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   Table of Contents - Current issue
Coverpage
April-June 2022
Volume 18 | Issue 2
Page Nos. 41-93

Online since Friday, July 15, 2022

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EDITORIAL  

Ready, Set, and Go! p. 41
Venugopalan Gunasekaran, Arvind Mathur
DOI:10.4103/0974-3405.351074  
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ORIGINAL ARTICLES Top

The outcome of head up tilt test in older adults with typical versus atypical features of syncope p. 43
Rakesh Mishra, Prasad Mathews, KG Gopinath
DOI:10.4103/jiag.jiag_22_22  
Background: Syncope is usually a benign condition preventable by simple measures. Its diagnosis by history and inexpensive tests like head-up tilt table (HUTT) test save the patient unnecessary expenditure and stress. Objectives: To determine the outcome of head-up tilt test in older adult patients aged 60 years and more who present with typical versus atypical history of syncope, along with a study of the prodromal symptoms, association with comorbid burden, medications, grip strength, and cognitive function. Materials and Methods: An observational study of the patients presenting to the department of geriatrics with a history of neurocardiogenic syncope from May 2017 to October 2017 undergoing HUTT test looked at the association of the type of syncope based on the history and outcome of their HUTT test and association with prodromal symptoms, comorbidities, medications, triggering factors, electrocardiography, and Holter. Conclusions: The HUTT positivity rate for patients with a history of syncope was 31.8% with no association between typical or atypical syncope and HUTT positivity. Dizziness, lightheadedness, blurred vision, and sweating were significantly associated with typical syncope. No comorbidity or medication had an association with syncope or HUTT response but the comorbid burden had a significant association with positive HUTT response.
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Safety and efficacy of ayush rasayana A and B in improving functionality of the elderly – A single-arm multicenter study p. 49
Aparajit B Dey, Inderjeet Singh Gambhir, Jayram Hazra, Sakshi Sharma, Pallavi S Mundada, Sunita Mata, Avinash Chakrawarty, Om P Singh, Achintya Mitra, Rakesh K Rana, Richa Singhal, SK Vedi, Ramavtar Sharma, Adarsh Kumar, Bharti Gupta, Madan M Padhi, Narayanam Srikanth, Kartar Singh Dhiman
DOI:10.4103/jiag.jiag_5_22  
Background: As per Ayurvedic classics, Rasāyana is a term used for unique therapeutic measures intended to improve cognition, memory, physical strength and delay the degenerative processes. Ayush Rasayana A & B are developed from extracts of herbs pertaining rasayana property. Aims & Objectives: To assess the safety and effectiveness of 'Ayush Rasayana A and B' in improving physical endurance, quality of life and cognition of elderly. Materials and Methods: This is an open label, single arm, multi-centre study among 256 apparently healthy elderly between 60-75 years. Ayush Rasayan A was given for 6 days and Ayush Rayana B for 180 days. The effect of the trial drug was seen on functional capacity, quality of life and cognitive function and, safety of the intervention was assessed through haematological and biochemical tests, clinical examination and incidence of adverse events. Results: Significant improvement in 6 minute walk test and HMSE score was observed at 187th as compared to baseline (p<0.0001). Quality of life of the participants especially in domains of physical health, social relationship and environment also improved at the end of intervention period (p<0.0001). The haematological and bio-chemical parameters showed no significant changes as compared to baseline and no adverse events were observed during the study. Conclusion: Ayush Rasayana A and Ayush Rasayana B, both were well tolerated by all the participants. This ayurvedic intervention can be safely given to apparently healthy elderly to improve their functionality, quality of life and cognition. However, a randomized controlled trial is warranted to substantiate the efficacy of this drug. Trial Registration: CTRI/2015/04/005679 dated 8th April 2015.
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Factors contributing to falls and the effect of a multipronged approach on the incidence of falls in the older person in an outpatient setting in South India p. 58
Jini Chirackel Thomas, Surekha Viggeswarpu
DOI:10.4103/jiag.jiag_13_22  
Background: A fall is an important predictor of morbidity and mortality in an older adult. Objectives: The aim of this study was to enumerate the various factors contributing to falls and assess the effect of a multipronged approach on the incidence of falls in older individuals who are at a risk of falls. Methodology: In this prospective interventional trial, we recruited sixty subjects, who presented to the Geriatrics Outpatient department of a tertiary care hospital in South India. Using the Stop elderly accidents, deaths, and injuries protocol, we included subjects who presented with a history of fall in the year preceding the study, those with fear of fall and those who felt unsteady while standing or walking. These subjects were subjected to a detailed assessment and an individualized multipronged interventional program was initiated. The subjects were followed up telephonically after 1 and 3 months to assess compliance and the details of incident fall (if any). Results: At baseline, 48.3% had fallen in the year prior to enrolment, of whom 16.7% were recurrent fallers. Various contributory factors for falls were identified - including older age, polypharmacy, sedatives, and anticholinergic drugs. Following a multipronged intervention, 3.6% and 5.3% of the subjects reported falls after 1 and 3 months, respectively. Subjective improvement was reported by 80% and 78.2% of the subjects at 1 and 3 months' follow-up and the compliance with exercises during the follow-up period was good (73%). Conclusion: Identifying the subjects at risk for falls and implementing a tailored approach contributed to a reduction in the incidence of falls.
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Spectrum of cardiovascular diseases with increasing age and its association with geriatric syndromes p. 68
Pramod Kumar, Bhrigu Jain, Nidhi Soni, SN Dwivedi, Aparajit Ballav Dey, Prashun Chatterjee, Avinash Chakrawarty
DOI:10.4103/jiag.jiag_11_22  
Objective: The burden of cardiovascular diseases (CVDs) is highest among the older adults, who are often carriers of various geriatric syndromes. Studies evaluating CVDs among the old adults in the low- and middle-income countries are limited. This study was conducted to assess the frequency of CVDs and their risk factors among the older population and their association with geriatric syndromes. Subjects and Methods: In this cross-sectional study, 200 health-care seeking adults aged ≥75 years were subjected to routine comprehensive geriatric assessment (assessment for functionality, cognition, depression, frailty, and various geriatric syndromes) and a detailed cardiovascular evaluation using electrocardiography, chest X-ray, echocardiogram, HbA1c level, fasting lipid profile, thyroid function test, serum homocysteine level, and serum NT-pro-BNP. Results: The overall frequency of CVDs in this study was 76%. Polypharmacy, multi-morbidity, cognitive impairment, depression, frailty, and impairment of basic and instrumental activities of daily living were present in 50.5%, 91.5%, 6.5%, 10%, 30.5%, 24.5%, and 55% individuals, respectively. CVDs were significantly associated with increased risk of geriatric syndromes (multi-morbidity [odds ratio (OR) 3.61, confidence interval (CI) 1.13 – 11.54, P = 0.030], polypharmacy [OR 5.46, CI 2.23 – 13.34, P = 0.001] and frailty [OR 3.29, CI 1.01 – 10.64, P = 0.047]). Conclusion: The prevalence of CVDs and their risk factors among the older population was high and significantly associated with increased risk of geriatric syndromes. These observations further strengthen the need for routine geriatric assessment and integrated management of geriatric syndromes in older patients with CVDs.
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Pattern of dermatoses in the elderly population attending the dermatology clinic at a Tertiary Care Center in South-East Rajasthan p. 73
Avinash Sharma, Ramesh Kumar Kushwaha, Vartika Kesarwani, Suresh Kumar Jain, Devendra Yadav, Sonika Sharma
DOI:10.4103/jiag.jiag_7_22  
Introduction: The skin acts as the first line of defense for the body against external injuries. With aging, the architecture of the skin undergoes intrinsic changes that impair its capacity for repair. In addition, the aging skin is more susceptible to injury by external stimuli, including ultraviolet rays and environmental pollutants. The combination of these factors predisposes the elderly to a variety of dermatological disorders, including xerosis, pruritus, photoaging, eczematous disorders, and tumors. The elderly (>60 years of age) population in India accounted for 8.6% (104 million) in 2011, and the figure has been projected to increase to 19% by the year 2050. It is imperative to identify the pattern of cutaneous disorders in this population as skin care regimens aimed to improve epidermal function have been shown to be effective in the prevention and treatment of some of these aging-associated cutaneous disorders. Objectives: The objective of the study was to identify the pattern of dermatoses among the elderly population attending the dermatology clinic at a tertiary care hospital in South-east Rajasthan. Materials and Methods: We conducted a cross-sectional descriptive study of patients above the age of 60 years who attended the dermatology clinic at a tertiary care hospital in South-east Rajasthan from May 2018 to May 2020. A combination of history, physical examination, and clinical investigations (when appropriate) were used to establish the diagnosis. Results: A total of 210 patients were included in this study. Most patients were between the age group of 60–65 years (40.47%). One hundred and thirty-eight were male (65.71%) and 72 were female (34.28%), with a male to female ratio of 1.9:1. Our study demonstrated that xerosis was one of the most common diagnoses seen in 126 cases (60%), followed by eczematous skin conditions seen in 82 cases (39%). Conclusion: The elderly constitute an important part of the population. Cutaneous disorders in the elderly range from mild disorders such as cherry angiomas to dermatological malignancies. Therefore, it is important to recognize the pattern of dermatosis in this population so that appropriate therapeutic and preventive strategies could be implemented.
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Association of cognitive function, depression, and quality of sleep with statins among oldest-old individuals Highly accessed article p. 78
Sai Sruthi Regalla, Gunampalli Anaika, Bana Manishaa Reddy, Pawan Kumar Sharma, Enakshi Ganguly
DOI:10.4103/jiag.jiag_34_21  
Background: Oldest-old population is rapidly increasing in all countries, with many prescribed statin therapy. Statins are associated with multiple cardiovascular benefits at various ages. The benefits of statins above the age of 75 are being questioned. The objective of this study was to measure statins use among the oldest-old population, aged 80 years and above, and to study the effect of statins on cognitive function, depression, and quality of sleep. Materials and Methods: This cross-sectional study randomly enrolled 200 community-dwelling individuals aged >80 years. Data were collected upon home visits on sociodemographic, cognitive functions, depression, sleep, chronic diseases, functional limitations, and disabilities. Cognitive function (Mini Mental State Examination), depression (Geriatric Depression Scale), and quality of sleep (Pittsburgh Sleep Quality Index) among individuals using statins versus not using statins were compared. Chi-square test and t-test were done; odds ratios (ORs) with 95% confidence interval (95% CI) were reported. Logistic regression was done to calculate adjusted OR with age, antidepressants, sedatives, antihistaminics, and sleep medicines. P < 0.05 was considered statistically significant. Results: Overall prevalence of statin use in our study population was 12%; 11.3% in women and 13.2% in men. Cognitive functions, depression, and quality of sleep improved among those using statins (P < 0.05): cognitive impairment – OR: 0.38; 95% CI: 0.16–0.91; depression – OR: 0.41; 95% CI: 0.17–1.02, and poor sleep quality – OR: 0.39; 95% CI: 0.16–0.96. On stratification by gender, men showed a significant association of improved cognitive function and quality of sleep with the use of statins, whereas women did not show any significant associations with cognitive function and quality of sleep but showed almost significant association with improvement in depression. Conclusions: The prevalence of the use of statins was low in our population. Statins had positive effects on cognitive functions, quality of sleep, and depression over 80 years of age in our population, although gender difference exists.
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REVIEW ARTICLE Top

Orthostatic hypotension: An overlooked but clinically decisive entity p. 86
Gunja Jain, Sunny Singhal, Laxmi Kant Goyal, Ajay Mathur
DOI:10.4103/jiag.jiag_24_22  
Orthostatic hypotension (OH) is defined as a drop of >20 mm Hg of systolic or >10 mm Hg of diastolic blood pressure (BP) within 3 min of standing from lying position. It is a common geriatric syndrome caused by impaired orthostatic response of BP. Its clinical manifestation can range from dizziness to syncope. It is a common cause of recurrent falls and fracture in older adults. Its etiology ranges from neurological causes such as Parkinson and diabetes to hypovolemia. Drugs, especially cardiovascular drugs are also frequently identified as the cause of OH. The management of OH is primarily nonpharmacological including medication review, dietary, and lifestyle modifications. However, in partially responsive or resistant cases, medications such as fludrocortisone, midodrine, droxidopa, etc., are also used.
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LETTER TO EDITOR Top

Need for a deep dive into the timeline of tech world for people diagnosed with dementia and their family caregivers p. 91
Shweta Kapote, Srikanth Pallerla
DOI:10.4103/jiag.jiag_20_22  
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ANNOUNCEMENT Top

Young Scholar IAG Kota Chapter Award by IAG Society KOT p. 93
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