Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; Female ; Frailty ; diagnosis ; physiopathology ; Geriatric Assessment ; methods ; Humans ; Male ; Middle Aged ; Muscle Strength ; physiology ; Physical Functional Performance

Frailty is a distinct clinical syndrome wherein the individual has low reserves and is highly vulnerable to internal and external stressors. Although it is associated with disability and multiple comorbidities, it can also be present in individuals who seem healthy. Frailty is multidimensional and its pathophysiology is complex. Early identification and intervention can potentially decrease or reverse frailty, especially in the early stages. Primary care physicians, community nurses and community social networks have important roles in the identification of pre-frail and frail elderly through the use of simple frailty screening tools and rapid geriatric assessments. Appropriate interventions that can be initiated in a primary care setting include a targeted medical review for reversible medical causes of frailty, medication appropriateness, nutritional advice and exercise prescription. With ongoing training and education, the multidisciplinary engagement and coordination of care of the elderly in the community can help to build resilience and combat frailty in our rapidly ageing society.
Aged ; Aging ; Community Health Services ; Frail Elderly ; Frailty ; Geriatric Assessment ; methods ; Geriatrics ; methods ; Humans ; Nurses ; Nursing ; Primary Health Care ; methods ; Social Support

INTRODUCTION: The Asia-Pacific Clinical Guidelines for the Management of Frailty recommended the use of validated measurement tools for identifying frailty. In an effort to contribute to the development of best practice guidelines in frailty identification and measurement, our scoping review aimed to present a summary of published research on this topic among older adults in Singapore. Our findings are important given the need to consider the context of use and the goals of measurement in using validation tools. MATERIALS AND METHODS: We searched PubMed and CINAHL® for articles describing the identification and measurement of frailty among older adults (≥60 years) in Singapore and mined the bibliographies of eligible articles. An article was eligible if it involved empirical research on frailty using a structured frailty definition. We described such articles and the conceptual definitions they used, and summarized their operationalization of frailty. RESULTS: Our search yielded 165 records. After 2-stage screening of titles/abstracts and full-text articles, we retained 32 eligible articles for data extraction and thematic analysis. The extant literature in Singapore includes observational cross-sectional and longitudinal studies and intervention studies across community and tertiary care settings. Eligible articles commonly used the frailty phenotype and the deficit accumulation models in defining frailty, and reported measuring components of physical, cognitive, and/or social frailty. CONCLUSION Our scoping review provided a broad evidence synthesis of the underpinnings of research on frailty identification and measurement in Singapore. Consistently applying standard methods and approaches in frailty identification and measurement can support evidence-based practice and policies in Singapore.
Aged ; Evidence-Based Practice ; methods ; standards ; Frail Elderly ; Frailty ; diagnosis ; Geriatric Assessment ; methods ; Humans ; Singapore

Objective: To explore the relationship between frailty syndrome and falls in the elderly diabetics, in the communities. Methods: A three-year cohort study involving 653 community-dwelling adults who were over 65 years of age and participated in the Survey of Disease, Psychological and Social Needs in Dujiangyan Pingyi Community. Diabetic patients would include those who self-reported as having histories of diabetes or on anti-hyperglycemic therapies. Frailty, functional and other geriatric status were assessed respectively. Falls was defined as having had multiple falls or at least one event but with injury. Results: The highest prevalence of falls was found in the group of frail diabetic group (62.5%). Data showed that baseline frailty was associated with falls in both diabetic and non-diabetic groups but the odds ratio in the diabetic group was higher than that of the non-diabetic group (OR=3.87, 95%CI: 1.45-10.28 vs. OR=6.68, 95%CI: 1.14-38.99). Conclusion: Frailty could be used as a strong clinical predictor to prevent falls, for the elderly diabetic Chinese living in the communities.
Accidental Falls/statistics & numerical data* ; Aged ; Cohort Studies ; Frail Elderly/statistics & numerical data* ; Frailty/epidemiology* ; Geriatric Assessment/methods* ; Humans ; Independent Living ; Odds Ratio ; Prevalence ; Prospective Studies ; Risk Assessment/methods* ; Surveys and Questionnaires ; Syndrome

BACKGROUNDElderly multiple myeloma (MM) patients often tend to suffer a variety of diseases, so the treatment of choice is very difficult for the elderly myeloma patients. The overall survival (OS) time and side effects with elderly patients are unclear in China. The study tried to find out the role of geriatric assessment in the Chinese elderly MM.

METHODSWe retrospectively analyzed the data of 628 newly diagnosed patients from six hospitals from June 2011 to June 2013. A geriatric assessment had been performed to assess comorbidities, cognitive, and physical status for these patients. The primary endpoint was to evaluate different physical states of elderly patients with OS time and treatment-related side effects.

RESULTSAn additive scoring system (range: 0-5), based on age, Katz's Activity of Daily Living (ADL) and Lawton's Instrumental Activity of Daily Living (IADL) ≤5 and Charlson Comorbidity Index (CCI) was developed to identify three groups: fit (score = 0); intermediate-fitness (score = 1); and frail (score ≥2). The 3-year OS was 63% in fit patients, 63% in intermediate-fitness patients, and 49% in frail patients ≥3 hematologic adverse events (AEs) were documented in 45 (35.4%) fit, 34 (34%) intermediate-fitness, and 121 (30.2%) frail patients. The risk of a grade ≥3 hematologic AEs was not significantly increase in intermediate-fitness (hazard ratios [HR]: 0.99, 95% confidence interval [CI]: 0.54-1.47, P = 1.000) and in frail patients (HR: 1.16, 95% CI: 0.70-1.93, P = 0.558) compared with fit ones.

CONCLUSIONSMM occurs earlier in life and being advanced when the diagnosis is made in the mainland of China. The overall survival in frailty with International Staging System (ISS) II/III was the worst in all patients.

Activities of Daily Living ; Aged ; China ; Cognition ; physiology ; Female ; Geriatric Assessment ; methods ; Humans ; Kaplan-Meier Estimate ; Male ; Multiple Myeloma ; mortality ; physiopathology ; psychology ; Retrospective Studies

OBJECTIVETo review and analyze the risk factors of postoperative surgical site infection (SSI) in geriatric patients who undergo surgical treatment of oral squamous cell carcinoma.

METHODSA retrospective study was conducted on 143 geriatric patients who have undergone surgical treatment of oral squamous cell carcinoma. Factors were classified into four types, namely, characteristics, tumor factors, general comorbidity factors, and perioperative factors. The primary outcome variable was the presence of SSI. A logistic stepwise regression model was used for the subsequent multivariate analysis, wherein only significant risk factors in the univariate analysis were included.

RESULTSAmong 143 cases, 33 showed postoperative SSI. Results of univariate analysis indicated that risk factors included age, body mass index (BMI), tumor location, tumor size, diabetes, chronic obstructive pulmonary disease, American Society of Anesthesiologists (ASA) score, Charlson comorbidity index (CCI), adult comorbidity evaluation-27 (ACE-27) score, previous radiotherapy, reconstructive method, operation time, and blood transfusion. Among these factors, six parameters were identified to have a significant factor association with the development of SSI, namely BMI, diabetes, ASA score, ACE-27 score, operation time, and reconstructive method.

CONCLUSIONSpecial attention should be given to factors associated with the development of SSI before operation of geriatric patients with oral squamous cell carcinoma.

Adult ; Aged ; Aged, 80 and over ; Body Mass Index ; Carcinoma, Squamous Cell ; surgery ; Female ; Geriatric Assessment ; Humans ; Logistic Models ; Male ; Mouth Neoplasms ; surgery ; Multivariate Analysis ; Operative Time ; Postoperative Complications ; Postoperative Period ; Reconstructive Surgical Procedures ; methods ; Retrospective Studies ; Risk Factors ; Surgical Wound Infection ; etiology

The geriatric population is increasing, and asthma severity increases with age. We determined the predictors of asthma control, exacerbation, and the factors that affect asthma-specific quality of life (A-QOL) in elderly asthmatic patients. This was a prospective, multicenter, real-life study for 6 months with stepwise pharmacologic treatment based on the Global Initiative for Asthma (GINA) guideline. A total of 296 asthmatic patients aged > or = 60 yr were recruited from 5 university centers in Korea. The improved-asthma control group was defined as the group of patients who maintained well-controlled or improved disease and the not-improved asthma control group was defined as the remaining patients. Fewer number of medications for comorbidities (2.8 +/- 3.3 in the improved vs. 4.5 +/- 4.4 in the control) and higher physical functioning (PF) scale (89.8 +/- 14.2 in the improved vs. 82.0 +/- 16.4 in the control) were significant predictors in the improved-asthma control group (OR = 0.863, P = 0.004 and OR = 1.028, P = 0.018, respectively). An asthma control test (ACT) score of < or = 19 at baseline was a significant predictor of asthma exacerbation (OR = 3.938, P = 0.048). Asthma duration (F = 5.656, P = 0.018), ACT score (F = 12.237, P = 0.001) at baseline, and the presence of asthma exacerbation (F = 5.565, P = 0.019) were significant determinants of changes in A-QOL. The number of medications for comorbidities and performance status determined by the PF scale may be important parameters for assessing asthma control in elderly asthmatic patients.
Aged ; Aged, 80 and over ; Anti-Asthmatic Agents/*administration & dosage ; Asthma/*diagnosis/epidemiology/*therapy ; Critical Pathways/statistics & numerical data ; Dose-Response Relationship, Drug ; Female ; Geriatric Assessment/*methods/statistics & numerical data ; Humans ; Male ; Middle Aged ; Outcome Assessment (Health Care)/*methods ; *Quality of Life ; Reproducibility of Results ; Republic of Korea/epidemiology ; Sensitivity and Specificity ; Treatment Outcome

PURPOSE: This study was done to develop and test the validity and reliability of the Korean version of the Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC-K) in assessing pain of elders with dementia living in long-term care facilities. METHODS: The PACSLAC-K was developed through forward-backward translation techniques. Survey data were collected from 307 elders with dementia living in 5 long-term care facilities in Korea. Data were analyzed using descriptive statistics, Pearson correlation, Spearman's rho, paired t-test, ROC (receiver operation characteristic) curve with the SPSS/WIN (20.0) program. RESULTS: The PACSLAC-K showed high internal consistency (.90), inter-rater reliability (.86), intra-rater reliability (.93), and high concurrent validity (.74) in paired t-test with PAINAD. Discriminant validity also showed a significant difference compared with no pain. The PACSLAC-K showed a sensitivity of .93, specificity of .88, and Area Under the Curve of .95 in the ROC curve. CONCLUSION: The findings of this study demonstrate that PACSLAC-K is useful in assessing pain for elders with dementia living in long-term care facilities.
Aged ; Aged, 80 and over ; Area Under Curve ; Checklist ; Dementia/*physiopathology ; Female ; Geriatric Assessment/*methods ; Humans ; Long-Term Care/*methods ; Male ; *Pain Measurement ; Questionnaires ; ROC Curve ; Republic of Korea

INTRODUCTIONFalls are common among older people. Previous studies have shown that falls were multifactorial. However, data regarding community-dwelling Chinese population are minimal. We aimed to study factors associated with falls among community-dwelling older Chinese people.

MATERIALS AND METHODSWe conducted a cross-sectional study in a community hospital in Taiwan in 2010. Our sample included 671 elders from the 3680 examinees of the free annual Senior Citizens Health Examination. Participants were interviewed with a detailed questionnaire, and 317 elders were further invited for serum vitamin D tests. The main outcome was falls in the previous 12 months. Predictor variables included sociodemographic characteristics, lifestyle risk factors, body stature, frailty, serum 25 (OH) D levels, and medications.

RESULTSThe mean age of the 671 participants was 75.7 ± 6.4 years old, and 48.7% of which were female. Fallers comprised 21.0% of the study population. In multivariate models, female gender (adjusted odds ratio (aOR): 2.32), loss of height in adulthood (aOR: 1.52), low body weight (aOR: 2.69), central obesity (aOR: 1.67), frailty (aOR: 1.56), polypharmacy (aOR: 2.18) and hyperglycaemia (aOR: 1.56) were factors associated with falls. Vitamin D insufficiency (serum 25 (OH) D levels <30 ng/mL) was not associated with falls (OR: 0.78; 95% CI, 0.38 to 1.60) (n = 317) in this study.

CONCLUSIONAmong community-dwelling older people in Taiwan, falls were mainly associated with female gender, polypharmacy, frailty, reduced body height, low body weight or central obesity, and hyperglycaemia. In addition to other risk factors, body stature should be considered as a novel risk factor when screening elders at risk for falls.

Accidental Falls ; prevention & control ; statistics & numerical data ; Aged ; Aged, 80 and over ; Body Constitution ; Cross-Sectional Studies ; Demography ; Female ; Geriatric Assessment ; methods ; Humans ; Hyperglycemia ; epidemiology ; Independent Living ; statistics & numerical data ; Male ; Middle Aged ; Odds Ratio ; Polypharmacy ; Risk Assessment ; methods ; statistics & numerical data ; Risk Factors ; Sex Factors ; Socioeconomic Factors ; Taiwan ; epidemiology

INTRODUCTIONThe Short Portable Mental Status Questionnaire (SPMSQ) is a brief cognitive screening instrument, which is easy to use by a healthcare worker with little training. However, the validity of this instrument has not been established in Singapore. Thus, the primary aim of this study was to determine the diagnostic performance of SPMSQ for screening dementia among patients attending outpatient cognitive assessment clinics and to assess whether the appropriate cut-off score varies by patient's age and education. A secondary aim of the study was to map the SPMSQ scores with Mini-Mental State Examination (MMSE) scores.

MATERIALS AND METHODSSPMSQ and MMSE were administered by a trained interviewer to 127 patients visiting outpatient cognitive assessment clinics at the Singapore General Hospital, Changi General Hospital and Tan Tock Seng Hospital. The geriatricians at these clinics then diagnosed these patients with dementia or no dementia (reference standard). Sensitivity and specificity of SPMSQ with different cut-off points (number of errors) were calculated and compared to the reference standard using the Receiver Operator Characteristic (ROC) analysis. Correlation coefficient was also calculated between MMSE and SPMSQ scores.

RESULTSBased on the ROC analysis and a balance of sensitivity and specificity, the appropriate cut-off for SPMSQ was found to be 5 or more errors (sensitivity 78%, specificity 75%). The cut-off varied by education, but not by patient's age. There was a high correlation between SPMSQ and MMSE scores (r = 0.814, P <0.0001).

CONCLUSIONDespite the advantage of being a brief screening instrument for dementia, the use of SPMSQ is limited by its low sensitivity and specificity, especially among patients with less than 6 years of education.

Age Factors ; Aged ; Aged, 80 and over ; Ambulatory Care Facilities ; statistics & numerical data ; Comparative Effectiveness Research ; Dementia ; diagnosis ; epidemiology ; psychology ; Educational Status ; Female ; Geriatric Assessment ; methods ; statistics & numerical data ; Humans ; Intelligence Tests ; standards ; statistics & numerical data ; Male ; Mass Screening ; methods ; standards ; Mental Competency ; Middle Aged ; ROC Curve ; Reference Standards ; Reproducibility of Results ; Singapore ; epidemiology