly patients

Aim:   Most studies looking at the relation between medication use and fall among the hospitalized elderly patients, were done in Western countries. So, a study was planned to investigate the role of medications in causing falls in hospitalized Asian elderly patients.
Methods:   Case note review was done for all patients age 65 years and above, who fell at least once during their hospital stay over a 12-month period. Information obtained from the case notes included: (i) demographic information; (ii) Modified Morse Fall scale; (iii) circumstances and time of fall; and (iv) medication use. From the hospital admission database, an age- and sex-matched control group was selected for comparison.
Results:   Over the 12-month study period, 298 patients met the study criteria. Average age of the patients was 75.8 years, 60.4% were male and 84.9% were Chinese. Multivariate analysis showed that fallers had longer lengths of stay and were more likely to have a history of falls. Fallers were also more likely to be taking hypnotics, cough preparations and anti-platelets, but less likely to be taking paracetamol. Fallers were on fewer medications.
Conclusion:   Elderly hospitalized patients on hypnotic drugs, cough preparations and anti-platelets were more likely to fall. Appropriate usage of analgesics, especially paracetamol, to relieve pain may reduce falls.     

Comparison of nutritional risk between urban and rural elderly

Urban and rural elderly face a multitude of barriers to healthy aging and maintaining adequate nutrition. Looking at commonalties and differences between urban and rural elderly that are associated with nutritional risk is an important first step in identifying and correcting nutritional insufficiencies. To examine health behaviors and nutritional information associated with nutritional risk in urban and rural areas and to develop a profile of nutritional risk for rural and urban elderly, data from one retrospective and two prospective studies were analyzed. One hundred, eighty-three (183) urban-living and 167 rural-living older adults (average age 77 years old) participated in the studies. More than 60% of participants were women. Overall health ratings were significantly higher for urban than for rural elderly. Rural dwellers had significantly fewer dental visits (41% versus 76%) but higher albumin values than their urban counterparts. Results from the synthesis of these four studies indicate that as people become more physically debilitated and lose independence in daily activities, their risk for malnutrition increases and their quality of life decreases. Although rural residents are believed to be at higher risk of malnutrition, these results suggest that this may not be the case. Physical, social, and environmental factors may affect the nutritional status of seniors regardless of where they reside.     

Satisfaction among rural and urban Japanese elderly in three-generation families

For the purpose of testing an assumption on the dual nature of aging in Japanese society, this study compared and contrasted three-generation adult families in Yamato-machi, a rural town in Niigata Prefecture in northern Japan, and in Setagaya-ku, an urban ward in Tokyo. The average ages for each generation in the study were G1 = 85, G2 = 60, and G3 = 35. The findings reveal regional variation in basic demographic characteristics such as population density, family size, proportions of the elderly 65 and over and 90 and over, as well as the prevalence of the three-generation family households. This supports the existence of dual patterns of aging in Japan today. The data also show significant differences between these regional sectors in the level of educational and economic conditions of the elderly. However, measures of the extent of satisfaction do not reveal any significant difference between rural and urban elderly. It is suspected that this is because only three-generation healthy families were interviewed in this study.     

Concurrent alcohol and medication poisoning hospital admissions among older rural and urban residents

ABSTRACT

Background: Alcohol and medication interactions are projected to increase due to the growth of older adults that are unsafely consuming alcohol and medications. Plus, aging adults who reside in rural areas are at the highest risk of experiencing medication interactions. Objective: Estimate concurrent alcohol and medication (alcohol/medication) hospitalizations in adults 50+ years, comparing age groups and rural/urban regions. Methods: Kentucky nonfederal, acute care inpatient hospital discharge electronic records for individuals aged 50+ years from 2001 to 2012 were examined. Rate differences were estimated across age and regional strata. Differences in the underlying principal diagnosis, intent, and medications were also examined. Results: There were 2168 concurrent alcohol/medication hospitalizations among 50+ year olds identified. There was a 187% increase in alcohol/medication hospitalizations from 2001 (n = 104) to 2012 (n = 299). The per capita alcohol/medication hospitalization rate increased from 8.91 (per 100,000) in 2001 to 19.98 (per 100,000) in 2012, a 124% increase. The characteristics of the hospitalizations included 75% principal diagnosis as medication poisoning, self-harm as the primary intent (55%) in 50–64-year olds, and unintentional intent (41%) in 65+ adults. Benzodiazepines were most often involved in the poisonings (36.5%). Conclusions: Concurrent alcohol/medication hospitalizations in Kentucky are increasing among aging adults. Greater increases in rural areas and the 65+ aged adults were seen, although there were also higher alcohol/medication hospitalizations in urban and 50–64 aged adults. These findings indicate the need for public-health prevention and clinical intervention to better educate and manage alcohol consuming older adults on safe medication and alcohol practices.     

Depression and social support between China' rural and urban empty-nest elderly

This study compared levels of depression and social support among empty-nest elderly who living in the rural and urban area of Hunan province, China. This cross-sectional study enrolled 809 empty-nest elderly living throughout the province as the study respondents. The general information, depression conditions and social supports were investigated by using the self-made General Information Questionnaire, Geriatric Depression Scale (GDS) and Social Support Rating Scale (SSRS). Variables are presented as mean±standard deviation (SD) or frequency. Independent t-test and χ(2)-tests were used to compare the socio-demographic factors, depression score and social support scores of the rural empty-nest elderly to the urban empty-nest ones; multilevel modeling was used to analyze the socio-demographic factors and social support predicted the level of depression among the empty-nest old subjects. The differences in gender, education level, marital status, economic status, self-perceived income, insurance, children visit frequency and religious beliefs factors between rural and urban empty-nester old people were statistically significant (p<0.05). The average GDS score of rural group was (14.57±5.43), which was higher than the average GDS score (13.18±6.51) of urban group (p<0.01). Objective support scores showed statistical significance between the rural and urban empty-nest elderly (p<0.05). There are differences between rural and urban empty-nest elderly in the aspects of general data, depression status, social support and so on, we should intervene them effectively according to their different characteristics.     

Cardioprotective medication use in hemodialysis patients

BACKGROUND: Cardiovascular disease is the leading cause of mortality in patients with renal failure, accounting for more than 50% of deaths in end-stage renal disease. Risk factor modification with the use of cardioprotective medications such as angiotensin-converting enzyme inhibitors (ACEIs), beta-adrenergic antagonists (beta-blockers), acetylsalicylic acid (ASA) and 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) has been shown to reduce mortality in the general population. OBJECTIVE: To determine the extent of use of these medications in a hemodialysis population. METHODS: This was a cross-sectional study of a cohort of 185 prevalent hemodialysis patients. The inclusion criterion was dialysis dependence and there were no exclusion criteria. Data collection was by chart review. Contraindications to individual medication classes were not obtained. RESULTS: There were 185 patients enrolled, the mean age was 63.42+/-15.1 years and 126 (68.1%) were male. Sixty-six (35.7%) patients had diabetes and 89 (48.1%) patients had established coronary artery disease (CAD). Forty-six (24.9%) patients were on ACEIs or angiotensin II receptor blockers, 59 (31.9%) were on beta-blockers, 70 (37.8%) were on ASA and 84 (45.4%) were on statins. Although these medications were used in fewer than 60% of patients, those with CAD were more likely to be prescribed an ACEI or an angiotensin II receptor blocker (P=0.026), a beta-blocker (P<0.001), ASA (P<0.001) or a statin (P=0.001) than those without CAD. There were no differences in the use of these medications between diabetic and nondiabetic patients. CONCLUSIONS: Many hemodialysis patients are not prescribed cardioprotective medications. Given the high cardiovascular mortality in this high-risk population, more attention to reducing cardiovascular risk is warranted.     

Implantable cardioverter-defibrillator use in elderly patients receiving cardiac resynchronization: A meta-analysis

BackgroundImplantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT) reduce sudden cardiac death and all-cause mortality in patients with heart failure with reduced ejection fraction (HFrEF). Current guidelines do not suggest any upper age limit for ICD and CRT but recommend avoidance of ICD and CRT in frail patients with a life expectancy of less than 1 year. It remains unclear whether elderly patients undergoing CRT derive the same additional benefit from ICDs as younger patients. We aimed to assess the use of ICDs in elderly compared to younger patients receiving CRT.MethodsWe searched electronic databases, up to April 11, 2016, for all studies reporting on ICD use stratified by age in patients who received CRT. We used random-effects meta-analysis models to calculate the summarized baseline characteristics and rates of implantation of ICD among patients enrolled in the studies.ResultsWe retained six observational studies enrolling 613 patients ≥75 years old and 2810 patients <75 years old. The aggregate mean age was 82.7 years for the elderly patients compared to 66.3 years in the younger patients. There was a significantly lower use of ICDs in elderly patients compared to that in younger patients (37.9% versus 64.3%) (odds ratio: 0.26; 95% confidence intervals: 0.14-0.46; p < 0.0001).ConclusionsIn conclusion, ICD was less frequently used in patients ≥75 years old receiving CRT compared to younger patients receiving CRT. Future studies that evaluate the efficacy and effectiveness of ICDs in elderly patients with indications for CRT are needed to guide management of this increasing population.     

Children's support for elderly parents in urban and rural China: Results from a national survey

This study examines the factors that determine adult children's financial support for elderly parents, using data from the China Survey on Support Systems for the Elderly conducted in 1992. The findings support the hypotheses of need-based transfers. In both urban and rural areas, children's financial transfers to their elderly parents are based on the parents' need, and familial support compensates for inequalities in elderly persons' access to public resources. The data also suggest that elderly support is an outcome of short- and long-term arrangements between generations. Elderly Chinese, especially those in urban areas, have short-term exchanges with their adult children, providing housing or other services and receiving financial support in return. Also, adult children's support for elderly parents may be a repayment of parental investment made in them earlier.     

Inappropriate medication prescribing for elderly ambulatory care patients

BACKGROUND: Inappropriate medication use in elderly patients has been linked to a large share of adverse drug reactions and to excess health care utilization. METHODS: Trends in the prevalence of potentially inappropriate drug prescribing at ambulatory care visits by elderly persons from 1995 to 2000 were examined with data from office-based physicians in the National Ambulatory Medical Care Survey and from hospital outpatient departments in the National Hospital Ambulatory Medical Care Survey. Explicit criteria were used to identify potentially inappropriate prescribing. Multivariate regression was used to identify related factors. RESULTS: In 1995 and 2000, at least 1 drug considered inappropriate by the Beers expert panel was prescribed at 7.8% of ambulatory care visits by elderly patients. At least 1 drug classified as never or rarely appropriate by the Zhan expert panel was prescribed at 3.7% and 3.8% of these visits in 1995 and 2000, respectively. Pain relievers and central nervous system drugs were a large share of the problem. The odds of potentially inappropriate prescribing were higher for visits with multiple drugs and double for female visits. The latter was due to more prescribing of potentially inappropriate pain relievers and central nervous system drugs. CONCLUSIONS: Potentially inappropriate prescribing at ambulatory care visits by elderly patients, particularly women, remains a substantial problem. Interventions could target more appropriate drug selection by physicians when prescribing pain relievers, antianxiety agents, sedatives, and antidepressants to elderly patients. Such behavior could eliminate a large portion of inappropriate prescribing for elderly patients and reduce its higher risk for women.     

Hip fracture among the elderly in a mixed urban and rural population

Among the 27314 people aged 60 years or more living in the northern part of the county of Storstr ?m, Denmark, 117 were hospitalized with hip fracture in one year (1978), making an incidence of 4.3 per 1000. All 117 patients were seen soon after their admittance to hospital, and after one year the 86 surviving patients were seen in their homes. A higher death rate was found during the first three months, but only among patients with additional disabling diseases. Among the survivors, the possibility of leading a regular life was found to be only slightly reduced as measured by their activity-level, mobility and state of independence. Thirteen per cent of the survivors were institutionalized. The mean stay in hospital was 66 days, including transfer to a geriatric department in some instances.     

长治市某社区农村老年患者认知功能障碍的危险因素

目的 探讨居住城市社区的农村老年患者认知功能障碍发生的危险因素. 方法 通过简易智力状态检查表(MMSE)对118例老年患者的认知功能进行评价,收集患者的一般资料,调查是否合并冠心病、高血压病、糖尿病、脑卒中、慢性阻塞性肺疾病,收集患者的血清低密度脂蛋白胆固醇(LDL-C)、同型半胱氨酸(Hcy)等资料并进行分析. 结果 118例患者中有17例出现不同程度的认知功能障碍,认知障碍的发生率为14.4％;单因素回归分析显示年龄、脑卒中病史、Hcy、LDL-C与智力状态检查结果呈相关性(x2 =21.166、19.323、13.672、3.698,P＜0.01或P＜0.05);性别、配偶是否健在、高血压病、冠心病、糖尿病、慢性阻塞性肺疾病等因素均与卒中后认知功能障碍不相关(P＞0.05).多因素回归分析显示,年龄(OR=0.853,95％ CI:0.765～0.951)、脑卒中病史(OR=0.764,95％ CI:0.629～0.929)、LDL-C(OR=0.208,95％ CI:0.062～0.701)和日常生活能力评分(ADL)(OR=0.839,95％ CI:0.725～0.972)是老年患者认知功能障碍的独立危险因素. 结论 年龄、脑卒中病史、低密度脂蛋白胆固醇和日常生活能力是居住城市社区的农村老年患者认知功能障碍的独立危险因素.     

北京市城市、农村老年人生活满意度的对比分析

利用＂北京老化多维纵向研究＂１９９２年基线调查资料，对比分析了１６９３例城市老年人和８５０例农村老年人，对夫妻、子女关系、一般生活、经济、住房、健康、休闲活动、医疗等八个方面的满意度，以及由此得出的总体生活满意度的结果。城市老年人中满意度最低的是住房，农村则是健康。满意度最高的都是生活。两地老年人总体生活满意度均在２级左右（１级为很满意，５级计分），农村老年人总体生活满意度较城市高。分析这种差别主要归于受教育水平的不同。