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   Table of Contents - Current issue
October-December 2020
Volume 16 | Issue 4
Page Nos. 137-179

Online since Wednesday, February 24, 2021

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Common clinical issues in older adults p. 137
Arvind Mathur
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The clinical and coronary angiographic profile of 601 older adult patients with acute coronary syndrome treated at a tertiary hospital in North India and complications of percutaneous coronary intervention with the 30-day mortality p. 139
Umar H Khan, Murtaza R Pala, Imran Hafeez, Afshan Shabir, Aamir Rashid, Nisar Tramboo, Hilal Rather
Aims: The aim is to identify clinical and coronary angiographic (CAG) profile of older adult patients with the acute coronary syndrome (ACS), assess complications of percutaneous coronary intervention (PCI) and the 30-day mortality. Materials and Methods: This was a prospective observational study of 601 older adult patients with ACS who underwent CAG over 2 years (2017–2019). The study population was divided into two groups: the young, old group (60–70-year-old), and the old group (>70-year-old). Results: Mean age of presentation was 77 ± 17 years. The majority were males 486 (80.9%). Presenting symptoms was chest pain (94.8%), followed by diaphoresis (33%) and dyspnea (27.4%). ST-elevation myocardial infarction (STEMI) was seen in 377 (62.7%) of the study population, followed by non-STEMI 176 (29.2%) and unstable angina (UA) in 48 (7.9%) patients. Hypertension was the most prevalent risk factor (78%) in the study population. The left anterior descending artery (LAD) was most commonly involved vessel in 415 patients (69.1%) followed by right coronary artery 322 (53.6%) and left circumflex artery 240 (39.9%). Contrast nephropathy (contrast-induced nephropathy [CIN]) occurred in 3.3%, and intra cerebral hemorrhage (ICH) was seen in one patient only. The 30-day mortality was 2.7% in 60–70 years and 14.1% in >70 years. Conclusion: Older patients with ACS differ from their younger counterparts in their clinical presentation, comorbidities, and outcome. Elderly patients can present with atypical symptoms. The 30-day mortality was higher in patients presenting with atypical symptoms, which was statistically significant in multivariate analysis. Like their younger counterparts, most older ACS patients had single-vessel disease, and the most common vessel involved was the LAD. Overall mortality was 5.3%. Even though elderly patients have a high coronary risk because of associated comorbidities, this study proves that PCI's CAG (if indicated) resulted in fewer CIN and ICH complications in older patients with ACS.
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Prevalence and disparity of malnutrition among elderly: A cross-sectional study p. 145
Md Taj Uddin, Momduha Akter, Md Shah Noor, Md Kamal Hussain, Iqbal Ahmed Chowdhury
Objective: This study attempts to assess the prevalence and disparity of the nutritional status of the elderly with their socioeconomic characteristics. Materials and Methods: A total of four hundred elderly in Sunamgonj district of Bangladesh have been interviewed through a structured questionnaire from July to September 2019. Descriptive statistical tools and mini nutrition assessment short Form, t-test, and F-test have been applied for data analysis. Results: The analysis reveals that 40% of elderly suffer from malnutrition, 59% are at risk of malnutrition, and 1% are normal nutrition. The findings show that the nutrition status of elderly is significantly varied with their occupation, place of residence, marital status, religion, age, family type, living arrangement, take care, and sleeping disorder. It is observed that more proportion of the elderly is at risk of malnutrition. Conclusion: Therefore, measures should be taken to improve the nutrition status of the elderly.
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Study on the role of inflammation in healthy aging and nutritional status in older persons p. 151
B Krishnaswamy, S Deepa, D Thangam
Objective: The objective of this study is to assess the levels of inflammatory cytokines such as highly sensitive C-reactive protein (hsCRP) and interleukin (IL)-6 in healthy older persons compared to healthy younger persons. To determine the association between the nutritional status and levels of inflammatory markers in older persons. Methods: This is a single center, cross-sectional, analytical study, conducted in the Geriatric Unit of Rajiv Gandhi Government General Hospital, Madras Medical College, Chennai, India, during the period, February 2013–November 2013. Ninety healthy older persons aged 60 years and above and 90 healthy young adults aged 40 years and below were randomly selected to participate in this study. Blood samples were collected from the participants to analyze the hsCRP and IL-6 levels. Mini nutritional assessment was done in older participants to find out the nutritional status. Results: The older participants' mean age was 66.83 ± 6.1, and the mean age of the younger participants was 29.31 ± 7.4. The mean ± standard deviation of hsCRP level in healthy younger participants was 5.69 ± 3.21 and in healthy older participants was 6.05 ± 3.49. There was no significant difference in the level of inflammatory marker hsCRP between healthy younger and older participants (P = 0.476). The mean rank value of IL-6 in healthy younger participants was 84.45 and in healthy older participants was 96.55. There was no statistically significant difference in the levels of inflammatory marker IL-6 between healthy younger and older participants (P = 0.092). In this study, there was no statistically significant association between nutritional status and hsCRP (P = 0.156) and IL-6 (P = 0.286) levels in older people. Conclusion: The hsCRP and IL-6 levels were not significantly elevated in healthy older people than healthy younger adults in this study. There was no significant association between nutritional status and hsCRP and IL-6 levels in the older people in this study.
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Pattern of drug utilization at community geriatric outpatient department attached to a tertiary hospital p. 156
Amit S Bhondve, US Saurabha
Context: Material management is a process of management; one of its essential functions is inventory control. The various inventory management types are ABC, VED, FSN, SDE, HML, XYZ, and SOS. Proper inventory control is required for the sound management of a health-care facility. Methodology: A cross-sectional descriptive study based on secondary data, conducted in the geriatric outpatient department, a peripheral health training center of a tertiary care medical college. The indent record of the pharmacy for the year 2018 was procured. The data thus obtained were tabulated and analyzed in Microsoft Excel. ABC, SDE, FSN, and XYZ analyses were carried out. Results: ABC analysis category A accounted for 67.5%, category B 20.1%, and category C 12.4% of the annual expenditure. VED analysis showed that 50% of the drugs were vital for the center's functioning; this accounts for 49.2% of the yearly expenditure. FSN, SDE, and XYZ analyses of the drug showed the more than half of the drugs. 55.7% of the drugs are fast moving; 50.8% of the drugs are easily available on indenting for them, and 63.7% of the drugs belong to X category as per XYZ analysis. Conclusion: A combined usage of the various inventory management methods, specific to the type of health-care delivery center, will help in the smooth functioning of the center.
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Impact of socioeconomic status on morbidities, disabilities, activity limitation, and participation restriction in the geriatric population living in urban area: A comparative study p. 160
Vivek Aggarwal, VK Sashindran, Puja Dudeja, V Vasdev, Anuj Singhal
Introduction: Socioeconomic inequalities have been considered as an important factor for disparity in the prevalence of disabilities among geriatric population belonging to different socioeconomic strata with significantly increased of disability in elderly population belonging to lower socioeconomic status. The impact of socioeconomic status on the morbidity and disability profile of elderly in India is very scarce. This study would help in planning geriatric health care services for different communities depending upon their socioeconomic status. Aim: The aim of this study was to compare the morbidity profile, disability profile, and perceived health care needs in Indian elderly population belonging to two different socioeconomic strata residing in city of western India. Methodology: This was a cross sectional qualitative comparative study done in Aug 2016 to Dec 2016. In this study two geriatric cohorts one belonging to high income group staying in a gated community and other belonging to low income group staying in a urban slum were compared. House to house survey was done based on prevalidated WHO DAS scale predesigned questionnaire to assess the activity limitation and participation restriction of the elderly population in city dwellers in Western India. After initial sensitisation workshops to sensitise and train the medical students, paramedics and the social workers, the house to house survey was on holidays. Results: Total 406 elderly patients were interviewed in HIG and 409 were interviewed in LIG. Females outnumbered the males in both the cohorts with 53.7% in HIG and 63.8% in LIG. It was noted that 14.5% of the elderly were staying alone in HIG where as against 10.2% in LIG. It was also noted that 14.5% of elderly in HIG required help of outside caregiver from doing the activities of daily living (ADLs) where as 28.9% in LIG required outside help to do ADLs. It was noted that there was a significant difference in the activity limitation score in both the cohorts with 64% of elderly in HIG having a good score (0-18) as against 13.9 % in LIG. in participation restriction score with 77% of elderly belonging to HIG having a good participation score as against 40.6% in the elderly belonging to LIG. Conclusion: The morbidity profile, disability profile, and perceived health care needs in Indian elderly population belonging to two different socioeconomic strata residing in city of western India are different. Public health care penetration was poor in the elderly living in LIG as most of them visited the doctor only during emergencies and that too majority of them had access to alternative medicine system. Dedicated geriatric services along with provision of medicines, ambulance and geriatric helpline was the most felt needs in the society.
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A cross-sectional study to assess prevalence of polypharmacy and potentially inappropriate medicines in geriatric population of western Maharashtra p. 165
Vivek Aggarwal, VK Sashindran, Ankit K Rai, V Vasdev
Introduction: With advancing age, polypharmacy is increasing due to multiple diseases, multiple doctors and symptoms specific over the counter self medication. This leads to adverse drug reactions and increase in potentially in appropriate medicines (PIMs). This study was undertaken to assess the prevalence of poly -pharmacy in elderly. The secondary objectives were to look for an association between common geriatric symptoms and polypharmacy and estimate prevalence of PIMs. Methodology: Analytical observational cross-sectional study conducted in a tertiary care hospital in Western Maharashtra over a period of 6 months between Aug 2016 to Dec 2016. PIMs were estimated base on BEERS criteria. Results: A total of 168 participants were interviewed. They were selected sequentially from a polyclinic with high geriatric load. Among the participants, there were 120 (71.43%) males and 48 (28.57%) females. The mean age was 70.25 years ± 6.25 years (range 51 to 90 years). Most (77.98%) of the elderly suffered from 2 or more diseases. The average number of drugs taken was 6.85 ± 3.42. Numerical polypharmacy (> 5 drugs) was present in 124 (73.81 %) elderly, with micro-polypharmacy (> 5 drugs) in 83 (49.40 %) and macro-polypharmacy (> 10 rugs) in 41 (24.41 %). According to Beers' criteria, 87 (37.8 %) participants had been prescribed at least one PIM Conclusion: Polypharmacy is widely prevalent in the geriatric age group and has a significant association with PIMs. It is important to evaluate the patient comprehensively and deprescribe unnecessary medicines to reduce PIMs, adverse drug reactions and drug drug interactions.
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Caregiver burden and its correlates among people with Alzheimer's dementia: An exploratory study from Nepal p. 169
Ramesh Kandel, Pawan Sharma, Swarndeep Singh
Background: Alzheimer's dementia has a spectrum of health and socioeconomic implications for patients and caregivers. The study is intended to assess the burden of caregivers and explore some of the possible influencing factors. Materials and Methods: A cross-sectional design and purposive sampling were conducted with the semi-structured questionnaire to the caregivers of patients with Alzheimer dementia attending the dementia clinic between January 2019 and June 2019. Results: About 94.2% of the caregivers included in the present study reported a Zarit burden score of 17 and above, indicative of high caregiver burden. There was no significant correlation between the age of patient and caregiver burden (r = −0.18, P = 0.8). In bivariate analysis, the number of comorbid medical illnesses (ρ = 0.37, P < 0.01), number of medication doses taken per day (ρ = 0.42, P < 0.01), Katz activities of daily living (ADL) score (ρ = −0.56, P < 0.01), and additional care burden calculated by counting the number of other care services such as diaper care and bedsore care provided to the patient daily (ρ = 0.48, P < 0.01) were significantly correlated with caregiver burden. In multiple linear regression analysis, the Katz ADL score of patients with dementia (β = −0.38, P = 0.002) was the single most significant correlate of Zarit burden score, representing caregiver burden. Conclusion: There is a high level of burden among caregivers for people with dementia in the Nepalese population. The single most important independent factor affecting caregiver burden was Katz ADL score. This study's outcomes support the idea of the development of long-term care systems for families with high caregiver burden.
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Care of older people in the present era in India p. 174
Jag Mohan Mathur
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Health workforce development for geriatric services in India p. 176
Abhijith Rajaram Rao, Arvind Mathur, AB Dey
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