Showing papers by "Liang Kung Chen published in 2009"

Potentially inappropriate medication for emergency department visits by elderly patients in Taiwan.

Abstract: Purpose The potential for adverse drug events caused by potentially inappropriate medication (PIM) use in elderly patients at emergency department (ED) visits is a growing concern. The objects of this study were to determine the prevalence, characteristics and risk factors of PIM use among elderly ED visits in Taiwan. Methods The nationwide computerized claims database of elderly ED visits under the National Health Insurance (NHI) in Taiwan during 2001–2004 was accessed. PIM, independent of diseases diagnoses or conditions and should be generally be avoided in elderly people, was evaluated using the updated 2003 Beers criteria. Results Between 2001 and 2004, 14.7% of total 1 429 463 elderly ED visits with prescriptions had PIM, and 19.3% of elderly people who visited ED received at least one PIM annually. Odds ratio for PIM prescriptions to ED elderly was higher for visits at which more drugs were prescribed, visits at local community hospital, female and older physicians, patients aged 65–69 years and female patients. Common PIM categories were short acting nifedipine, muscle relaxants and anti-spasmodics, antihistamines and ketorolac. When health care resource utilization was compared in 2004, subjects receiving PIM at ED visit had significantly more mean ambulatory care visits, ED visits and hospital admissions than subjects who did not receive PIM. Conclusions About one fifth of elderly people who visited ED received PIM annually in Taiwan. The public and physicians should be educated, and a computerized drug surveillance system might be needed to avoid PIM prescriptions to the ED elderly patients. Copyright © 2008 John Wiley & Sons, Ltd.

Depression is the Strongest Independent Risk Factor for Poor Social Engagement Among Chinese Elderly Veteran Assisted-living Residents

Abstract: Background: Social engagement prolongs the lifespan and preserves cognition in the elderly. However, most studies concerning social engagement have been conducted in Western countries; few have been performed in the Chinese population. This study attempted to identify the risk factors for poor social engagement among elderly veterans in Taiwan. Methods: A total of 597 male veterans were enrolled, with a mean age of 80.8 ± 5.0 years. This cross-sectional study employed the Resident Assessment Instrument (RAI) Minimum Data Set (MDS), the Geriatric Depression Scale–Short Form (GDS-SF), and the Mini-Mental State Examination (MMSE). Multivariate logistic regression analysis was done to investigate significant independent risk factors for poor social engagement, which were identified using the MDS Index of Social Engagement (ISE). Results: Mean ISE score was 1.5 ± 1.3 (range, 0–5); 52% of subjects had poor levels of social engagement (ISE < 2; 312/597). Regression analyses suggested that depression (OR, 6.6; 95% CI, 2.7–16.1; p < 0.001), illiteracy (OR, 2.2; 95% CI, 1.3–3.8; p = 0.003), the presence of unsettled relationships (OR, 3.6; 95% CI, 1.5–8.7; p = 0.004), and cognitive impairment (OR, 2.0; 95% CI, 1.1–3.9; p = 0.03) were significant independent risk factors for poor social engagement, after controlling for age, marital status, level of daily living activity and degree of sensory impairment. Conclusion: Poor social engagement is common among Chinese assisted-living veteran home residents. Depression is the greatest risk factor of poor social engagement in this population. [J Chin Med Assoc 2009;72(9):478–483]

Urinary incontinence among institutionalized oldest old Chinese men in Taiwan

Abstract: Aims To explore prevalence and related factors for urinary incontinence (UI) among the oldest old institutionalized Chinese men in Taiwan. Methods All residents living in Banciao Veterans Care Home were invited for study. UI was defined as urinary leakage at least once weekly. Additional data items from the Minimum Data Set (MDS Nursing Home Chinese Version 2.1) were used to explore impact associated with physical function, cognitive status and quality of life (social engagement, SocE). Depressive symptoms were screened by the Short Form Geriatric Depression Scale. Results Data from 594 male residents (mean age: 80.9 ± 5.3 years) were analyzed. Among all study subjects, 92.8% were functionally independent, 20.4% had certain cognitive impairment and 8.2% had depressive symptoms. The prevalence of UI in the Banciao Veterans Care Home was 10.1%. Compared with residents without UI, subjects with UI had poorer physical function, cognitive status, and more depressive symptoms. The mean SocE score was 1.5 ± 1.3, and was similar between UI (+) and UI (−) subjects (1.4 ± 1.2 vs. 1.6 ± 1.3, P = 0.411). By multivariate logistic regression, poorer physical functional status, cognitive impairment and depressive symptoms were independent risk factors for UI (P < 0.05). Conclusions Poorer physical function, poorer cognitive status and depressive symptoms were all statistically significant independent risk factors for UI. However, SocE score (proxy indicator of quality of life) did not differ between subjects with and without UI. Further investigations are needed to evaluate the impact of UI on quality of life among oldest old institutionalized Chinese men in Taiwan. Neurourol. Urodynam. 28:335–338, 2009. © 2008 Wiley-Liss, Inc.

Geriatric syndromes in elderly patients with rheumatoid arthritis

Abstract: Objective. Geriatric syndromes (GSs), i.e. cognitive impairment, depression, fall, incontinence and malnutrition, are extensively used to highlight the unique features of common health problems in the frail elderly. Although GS is common in older RA patients, it is rarely reported earlier. We evaluate the prevalence of GS in elderly RA patients and explore the interrelationship between GS and RA. Methods. All enrolled RA patients were categorized into elderly RA (aged 565 years) and younger RA (aged <65 years). A comprehensive geriatric assessment was done to determine the presence of GS. HAQ score and disease activity of RA, including 28-joint disease activity score (DAS28), were assessed. Results. In total, 65 elderly and 25 younger RA patients were enrolled. The prevalence of GS in the elderly participants, especially cognitive impairment and fall, was significantly higher than that in the young. Older RA patients were more physically dependent than the young. Compared with subjects without GS, older RA patients with GS had longer disease duration, higher DAS28 scores, lower haemoglobin levels and more physical dependence. By using binary logistic regression, we found that a higher DAS28 score and a lower haemoglobin level were independent risk factors for GS. Conclusions. The prevalence of GS was higher in the elderly RA patients than that in the young. A higher DAS28 score and a lower haemoglobin level were independent risk factors for GS in older RA patients. Further study is needed to evaluate the prognostic role of GS.

Predicting new onset diabetes mellitus in older Taiwanese: Metabolic syndrome or impaired fasting glucose?

Abstract: Aim: Metabolic syndrome (MS) has been shown to predict diabetes mellitus (DM) in previous studies, but little is known about older adults. The main purpose of this study is to evaluate whether MS predicts new onset diabetes (NOD) in older community-living Taiwanese.Methods: Community-living people aged over 40 who participated in annual health examinations held by community health clinics were invited to enrol in the study in 2000 and the status of DM was determined in 2005.Results: In total, 480 subjects (mean age: 63.7±10.8 years in year 2000, 43.8% males) were enrolled in this study. The prevalence of MS in 2000 was 25.4%. Overall, the 5-year cumulative incidence of NOD was 10.8%, and it was significantly higher in the MS group than non-MS group (17.2% vs. 8.7%, p=0.011). Adjusted for age and gender, MS significantly predicts NOD (OR: 2.20, 95% CI: 1.214.00, p=0.010). Moreover, both impaired fasting glucose (IFG) (OR: 4.48, 95% CI: 2.418.33, p<0.001) and hypertriglyceridemia (OR: 2.03, 95% CI: 1.043.94, p=0.037) significantly predicted NOD among all 5 diagnostic components. In terms of predicting NOD, IFG showed a higher positive predictive value than MS (42.9% vs. 17.2%).Conclusion: Both MS and IFG can effectively predict NOD among community-living older Taiwanese in 5-year follow-up; however, IFG alone may be a more efficient predictor of NOD because of a higher positive predictive value and lower laboratory cost.

Potentially inappropriate urinary catheter indwelling among long-term care facilities residents

Abstract: Purpose To evaluate the prevalence of long-term urinary catheter (UC) indwelling and potentially inappropriate urinary catheterization among residents of long-term care facilities (LTCFs) in Taiwan. Method From January to March of 2007, residents with long-term urethral UC indwelling of LTCFs in northern Taipei were invited for study and were enrolled when the informed consent was obtained. For every subject, UC was removed by home care nurses, and self-voiding (SV) status was determined after a 4-hour observation period. Residual volume (RV) was measured when the UC was re-indwelled. Potentially inappropriate UC indwelling was defined by the concomitant presence of SV and the RV less than 150 mL. Results In total, 252 residents from eight LTCFs were screened and 45 out of 62 residents with long-term UC indwelling were enrolled (mean age = 80.4 +/- 8.9 years, 40% were males, 95.6% were severely disabled). SV was noted in 86.7% (39/45) of study subjects, and 71.8% (28/39) self-voided subjects had their RV less than 150 mL. By definition, the prevalence of potentially inappropriate UC indwelling in this study was 62.2%. The mean RV was significantly lower in subjects with SV (101.3 +/- 66.1 vs. 221.7 +/- 154.1 mL, P = 0.002) and subjects with SV were more prone to have the RV less than 150 mL (P = 0.018). Conclusion The prevalence of long-term UC indwelling among Taiwanese LTCF residents was high and a high proportion of their UC may be removable. A national audit and introducing a practice guideline for continence care in LTCFs may help to promote quality of care for institutionalized older people in Taiwan.