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   Table of Contents - Current issue
October-December 2022
Volume 18 | Issue 4
Page Nos. 155-238

Online since Tuesday, December 27, 2022

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The economic case for integrated care for older people p. 155
Arvind Mathur
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Leptin as a predictor of delirium in geriatric inpatients: An observational study Highly accessed article p. 157
Yamini Ajmera, Avinash Chakrawarty, Masroor Anwar, Maroof Ahmad Khan, Prasun Chatterjee, Sharmistha Dey
Background: Delirium is a complex, reversible neuropsychiatric disorder that frequently occurs in the geriatric age group in acute care settings with multifactorial etiology and numerous knowledge gaps in the pathogenesis. Objective: This study aimed to establish an association between leptin levels and delirium in patients aged 60 years and above admitted under the geriatric medicine department of a tertiary care hospital. Materials and Methods: A prospective observational study was conducted in consecutively admitted patients to the geriatric ward. Patients were assessed for delirium within 24 h of admission and daily thereafter until they were discharged from the hospital or died using the Confusion Assessment Method (CAM) or CAM-intensive care unit with subsequent division into delirium and nondelirium groups. Serum leptin levels were measured using enzyme-linked immunosorbent assay. Results: Two hundred patients were recruited in the study. The mean age of participants was found to be 73.1 ± 8.8 years. Prevalence rates of delirium at the time of admission and incidence rates during hospital stay were found to be 20% and 5%, respectively. The occurrence of delirium was also found to be significantly associated with mortality (32.5% vs. 8.7%, P = 0.001). Serum leptin levels were found to be significantly lower in patients with delirium (2.58 ± 1.01 ng/mL vs. 10.72 ± 1.46 ng/mL, P = 0.03). Multivariable regression analysis revealed delirium to significantly correlate positively with age (Odds Ratio [OR]: 1.63 (1.07–2.47), P = 0.021) and negatively with leptin levels (OR: 0.94 (0.90–0.99), P = 0.018). Conclusion: Delirium is a frequently occurring condition in hospitalized older adults with high mortality rates. Leptin might serve as a potential predictor of delirium owing to its probable role in the pathophysiological processes of delirium.
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Depression in the elderly: Prevalence and associated factors in urban population p. 162
Rupali Verma Bagga, Anamika Prashant
Introduction: Depression in elderly population is a serious public health concern but is often undetected and ignored as a medical problem, leading to poor quality of life. Aim and Objectives: The objectives of this study were to estimate the prevalence and degree of depression among the elderly population using a Geriatric Depression Scale (GDS-15) Short Form and to study some correlates associated with depression in them. Materials and Methods: A community-based cross-sectional study was conducted with a sample size of 100 elderly subjects using systematic random sampling technique. After getting informed consent, information was collected using GDS-15 Marathi version. Results: Of 100 respondents interviewed, 52 were 70 years and above and 54 were male. The prevalence of depression among the elderly was 84.0%. Sixteen (8 males and 8 females) were suffering from severe depression. Age, sex, death of spouse, education, occupation, and morbidity status were found to be significantly associated with depression. Conclusions: The prevalence of depression among the urban elderly was very high. By identifying risk factors for depression among the elderly population and screening them on time, we can go a long way in adding life to their years instead of years to life of the elderly.
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Clinical profile and etiological spectrum of acute symptomatic seizures in the elderly populace p. 168
Archana Verma, Alok Kumar, Divyata Sachan
Aim: The current study aimed to analyze the etiology and the clinical spectrum of acute symptomatic seizures (ASS) and the predictors of in-hospital mortality in the elderly population. Materials and Methods: We evaluated 94 elderly (≥60 years of age) hospitalized patients with ASS for clinical profile, etiologies, and predictors of in-hospital mortality. Results: Mean age of onset of ASS was 67.63 ± 11.48 years. The main seizure type was focal seizure in 62 (59.7%) cases, followed by tonic-clonic seizures in 30 (31.9%) cases. The most common aetiologies in ASS were stroke in 61.7%, followed by infective cause in 30.9% of cases. In-hospital mortality in the ASS in the elderly was 21 (22.3%) in our series, and stroke was the most common cause of mortality. Conclusion: Stroke was the most common etiology of ASS in the elderly and was also related to mortality. It is necessary for us to analyze the causes of ASS in the elderly, to reduce in hospital mortality.
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Patterns and outcomes of empirical antimicrobial use in elderly outpatients: A pilot observational study from North India p. 172
Bisweswar Ojha, Amit Singh, Sankha Shubhra Chakrabarti, Upinder Kaur
Introduction: Despite the rampant use of antimicrobials in health-care settings, the safety and clinical outcome data of antimicrobials are scarce in the elderly population. The main aim of this study is to assess the prescription pattern, therapeutic gains, and adverse reactions resulting out of antimicrobial use in elderly outpatients. Subjects and Methods: This was a prospective observational study conducted for 7 months from June 2019 to December 2019 in elderly patients visiting the geriatric outpatient department of a tertiary hospital of North India. Primary outcomes included clinical improvement as well as the incidence and type of adverse drug reactions (ADRs) observed with antimicrobial use. Results: Of 110 participants recruited, 107 were assessed for clinical outcomes. The common indications of antimicrobial use were lower respiratory tract infection (48.6%), urinary tract infection (18.7%), and worm infestations (14%). Macrolides (57%) and beta-lactams (43%) were the commonly prescribed individual antimicrobials. Outcome-wise, clinical improvement was seen in 91.3%, 88.5%, and 14.3% of patients receiving beta-lactams, macrolides, and antiprotozoals, respectively. ADRs occurred in 17.7% of participants and gastrointestinal disturbance was the commonly reported ADR. Beta-lactams and macrolides were responsible for the majority of ADRs, in 19.6% and 13.1% of participants, respectively. No association of antimicrobial-associated clinical responses or ADRs was observed with demographics and underlying comorbidities. Conclusions: Elderly patients with respiratory tract infections showed improvement with empirical extended-spectrum beta-lactams and azithromycin therapy. The response was suboptimal to empirically selected antiprotozoal therapy. Elderly patients are at increased risk of ADRs. Close to one out of every five elderly prescribed beta-lactams may develop ADR to the antimicrobial agent. Larger clinical studies are required to predict the risk factors of ADRs and poor responsiveness to antimicrobials.
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Caregiving for elderly population: A mixed-method study conducted in the urban population of Tamil Nadu p. 177
K Premanandh, M Rajalakshmi, Reenaa Mohan
Background: Caregiving for elderly individuals is an emerging health issue that affects the quality of life of caregivers. The objective of this study was to explore the difficulties faced by caregivers in providing care to the elderly population. Methodology: This study was conducted using an explanatory mixed-method study design, in which a quantitative component (cross-sectional study) was followed by a qualitative component (in-depth interview). A total of 101 caregivers of the elderly population (with moderate disability level and above) were screened for personal stress using a perceived stress scale. Following quantitative data collection, an in-depth interview was conducted among caregivers selected by purposive sampling using an interview guide to explore the issues faced by caregivers. Results: A total of 384 individuals aged 60 years and above were screened for the level of disability. A total of 101 caregivers who were providing supportive care to elderly people with moderate and severe levels of disability were screened for stress using a perceived stress scale. Around 54% of the caregivers reported high perceived stress and 28% of the caregivers reported moderate stress. In-depth interviews using purposive sampling identified the following themes for caregivers of elderly individuals: frustration about providing continuous care, dealing with personal health problems, feeling anger, and isolation and financial stress. Conclusions: The need for caregiving for the older population is increasing. A significant amount of stress has been reported among caregivers. Frustration about providing continuous care, dealing with personal health problems, and feeling isolation and financial stress were the common challenges reported by the caregivers.
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Ocular morbidities among the geriatric persons, attending the ophthalmology outpatient department of a tertiary care hospital in eastern Odisha: A cross-sectional study p. 181
Smaraki Mohanty, Saumendu Mohanty, Minakshi Mohanty, Tapas Ranjan Behera
Background: According to the census of 2011, 13% of the Indian population was 60 years of age or older. As the geriatric population is the most vulnerable part of society, they are prone to all type of diseases including eye problems which are preventable or correctable but requires constant medical, financial, and social support. This study will find the magnitude of various ocular morbidities and their relationship with sociodemographic factors among geriatrics. Objective: 1. To find the magnitude of ocular morbidities among the elderly. 2. To study the relationship of different sociodemographic factors with ocular morbidities. 3. To estimate the average time spent for getting ophthalmic care at the outpatient department (OPD). Subjects and Methods: It was a hospital-based cross-sectional study conducted in the Ophthalmology OPD of Sriram Chandra Bhanja Medical College and Hospital, Cuttack, Odisha, from January to December 2016. A total of 1320 geriatric persons were enrolled during this period. Ethical clearance was obtained. Results: Out of the 1320 geriatric patients, 58.86% were in the age group of 60–69 years, 35.22% in 70–79 years, and 5.9% ≥80 years with a mean age of 67.7 ± 6.7 years. Males accounted for 70.98% and females for 29.02%. Different ocular morbidities detected are cataract (59.2%), refractive error (18%), ocular injury (5.9%), diabetic retinopathy (3.9%), glaucoma and chronic dacryocystitis (3%), and foreign body in the eye (2%). The total waiting time in the ophthalmology OPD to get ophthalmic care was 7.8 ± 3.2 min. The total consultation time in the OPD was 75.59 ± 27.15 min. Conclusion: The most common cause of visual impairment/blindness in the geriatric age group are cataract and refractive errors which are treated/corrected free of cost at any government health facility under the National Programme for Control of Blindness. People should be aware of the causes, prevention modalities, and treatment of the causes of blindness.
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Quality of life among malnourished elderly population in rural Puducherry, South India p. 186
Aruljothi Sivapushani, Prakash Mathiyalagen, Premnath Dhasaram, Thirunavukarasu Sivadamien
Context: Health of the elderly will be an important issue in defining the health status of a population in coming years. There is a paucity of information with regard to quality of life (QOL) among malnourished elderly. Aims: To assess the QOL among malnourished elderly in a rural field practice areas of tertiary care hospital, Puducherry, and to find the sociodemographic factors associated with QOL among malnourished elderly population. Settings and Design: A community-based cross-sectional study in the rural field areas of Government Medical College of Puducherry. Subjects and Methods: After obtaining ethical approval, the study was conducted among 225 malnourished elderly (>60 years) from April to June 2019 using multistage random sampling technique. Sociodemographic data were obtained using a semistructured questionnaire. Malnutrition was screened using Mini Nutritional Assessment Short Form and QOL was assessed using World Health Organization QOL-BREF questionnaire. Results: The mean and standard deviation of the study participants' age was 69.89 + 6.3 years. 57.8% of them were female, 81.3% were unemployed, and 73.3% were dependent on their old age pension for their livelihood. QOL of malnourished elderly was poor in all the domains when compared to those without malnourished and this is found to be statistically significant. In binomial logistic regression analysis, the presence of comorbidity (adjusted odds ratio [AOR]: 2.4 and 95% confidence interval: 1.3–4.4), unemployed (AOR: 4.8; 1.4–15.9), and living without family (AOR: 0.2; 0.06–0.7) revealed the statistically significant association with low QOL score among malnourished elderly. Conclusions: The mean score of QOL among malnourished elderly was below average in all four domains in which psychosocial domain was badly affected.
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Factors affecting hypertension among rural geriatric population in Odisha: Findings from AHSETS study p. 191
Ramesh Kumar Biswal, B Swagat Kumar Subudhi, Somanath Sethi, Jaya Singh Kshatri, Trilochan Bhoi
Background: Worldwide, around 1.28 billion adults, aged 30–79 years have hypertension (HTN) and most (two-thirds) of them living in low- and middle-income countries like India. While only less than half of adults (42%) with HTN are diagnosed and treated. This study is an effort to estimate the prevalence and determine the determinants of HTN among the rural elderly population in Tigira block, Cuttack district of Odisha. Methodology: This cross-sectional study was carried out among 725 rural elderly (>60 years) people using probability proportionate to sample (PPS) sampling in the year 2019–2020. Previous medical history of HTN diagnosed by medical professional was taken as positive for HTN. Bivariate analysis was performed using the Chi-square test. The binary logistic regression model was used to find out the predictors of HTN. Results: This cross-sectional study found an HTN prevalence of 34.75% (n = 252) among rural older adults. Factors found to be significantly associated with HTN were female gender (adjusted odds ratio [AOR] = 1.73, confidence interval [CI] = 1.129–2.666), elderly aged ≥80 years (AOR = 1.98, CI = 1.170–3.379), not working elderly (AOR = 2.14, CI = 1.178–3.89), lower-middle socioeconomic status (SES) (AOR = 1.61, CI = 1.093–2.372), overweight elderly (AOR = 2.01, CI = 1.309–3.098) and diabetics (AOR = 4.56, CI = 2.704–7.718), respectively. Conclusion: HTN prevalence was found to be high in the rural area, and the factors such as female gender, elderly aged ≥80 years, not working elderly, lower-middle SES, overweight elderly, and diabetes were found to be the determinants of HTN in the rural elderly population of Odisha.
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A comparative study on quality of life of elderly among those living with families and in old age homes in a District in South India p. 196
Nawin Jai Vignesh, Neethu George, S Hemadharshini
Introduction: The elderly population in India is steadily increasing and it is expected to triple in 2050 as of the census 2011. Drastic improvements in health care made betterment in physical health but their subjective well-being remains unaccounted. Therefore, the present study aims to assess the quality of life (QoL) among elderly and to compare the differences in QoL among elderly population residing in homes and in old age homes. Methodology: An analytical cross-sectional study among elderly above the age of 60 years residing with families and other 40 elderly population residing in old age homes. A questionnaire-based interview was conducted using a standard semistructured World Health Organization-BREF QoL questionnaire. Results: In the study, most of the participants 45 (56.3%) were male and 35 (43.8%) belonged to the age group of 70–79 years with a mean (standard deviation) age of 73.96 (7.44) years. The study found that there is nil significant difference in QoL among elderly living in old age homes and in family setups. The domain scores of psychological, social, and environmental domains showed a slight nonsignificant increase in elderly among old age homes. Conclusion: The study showed nil significant difference in QoL score in all domains for the elderly. The concept of QoL needs to be looked into with more preference to psychological, social, and environmental domains.
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Morbidity pattern and health-seeking behavior among the elderly residing in slums of Eastern Odisha: A cross-sectional study p. 201
Asmita Patnaik, Smaraki Mohanty, Srabani Pradhan, Tapas Ranjan Behera
Introduction: Of the total population, elderly people comprised of 8.14% in India where in India or globally. Main challenges faced by the elderly in our country are feminization, ruralisation, migration, and an increasing number of 80-plus adults. This sudden change of environment or being left stranded alone unattended or being dependent on children for their necessities is a major cause of mental illnesses. Objectives: To study the socio-demographic profile, find out the different morbidities and assess the health-seeking behaviour of the study subjects. Materials and Methods: A community-based cross-sectional study was conducted in the field practice area of urban health and training center using the simple random sampling method. Results: The mean age of study subjects was 67.58 ± 6.53 years. Majority of participants, i.e., 308 (73.0%) were young old. 207 (49.1%) were illiterate, 272 (64.5%) unemployed 272 (64.5%) and 224 (53.1%) were living with their children, i.e., 224 (53.1%). Inappropriate health-seeking behavior was significantly associated with under-weight (P < 0.001) which accounted for 2/3rd of participants. Severe depression was observed among 59.5% participants. Females showed a higher proportion of myalgia (5.7%), whereas males showed preponderance of upper respiratory tract diseases (19.2%). The prevalence of inappropriate health-seeking behavior was higher in females (65.1%). The proportion of the elderly with poor health-seeking behavior was found to be 50.4%. Conclusion: Morbidity among the elderly is very high and health-seeking behavior is very poor. Hence, strong efforts are needed to provide them holistic care. Hence, this study was conducted to threw some light on health status of the elderly, their morbidity pattern and health-seeking behavior. It will help the policy-makers to prepare the intervention strategies at the community level.
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Chronic musculoskeletal pain in older people p. 208
Gunja Jain, Sunny Singhal, Laxmi Kant Goyal, Ankita Agarwal, Ajay Mathur
Musculoskeletal pain is a common and debilitating symptom in older adults. However, its importance is often underestimated. In this review article, we discuss its proper evaluation and management. Pain evaluation includes detailed history taking, physical examination, imaging, and laboratory investigations. Management of musculoskeletal pain requires a multidomain approach including nonpharmacological, pharmacological, and surgical modalities. A step-wise approach recommended by the World Health Organization can be used for pain management. Common musculoskeletal conditions causing pain are osteoarthritis, low-back pain, gout, pseudogout, rheumatoid arthritis, polymyalgia rheumatica, and fibromyalgia.
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Geriatric syndromes: A therapeutic challenge p. 213
Vandna Pandey, Nancy Kurien, Remiya Mohan
Aging is a natural phenomenon that is irrevocable. The older adult population is increasing rapidly in India, projected to increase from 6% to nearly 20% in 2050. Clinical conditions found among the elderly that do not fit into discrete disease categories and result from accumulated impairments in multiple systems are called geriatric syndromes. The authors have done a literature search of research papers from indexed and nonindexed journals e databases, Google Scholar, PubMed, and Scopus, Science Direct, Research Gate, and Cochrane. The search terms included were geriatric population, geriatric syndrome, geriatric care, elderly health problem, and comprehensive approach. The management of geriatric syndromes is a challenge to modern geriatric clinical practice. The comprehensive assessment of older adults using standardized tools must be carried out in any healthcare facility to ensure that their needs are met through care and treatment. Evidence-based standards of practice need to be implemented to provide nursing care for dealing with the therapeutic challenges of various geriatric syndromes.
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Need for artificial intelligence in pharmaceutical industry and its limitations p. 217
Varun Pareek, Lokendra Sharma, Sushil Kumar, Vishal Sharma
Artificial intelligence (AI) is often being touted as the means to bring about the fourth industrial revolution and its role in almost all sectors of our society is almost certain. This brings about an urgent need for evaluating the benefits and limitations of AI and machine learning (ML) across various sectors. Pharmaceutical industry has pioneered in embracing the use of AI in all its core areas but the success as of now seems very limited. The major advantage of AI is that it reduces the time that is needed for drug development, and in turn, it reduces the costs that are associated with drug development, enhances the returns on investment, and may even cause a decrease in cost for the end user along with improved drug safety. Hence, in this article, we will review the scope and limitations of AI in the pharmaceutical industry along with the brief review of how AI/ML can impact geriatric health care.
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The aging larynx: An anatomical perspective p. 221
Deepa Devadas, Raghunath Shahaji More, Chetan Sahni, Mayank Gupta, Amit Kumar Nayak, Anand Mishra
There has been a striking increase in the geriatric population worldwide over the last few decades. As the aging process continues to alter functioning of all body systems, the human voice is also significantly affected. The senile voice is characterized by its changes in pitch, hoarseness, tremulousness, and breathiness with reduced harmonics and intensity. Such phonatory changes in the elderly may hinder effective communication, thus bringing down their confidence levels and impairing their quality of life. These characteristic features that distinguish the senile voice from younger speakers are accompanied by age-related changes in the organ of phonation, the larynx. The summative morphological and structural changes occurring in the elderly larynx have been referred to as “Presbylarynx.” The present review article is an attempt by the authors to explore the various anatomical age-related changes occurring in the larynx that may be responsible for altered vocal function in the elderly. An improved understanding of the anatomical basis of the aged voice can give further directions into the management of vocal disorders and improved speech performance in the elderly.
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Falls are preventable: A multicomponent falls preventive approach for elderly p. 227
Monika Kankarwal, Kamli Prakash
Indian aging population is increasing steadily and tremendously imposing a major impact on global implications and challenges in medicine and nursing world. The problem faced by the elderly population is numerous and alarming for the nation, society, health-care system, and family caregivers of the elderly. Falls are estimated to be the second-most leading cause of mortality worldwide among elderly and are considered geriatric giants. Falls are the resultant of complex interaction among various risk factors such as biological, behavioral, socioeconomic, environmental, intergenerational bonding, cultural practices, and ethnicity. These risk factors either alone or in combination cause falls among elderly. Falls are very much preventable among elderly at the primordial and primary prevention levels itself. Timely intervention with multicomponent falls preventive approach for the elderly at the community level has resulted not only decrease in the rate of falls and falls-related injuries among them but also proved to be most effective and relevant in terms of cost-effectiveness, time-consumption, and labor intensiveness for the health-care system, families, society, and community.
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Sepsis-induced autoimmune hemolytic anemia in the elderly p. 233
D Thangam, S Deepa, P Dinesh Kumar, P Santhosh Manikandan
Autoimmune hemolytic anemia (AIHA) secondary to hematological malignancy is well-known and common in the elderly. AIHA associated with infection is less commonly reported in the elderly. We are reporting a case of AIHA in an elderly female with comorbidities, probably secondary to Gram-negative infection. The case was admitted and treated during the peak of the second wave of the COVID pandemic. The treatment of AIHA also had an impact on the progress and outcome of the underlying disease, leading to readmission in a short span of time. The patient also developed a thrombotic complication known to be associated with AIHA.
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Caring for the carers of people living with dementia – Looking after yourself as a carer p. 237
Pallerla Srikanth, Gangadhar Reddy
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