Journal of Clinical Gerontology and Geriatrics最新文献

Background/Purpose

Magnesium deficiency has been a common, but easily ignored, electrolyte abnormality. Studies on magnesium deficiency are lacking in India, especially in a rural setting. Here, we have correlated serum magnesium levels with outcomes in elderly patients admitted to the medical intensive care unit with respect to the length of intensive care unit stay, need for mechanical ventilatory support and its duration, and outcome (discharge/death).

Methods

A prospective, observational study was conducted in patients aged 60 years and older, who had been admitted to the intensive care unit of the medicine department for over a year. The chi-square test was applied to correlate hypomagnesemia with the outcome.

Results

In our study, 59.30% of the elderly patients had hypomagnesemia. Compared with patients with a normal magnesium level, hypomagnesemic patients had no correlation with the duration of medical intensive care unit stay (5.57 ± 6.10 days vs. 5.61 ± 5.55 days), but the need for mechanical ventilation (57.84% vs. 45.71%), rate of discharge from the intensive care unit or cure (60.28% vs. 71.42% ), rate of death (39.21% vs. 28.57%), and mean duration of ventilation (3.07 ± 5.05 days vs. 2.15 ± 3.46 days) were higher. However, no significant statistical difference was found between these groups.

Conclusion

Hypomagnesemia was associated with a slightly higher mortality rate. Requirement and duration of ventilatory support were also higher, although not statistically significant. Hypomagnesemia was not found to have any impact on the duration of medical intensive care unit stay. Monitoring of serum magnesium levels may have prognostic and perhaps therapeutic implications in the elderly.

Japan has a unique system of commissioned welfare volunteers who are familiar with neighborhoods and can identify the households requiring assistance and connect them to public support. In the present study, an anonymous self-rated questionnaire was delivered to commissioned welfare volunteers to clarify the daily life supports provided for elderly households requiring assistance, and 2270 data were collected. The questionnaires included information about elderly households requiring assistance and public support provided. The mean number of households visited in a month was 16.5 ± 20.5 SD. The most frequent provided supports for households was “Confirmation of general condition by visit” (13.5%), “Conversational partner” (6.3%), “Meals on wheels” (4.1%), and “Confirmation of general condition by phone” (3.0%). These results indicated the potential needs of the households requiring assistance and provided daily life support as demonstrated by commissioned welfare volunteers.

Sarcopenia, a well-known geriatric syndrome, is defined as the age-related loss of muscle mass plus declined muscle function (muscle strength and/or physical performance). Sarcopenia is associated with a number of adverse outcomes, including poor quality of life, falls, disability, and mortality. The clinical impact of sarcopenia on older people will escalate along with the rapid growth of elderly population in Asia. Moreover, the differences of ethnic backgrounds between Asian people and Westerners have trigger the need for specific diagnostic criteria for Asian populations. After the publication of Asian Working Group for Sarcopenia consensus, sarcopenia has gained even more extensive research attention in Asia. In general, the reported prevalence of sarcopenia in Asia was lower than Western countries, ranging from 2.5% to 45.7%. Asian people tend to have lower muscle mass, weaker grip strength, slower gait speed, and higher body fat mass with central distribution. Compared to Western populations, the rate of age-related muscle mass decline in older Asian people remain relatively unchanged, but the decline rate in muscle strength or physical performance was more significant along with aging. With aging, Asian people presented with greater increase in fat mass and higher prevalence of central obesity, especially in women. Due to the great impact of sarcopenia, a life course program for good nutrition and physical activities would be of great benefit. However, various research challenges remain to be resolved in the future and more outcome-based trials are needed to formulate the most optimal strategy for sarcopenia in Asia.

Background/Purpose

A significant increase in the prescribing of nonbenzodiazepine hypnotic agents (z-hypnotics) has been noticed in the past decade. Several safety concerns have emerged after the excessive use of z-hypnotics. This study aims to characterize the z-hypnotics users with a focus on those with overlapping duration of z-hypnotics supply by using Taiwan's National Health Insurance Research Database.

Methods

Incident z-hypnotic users who received at least one z-hypnotic prescription from outpatient settings during 2001–2010 were identified and classified into three groups: duplicated users (those who received multiple z-hypnotic prescriptions on the same day), suspected duplicated users (those who received multiple z-hypnotic prescriptions with 7+ days of overlapping supply), and nonduplicated users. We examined the demographic profiles of these z-hypnotic users as well as z-hypnotics prescriptions (duration, daily consumption, and characteristics of providers).

Results

We identified 242,412 incident users of z-hypnotics with 2.4 million z-hypnotic prescriptions during the 10-year study. Almost 20% of them were duplicated (n = 29,948) and suspected duplicated users (n = 16,899). Duplicated and suspected duplicated users were more likely to be male and in their old age compared to the nonduplicated users. Approximately half of the suspected duplicated users (51.8%) and nonduplicated users (47.0%) received their z-hypnotic prescriptions from primary care clinics while duplicated users received their z-hypnotic prescriptions from metropolitan hospitals (29.9%) and academic medical center (26.2%). Duplicated z-hypnotic users were more likely to receive more days' supply and higher daily dose of z-hypnotics. Up to 31.0% of duplicated z-hypnotics users received > 1 defined daily dose/day if adding all prescriptions they received within 1 day.

Conclusion

Duplicated z-hypnotic users were more likely to receive prescriptions with long duration and high daily dose. Healthcare professionals and policy makers are recommended to put more efforts into dealing with this urgent drug safety issue.

Background/Purpose

The aim of this study was to present an overview of health care utilization (outpatient, inpatient, and emergency visits), total medical expenditure, and drug consumption between the elderly and general population under Taiwan's National Health Insurance program.

Methods

We conducted a cross-sectional analysis using the 2010 Taiwan's Longitudinal Health Insurance Database. Our analysis included 999,418 beneficiaries with eligible records under the National Health Insurance system. Among them, 10.43% (n = 104,273) were elderly (65 years and older). Health care utilization [including outpatient, emergency department (ED), and inpatient visits], medical expenditure, as well as drug consumption for the entire study cohort (“the general population”) and the elderly were estimated using patient-level data from the Longitudinal Health Insurance Database. Specifically, “polypharmacy” and “excessive polypharmacy” defined as the concomitant use of five or more drugs and 10 or more drugs, respectively, were used to quantify drug consumption.

Results

The annual use of outpatient visits [mean (standard deviation): elderly 26.7 (21.5) vs. 12.2 (14.5)] per elderly individual doubled that of the general population. Approximately one-in-five of the elderly were admitted to hospital (20.9%) and went to ED (22.6%) at least once annually. Only 7.7% and 14.0% of the general public were admitted to hospital and went to ER at least once annually. The elderly had higher drug consumption and were more likely to be users of polypharmacy than the general population (elderly 15.5% vs. 3.7%). The annual medical expenditure per elderly individual tripled that of the general population (elderly 1846 US$ vs. 554 US$).

Conclusion

Elderly people had higher medical utilization than the general population, which may contribute to a fragmented health care system. Strategies to integrate health care for older people would be considered a first priority task of policymakers and health professionals.

Medication adherence is a crucial component in the treatment of chronic diseases. In the elderly, clinicians are faced with a unique set of problems associated with adherence that they may not have been adequately trained for. In this paper, we demonstrate the importance of medication adherence in the elderly through a case study. The different factors affecting medication adherence in the elderly are highlighted: patient, medication, health care providers, health care system, and socioeconomic factors. Lastly, we have proposed various ways to address these factors. In doing so, clinicians can better understand the problems that the elderly face, thus achieving better therapeutic outcomes.