Elderly patients are being increasingly admitted to the intensive care unit (ICU) for mechanical ventilation. Previous studies demonstrated that 20% to 35% of elderly patients were reintubated within ...48 to 72 hours after extubation. Given the age-related physiologic changes and multiple comorbidities in elderly patients, the current conventional parameters for predicting extubation outcomes may not be applicable to this population. This study was performed to identify the association between age-related parameters and extubation failure in elderly patients.
Intubated elderly patients (age of ≥60 years) admitted to the medical ICU of a university-based hospital from October 2014 to July 2015 were included. Failed extubation was defined as reintubation within 48 hours after the first extubation. The associations of extubation failure with demographic data, vital signs, cognition and anxiety, and ventilator parameters at the time of intubation and extubation were analyzed.
In total, 127 intubated elderly patients were recruited. Extubation failure occurred in 15 patients (11.8%). Patients with failed extubation had a lower body temperature (37.0°C vs. 37.3°C, P < 0.05) but a higher Facial Anxiety Scale (FAS) score than those with successful extubation (3 vs. 2, P < 0.05). Patients with extubation failure had significantly higher levels of blood urea nitrogen (BUN) (39.88 vs. 58.47 g/dL), serum sodium (137.66 vs. 141.47 mmol/L), and serum calcium (9.52 vs. 10.0 g/dL) but a wider anion gap (12.23 vs. 9.97), but no significant differences in respiratory parameters were found between the two groups. Multiple logistic regression revealed no independent factors associated with successful extubation.
This study revealed no strong predictive factors. However, several physiological parameters (lower body temperature and higher FAS scores) and metabolic parameters (BUN, sodium, calcium, and anion gap) were significantly associated with the rate of extubation failure.
Sarcopenia, a newly recognized geriatric syndrome, is characterized by age-related decline of skeletal muscle plus low muscle strength and/or physical performance. Previous studies have confirmed the ...association of sarcopenia and adverse health outcomes, such as falls, disability, hospital admission, long term care placement, poorer quality of life, and mortality, which denotes the importance of sarcopenia in the health care for older people. Despite the clinical significance of sarcopenia, the operational definition of sarcopenia and standardized intervention programs are still lacking. It is generally agreed by the different working groups for sarcopenia in the world that sarcopenia should be defined through a combined approach of muscle mass and muscle quality, however, selecting appropriate diagnostic cutoff values for all the measurements in Asian populations is challenging. Asia is a rapidly aging region with a huge population, so the impact of sarcopenia to this region is estimated to be huge as well. Asian Working Group for Sarcopenia (AWGS) aimed to promote sarcopenia research in Asia, and we collected the best available evidences of sarcopenia researches from Asian countries to establish the consensus for sarcopenia diagnosis. AWGS has agreed with the previous reports that sarcopenia should be described as low muscle mass plus low muscle strength and/or low physical performance, and we also recommend outcome indicators for further researches, as well as the conditions that sarcopenia should be assessed. In addition to sarcopenia screening for community-dwelling older people, AWGS recommends sarcopenia assessment in certain clinical conditions and healthcare settings to facilitate implementing sarcopenia in clinical practice. Moreover, we also recommend cutoff values for muscle mass measurements (7.0 kg/m(2) for men and 5.4 kg/m(2) for women by using dual X-ray absorptiometry, and 7.0 kg/m(2) for men and 5.7 kg/m(2) for women by using bioimpedance analysis), handgrip strength (<26 kg for men and <18 kg for women), and usual gait speed (<0.8 m/s). However, a number of challenges remained to be solved in the future. Asia is made up of a great number of ethnicities. The majority of currently available studies have been published from eastern Asia, therefore, more studies of sarcopenia in south, southeastern, and western Asia should be promoted. On the other hand, most Asian studies have been conducted in a cross-sectional design and few longitudinal studies have not necessarily collected the commonly used outcome indicators as other reports from Western countries. Nevertheless, the AWGS consensus report is believed to promote more Asian sarcopenia research, and most important of all, to focus on sarcopenia intervention studies and the implementation of sarcopenia in clinical practice to improve health care outcomes of older people in the communities and the healthcare settings in Asia.
PurposeThis study aims to examine the effects of a self-management program (SMP) on self-care behavior, blood pressure and quality of life among older adults with uncontrolled ...hypertension.Design/methodology/approachA quasi-experimental design with repeated measures was conducted in two primary care units in Krabi, Thailand. One hundred and fifty-six older adults with uncontrolled hypertension were selected based on the inclusion criteria and divided into experimental and control groups with 78 participants in each. The experimental group received the SMP, including the intervention related to the self-management process (from the 1st to 4th weeks) and a follow-up phase (from the 5th to 16th weeks). The control group received standard care. The outcomes were measured over time, including self-care behavior (baseline, 4th and 16th weeks), blood pressure (baseline, 4th, 8th, 12th and 16th weeks) and quality of life (baseline and 16th week).FindingsThe generalized estimating equations showed that the SMP, compared with the control group, statistically significantly improved self-care behavior (p < 0.001), decreased blood pressure (p < 0.001) and improved quality of life (p < 0.001) at the 16th week.Originality/valueThe SMP improved the self-care behavior, decreased blood pressure and improved the quality of life among older adults with uncontrolled hypertension. Registered nurses could administer this program for long-term benefits and help reduce the burden on primary care services.
Scientific support for Thai traditional medicine (TTM) practice is warranted for reintroduction into modern healthcare systems. A promising TTM practice for treatment of pressure ulcers was selected ...to conduct a clinical trial. This study aimed to evaluate the efficacy of the TTM practice for the treatment of pressure ulcers using honey or a Thai Herbal Oil preparation (THO) based on the TTM wound diagnosis comparing with the standard practice.
The study design was an open-label randomized controlled trial. Sixty-six participants, with pressure ulcers at least stage II-IV or unstageable, were allocated to two groups via minimization. A TTM practice group received honey or THO depending on the TTM diagnosis via the Thai Traditional Medicine Pressure Ulcer Assessment Tool (TTM-PUAT). A standard practice group received advanced dressings, including hydrogel, alginate, silver-impregnated, or hydrocolloid dressings. The primary outcome was the Pressure Ulcer Scale for Healing (PUSH).
Both TTM practice and standard practice showed a significant reduction in PUSH scores after treatments. However, there was no significant difference in PUSH score reduction between the groups. The mean PUSH score reduction over the 6-week period was 2.58 ± 3.38 (95% CI 1.34–3.82) in the TTM practice group and 3.24 ± 3.49 (95% CI 1.91–4.57) in the standard practice group (p = 0.284). The TTM practice and standard practice accelerated pressure ulcer healing without statistically significant difference between the practices, during 6 weeks in a home-based care setting. This finding supported the TTM practice as an alternative treatment for pressure ulcer.
Aim: (i) To uncover geriatric problems and syndromes in multiple domains, including medical, functional, social and psychological aspects; and (ii) to evaluate the impact of a geriatric assessment ...clinic on practice management from the perspective of the family practitioner.
Methods: 177 patients were approached in a geriatric assessment clinic by a multidisciplinary team of geriatricians, nurses, clinical pharmacists, social workers and clinical psychologists. A cross‐sectional study survey was conducted after the clinic had been established for 18 months to evaluate the impact of the clinic in three areas: knowledge, system and attitude improvement.
Results: In the medical domain, the three most common disorders found were poor vision (81.5%), drug related problems (67.8%) and dental problems (30.5%). Prevention and screening had rarely been afforded patients. Eighty‐seven percent were never given stool occult tests or an influenza vaccination. The three most common geriatric syndromes found were dementia/mild cognitive impairment (MCI) (60.4%), depression (29.9%) and gait problems (30.5%). Each patient had roughly three syndromes. Regarding social domains, we found that 21.7% were caregiver burdens, 24% experienced family conflicts and 16.1% were subjected to elderly abuse. The impact of the geriatric assessment clinic on various satisfaction levels for care benefits as perceived by patients and caregivers was reported as high. Physicians reported high levels of satisfaction with respect to the holistic approach to primary care, although they also reported low levels of satisfaction with perceived knowledge gained from the clinic.
Conclusion: A geriatric assessment clinic has been shown to be effective in discovering geriatric problems in several domains and enhancing the overall primary health‐care system. Geriatr Gerontol Int 2011; 11: 204–210.
Although an increase in the burden of Alzheimer’s disease (AD) is evident worldwide, knowledge of costs and health-related quality of life (HRQOL) associated with AD in low- and middle-income ...countries is still lacking.
This study aimed to collect real-world cost and HRQOL data, and investigate their associations with multiple disease-severity indicators among AD patients in Thailand.
We recruited AD patients aged ≥60 years accompanied by their caregivers at a university-affiliated tertiary hospital. A one-time structured interview was conducted to collect disease-severity indicators, HRQOL, and caregiving information using standardized tools. The hospital’s database was used to retrieve healthcare resource utilization occurred over 6 months preceding the interview date. Costs were annualized and stratified based on cognitive status. Generalized linear models were employed to evaluate determinants of costs and HRQOL.
Among 148 community-dwelling patients, average annual total societal costs of AD care were $8014 (95% confidence interval CI: $7295-$8844) per patient. Total costs of patients with severe stage ($9860; 95% CI: $8785-$11 328) were almost twice as high as those of mild stage ($5524; 95% CI: $4649-$6593). The major cost driver was direct medical costs, particularly those incurred by AD prescriptions. Functional status was the strongest determinant for both total costs and patient’s HRQOL (P value <.001).
Our real-world findings suggest the distinct major cost driver that results from expensive AD treatment, emphasizing the demand of country-specific cost evidence. Increases in cognitive and functional status are significantly associated with decreases in total costs of AD care and improvement in patient’s HRQOL.
•Resulting from growth of the older population, Alzheimer’s disease (AD) imposes an increasing amount of economic burden on society around the world. All existing evidence has suggested that the burden has a major impact on informal caregivers who spend most of the personal time to take care of their patients (indirect costs).•The marked differences in cultural characteristics and, most importantly, high AD pharmaceutical prices make direct medical costs the major cost driver of AD care in Thailand, instead of indirect costs. This emphasizes that the availability of country-specific cost data is crucial, because extrapolating missing country evidence from other similar countries’ findings is prone to inaccuracy. Cost-effectiveness studies are also warranted to facilitate the government’s ability to curtail the costliness of AD medications.•Functional status is found to be the strongest determinant for both total costs of AD care and patient’s health-related quality of life. Together with our marginal estimate findings, strategies for improving functional status should be encouraged, since the better functional status is significantly related to not only reduction in economic burden of AD but also promotion of patient’s health-related quality of life.
Background
The Ginkgo biloba special extract, EGb 761® has been widely used in the treatment of neuropsychiatric disorders, including Alzheimer’s disease (AD).
Methods
To guide clinical practice in ...the Asian region, the Asian Clinical Expert Group on Neurocognitive Disorders compiled evidence‐based consensus recommendations regarding the use of EGb 761® in neurocognitive disorders with/without cerebrovascular disease.
Results
Key randomized trials and robust meta‐analyses have demonstrated significant improvement in cognitive function, neuropsychiatric symptoms, activities of daily living (ADL) and quality of life with EGb 761®versus placebo in patients with mild‐to‐moderate dementia. In those with mild cognitive impairment (MCI), EGb 761® has also demonstrated significant symptomatic improvement versus placebo. World Federation of Societies of Biological Psychiatry guidelines list EGb 761® with the same strength of evidence as acetylcholinesterase inhibitors and N‐methyl‐D‐aspartate (NMDA) antagonists e.g. memantine (Grade 3 recommendation; Level B evidence). Only EGb 761® had Level B evidence in improving cognition, behaviour, and ADL in both AD and vascular dementia patients. Safety analyses show EGb 761® to have a positive risk‐benefit profile. While concerns have been raised regarding a possible increased bleeding risk, several randomized trials and two meta‐analyses have not supported this association.
Conclusions
The Expert Group foresee an important role for EGb 761®, used alone or as an add‐on therapy, in the treatment of MCI and dementias, particularly when patients do not derive benefit from acetylcholinesterase inhibitors or NMDA antagonists. EGb 761® should be used in alignment with local clinical practice guidelines.
Aims
Diabetes is linked to cognitive impairment. Sleep plays a role in memory consolidation. Sleep disturbances, commonly found in patients with diabetes, were shown to be related to cognitive ...dysfunction. This study explored the role of sleep in cognitive function of patients with abnormal glucose tolerance.
Methods
A total of 162 patients (81 type 2 diabetes and 81 prediabetes) participated. Sleep duration and sleep efficiency (an indicator of sleep quality) were obtained using 7-day actigraphy recordings. Obstructive sleep apnea (OSA) was screened using an overnight in-home monitor. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA). Three sub-scores of MoCA, visuoexecutive function, attention and delayed recall, were also analyzed.
Results
Mean age was 54.8 (10.2) years. OSA was diagnosed in 123 participants (76.9%). Mean sleep duration was 6.0 (1.0) h and sleep efficiency was 82.7 (8.1) %. Sleep duration and OSA severity were not related to MoCA scores. Higher sleep efficiency was associated with higher MoCA scores (
p
= 0.003), and having diabetes (vs. prediabetes) was associated with lower MoCA scores (
p
= 0.001). After adjusting covariates, both having diabetes (vs. prediabetes) (
B
= − 1.137,
p
= 0.002) and sleep efficiency (
B
= 0.085,
p
< 0.001) were independently associated with MoCA scores. In addition, diabetes (
B
= − 0.608,
p
< 0.001) and sleep efficiency (
B
= 0.038,
p
< 0.001) were associated with visuoexecutive function. Sleep parameters were not related to delayed recall or attention scores.
Conclusion
Lower sleep efficiency is independently associated with lower cognitive function in patients with abnormal glucose tolerance. Whether sleep optimization may improve cognitive function in these patients should be explored.
Obesity is a worldwide medical condition that leads to physical and psychological impairment. Specific ethnicity, gender and age group are related to different performances of anthropometric indices ...to predict obesity. The objectives of this study were to estimate the performance of the anthropometric indices for detecting obesity based on percentage of body fat (PBF), to study the correlation among those indices, and to determine the optimal cut-off point of the indices among young Thai adults. This is a cross-sectional study of healthy urban subjects in Khon Kaen, Thailand who were aged 20–39 years. Baseline characteristics and anthropometric measures were collected. PBF was determined using bioelectrical impedance analysis. Demographic data and anthropometric variables were analyzed using descriptive statistics. Receiver-operating characteristic (ROC) curves were used to compare the performance of anthropometric measures as predictors of obesity. One-hundred men and 100 women were recruited for this study. Body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR) and waistto-stature ratio (WSR) were significantly correlated to PBF. BMI demonstrated the best performance according to the area under the ROC curves in both sexes at cut-off points of 22.5 in women or 25 kg/m² in men. WC and WSR showed better performance than WHR to detect obesity. In conclusion, anthropometric indices in young Thai adults were correlated well with PBF to predict obesity as shown in prior reports. Different cut-off points of these indices to define obesity in young Thai adults are recommended. The global cut-off points of WSR in women regardless of ethnicity are supported.
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