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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
Vivek Aggarwal, VK Sashindran, Puja Dudeja, V Vasdev, Anuj Singhal
October-December 2020, 16(4):160-164
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.
  2,267 63 -
Health workforce development for geriatric services in India
Abhijith Rajaram Rao, Arvind Mathur, AB Dey
October-December 2020, 16(4):176-179
  2,033 144 -
Self-reported morbidity profile among geriatric population in ICMR-model rural health research unit, Kallur, Tirunelveli
Vasna Joshua, K Sunitha, G Muthu, V Sinduja, P Venkatesh, P Nandini, K Shantaraman, P Manickam, MV Murhekar, Yuvaraj Jayaraman
July-September 2020, 16(3):95-100
Background: The Model Rural Health Research Unit at Kallur, Tirunelveli, established by the Department of Health Research, Government of India, is linked to Tirunelveli Medical College. It is mentored by the ICMR-National Institute of Epidemiology, Chennai. The key objective was to develop area-specific models to undertake field health research depending on the disease profile, topography, morbidity patterns, and better health-care services. As a part of the ongoing activity, we constructed a cohort of 36,289 people and analyzed the self-reported information on morbidities experienced by the registered population from different aspects. In this communication, we report some of the findings extracted from the data sets as descriptive epidemiology on the self-reported magnitude of illness and their utilization of health services in the rural cohort of a primary health center among the geriatric population 60 years or more. Methods: A demographic health database of 11,006 households (HH) with 36,289 individuals was constructed in the study area under the Primary Health Centre, Nadu Kallur, Tirunelveli. This database consists of self-reported morbidity data collected at baseline, pertaining to the cohort members with age 60 years or more and analyzed it. Results: The study area's total geriatric population with 60 years of age or more was 4891 (13.5%). In this cohort, the gender ratio was 824 males for every 1000 females, with an average of 0.4 geriatric persons per HH, and 37% of them were illiterates. About 38% of the study population were either widowed or separated. Nearly 65% of the people in the cohort lived in the same house for more than 10 years. Around 10% were pensioners, and almost 36% had to work for their daily living. Only 27% had health insurance or were covered by a health scheme. About 52% (2564) of the individuals reported about their one or more ailments. The total number of different types of ailments reported was 3704. Among them, 402 (11%) were not treated. For the remaining (3302 ailments) one or more treatments were taken, i.e., in all 4705 instances, treatment was taken either consulting a physician or self-treatment. Hypertension (25%) and diabetes mellitus (21%) were the major cause of morbidity among the elderly in this cohort. Conclusion: The above rural baseline survey portrays the commonly reported morbidities and their treatment-seeking behavior of a cohort of elderly people living in the area under Government Primary Health Centre, Nadu Kallur, South India. The findings indicate that the commonly reported morbidity and their treatment-seeking behavior remain unchanged even after rapid strides in India's health-care delivery. This study's data strengthen the need to increase the services for the geriatric population to improve their quality of life.
  1,781 130 1
New age technology in promoting healthy aging
Soumya S Inamadar, Ashish Goel, SV Madhu
July-September 2020, 16(3):124-129
Introduction: Digitalization of the world and the Internet of things have completely transformed social life and health care. Technologies such as artificial intelligence (AI), wearable and implantable devices, mobile applications, and the Internet have revolutionized health-care delivery. With the betterment of health care and control of infectious diseases, longevity has increased, resulting in the bane of chronic noncommunicable illnesses and comorbidities in the aging population. This study aims to review the existing literature on technology applications in health care and the scope for promoting healthy aging. Methods: An online search was done on electronic databases such as PubMed and Google in July 2019 using a combination of keywords mobile, Android, cellphone, artificial intelligence, machine learning, natural language processing, diabetes, blood sugar, hypertension, blood pressure, dyslipidemia, cognitive impairment, and falls. About 80,964 citations were found. On applying the filter title, 997 articles were obtained. In the title and abstract review, 15 unique articles were selected, by eliminating similar, duplicate, and nonrelevant articles. In addition, using cross-reference and Google search, ten articles were found. Discussion: Various applications of the technology in the management of noncommunicable diseases (NCDs) such as diabetes, hypertension, and obesity and geriatric syndromes such as falls and cognitive impairment have been classified into three sections: prevention and prediction; diagnosis and detection; and medication and management. The names of a few applications have been cited as examples. Conclusion: The new age technology has shown promise at various health-care intervention levels in a futuristic hope of taking medicine to the next level - Precision Medicine. The present work will allow physicians involved in older patients with NCDs and geriatric comorbidities to help them have an independent, comfortable, and functional aging.
  1,686 129 -
Ageing agony: Rape against elderly women
Mamta Patel
April-June 2021, 17(2):73-77
Introduction: Rape is a type of sexual assault and brutal, demeaning, cruel act perpetrated without concern. Despite extensive research on rape, especially in India, there exists an important gap in knowledge around elderly victims. The rapist has been considered by many clinicians as the victim of uncontrollable urges or the recipient of a disordered personality. Objective: The objective of this study was to examine the situation during the commission of the crime and what was the relationship between the victim and the offender in committing the heinous crime. Methods: In this research, data were obtained from print media and electronic media from 2004 to 2018. A total number of 49 cases were found reported during this period of work. This study is based on quantitative findings using the unobtrusive method of content analysis. The elderly women aged 60 and above were taken for the study. Results: The results show that cruelty was involved in more than one-fourth of the cases. In most of the cases, victims were targeted as they were alone in their homes. In some cases, the offenders were found in a state of inebriation at the time of the crime. The crime was committed mostly by the impulsive type rapist. Conclusions: The findings challenge the social norms and have implications for future research, policy, and practice.
  1,623 167 -
Prevalence and disparity of malnutrition among elderly: A cross-sectional study
Md Taj Uddin, Momduha Akter, Md Shah Noor, Md Kamal Hussain, Iqbal Ahmed Chowdhury
October-December 2020, 16(4):145-150
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.
  1,609 130 -
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
Umar H Khan, Murtaza R Pala, Imran Hafeez, Afshan Shabir, Aamir Rashid, Nisar Tramboo, Hilal Rather
October-December 2020, 16(4):139-144
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.
  1,527 158 -
Blood biomarkers in older subjects with mild behavioral impairment: A cross-sectional study from the memory clinic, all india institute of medical sciences, India
Abhijith Rajaram Rao, Meenal Thakral, Mamta Kumari Saini, Prasun Chatterjee, Aparajit Ballav Dey
July-September 2020, 16(3):91-94
Background: The presence of neuropsychiatric symptoms (NPS) in older adults with no cognitive impairment confers a high risk of future cognitive decline. Mild behavioral impairment (MBI) is a syndrome characterized by the new onset of NPS after 50 years, which is sustained and impactful. We report the distribution of various domains of MBI in subjects with mild cognitive impairment (MCI) and subjective cognitive impairment (SCI) and the association between different blood markers in individuals with MBI. Materials and Methods: This cross-sectional study was conducted in the Memory clinic of the Department of Geriatric Medicine in a tertiary health center. The study duration was 1½ years. Subjects with MCI and SCI were screened for the presence of NPS and MBI. Patients with dementia, impaired activities of daily living, and psychiatric illnesses were excluded. The mild behavioral impairment checklist ascertained the presence of various domains. Levels of various blood markers were assessed. Results: In this study, 124 participants were included. The mean age of the population was 69.21 ± 6.64, 71.77% were male, and 28.23% were female. Fifty-one participants were diagnosed to have MBI. Among the MBI domains, impulse dyscontrol was most commonly involved (68.63%) followed by decreased motivation (60.78%). Low Vitamin D (85.71%; P = 0.005) and high serum triglyceride (50%; P = 0.044) were associated with MBI. Conclusion: NPS, especially impulse dyscontrol and decreased motivation, in participants without dementia, were common in the memory clinic setting. Vitamin D deficiency and high triglyceride levels were significantly associated with MBI.
  1,541 122 2
Association of cognitive function, depression, and quality of sleep with statins among oldest-old individuals
Sai Sruthi Regalla, Gunampalli Anaika, Bana Manishaa Reddy, Pawan Kumar Sharma, Enakshi Ganguly
April-June 2022, 18(2):78-85
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.
  1,580 76 -
Frailty prevalence and agreement between assessment tools in elderly patients of Western India
Navin Kumar Yadav, Dharmendra Kumar, Vivek Aggarwal
July-September 2020, 16(3):116-123
Background: Frailty is a common clinical syndrome in the elderly with increased risk for poor health outcomes manifesting as falls, disabilities, hospitalization, and death. In this study, we measured the prevalence of frailty based on two commonly used tools, i.e., Fried frailty phenotype (FFP) and Edmonton frailty scale (EFS). Furthermore, the agreement between these tools was determined. Materials and Methods: In this cross-sectional study, 296 patients with age 60 years or more visiting geriatric outpatient department at a tertiary care center in Western India were assessed for frailty using FFP and EFS. The study groups' association is evaluated with the Fisher's test, Student's “t-test”, and Pearson's chi-squared test. Results: A total of 296 patients were assessed with the mean age group of 68.47 ± 5.92 years. There were 151 (51.1%) males and 145 (48.9%) females with the majority of patients from the age group of 60–70 years (68.8%). Total 68 patients (22.9%; males: 55.8%, females: 44.2%) and 50 patients (17%; males and females 50% each) were frail as per FFP and EFS, respectively. There was a statistically significant agreement between FFP and EFS (k = 0.602, P < 0.05). Conclusion: There is a significant agreement between frailty prevalence measured by FFP and EFS. In elderly population, measurement of frailty using these simple tools can be effective in screening and subsequent early interventions to reduce ageing-related mortality and morbidities.
  1,580 74 -
Study on the effect of COVID-19 lockdown on health care and psychosocial aspects of elderly in Kerala State
Padmakumar Balasundaram, GK Libu, Christina George, Alex J Chandy
July-September 2020, 16(3):101-106
Objective: The objective of the study was to determine the effect of COVID-19 lockdown on the health care and psychosocial aspects of the elderly in Kerala. Methodology: The study was a community-based cross-sectional study designed as an online survey, and the study setting was the entire state of Kerala. Target participants (more than 60 years old) were selected with nongovernment organizations working in geriatric welfare. The tool used for the survey was a semi-structured online questionnaire. To assess the magnitude of psychological distress, Geriatric Anxiety Scale-? Version 2.0 was used. Results: Five hundred and thirty-six elderly people were included in the study, of which 273 (50.9%) were males and 263 (49.1%) were females. Four hundred and forty-two people (82.5%) were on regular medications before the lockdown, of which 28 (6.3%) missed the same during lockdown. Routine laboratory testing went down from 404 (75.4%) to 294 (54.9%) and medical follow-up from 348 (64.9%) to 180 (33.6%) during the lockdown period. Two hundred and three elderly (37.9%) in the study population showed significant anxiety symptoms. Conclusions: Lockdown has adversely affected the health care and non-COVID medical services of the elderly. Fear of COVID infection and the presence of possible COVID infection symptoms were associated with psychological distress and anxiety. Proper psychosocial interventions are necessary to mitigate the effects of lockdown on health care and psychosocial aspects of the elderly.
  1,489 80 3
Caregiver burden and its correlates among people with Alzheimer's dementia: An exploratory study from Nepal
Ramesh Kandel, Pawan Sharma, Swarndeep Singh
October-December 2020, 16(4):169-173
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.
  1,408 91 1
Pattern of drug utilization at community geriatric outpatient department attached to a tertiary hospital
Amit S Bhondve, US Saurabha
October-December 2020, 16(4):156-159
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.
  1,377 100 -
Potentially inappropriate medication prescribing in older adults: American geriatric society updated beers criteria journey
Rishabh Sharma, Parveen Bansal, Ravinder Garg, Malika Arora
January-March 2021, 17(1):28-35
The present manuscript highlights Beers guidelines till date and puts them at a single platform to enable the physicians, academicians, and patients for the safe and timely use of medicines. Potentially inappropriate medications (PIM) are medications in which adverse risks exceed its health benefits. Complex and multiple comorbidities in older adults make them use multiple drugs that further become a reason for exclusion from randomized clinical trials (RCT). Hence, no set guidelines or RCT-based scientific shreds of evidence are available to support prescription decisions. PIM has become an increasingly common problem in older adults; hence the American Geriatric Society updated Beers criteria; the most crucial strategy to check its use/misuse. The Beers criteria have been formulated in 1991 with the help of validated and appropriate screening tools that explain the use/avoidance of various drugs in older adults based on their health status and are being further updated as and when required. This change in Beers criteria is due to some limitations in the study population, emerging adverse drug reactions/new drug molecules, change in pharmacodynamics of medicines with changing physiology of older adults. Beers guidelines are being updated; however, few significant issues that are not being touched by the committee responsible for constituting the criteria.
  1,381 83 -
Care of Older Adults in the Post-COVID Era
Arvind Mathur
July-September 2020, 16(3):89-90
  1,350 70 -
Study on the role of inflammation in healthy aging and nutritional status in older persons
B Krishnaswamy, S Deepa, D Thangam
October-December 2020, 16(4):151-155
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.
  1,277 88 -
Health-related quality of life of the geriatric population living in rural areas of West Tripura district of India: A cross-sectional study
Arpita Debnath, Himadri Bhattacharjya
October-December 2021, 17(4):105-110
Background: Growing life expectancy is challenging the quality of healthcare for elderly. Information regarding health-related quality of life (QOL) may help policymakers to design need-based health programs for this population. Objectives: The objective of this study is to estimate health-related QOL of the geriatric population living in rural areas of West Tripura district and to compare it between ethnic and nonethnic populations with respect to important domains. Methodology: This community-based cross-sectional study was conducted between February 1, 2019, and March 31, 2020, among 225 geriatric subjects of rural West Tripura district chosen by multistage sampling. The World Health Organization's QOL–BREF scale was used for data collection. Results: Among the study population, 46.2% had overall good health-related QOL. About 52.9% had good QOL in environment, and 37.3% had good QOL in social relationship domains. Marginally higher proportion of the subjects from ethnic origin had better QOL than the nonethnic, but it was not significant. A higher proportion of the Muslim subjects had better QOL than the rest, but it was also not significant. Bivariate analysis showed significant associations between QOL with age, sex, literacy, financial condition, socioeconomic status, and type of family. Multivariate analysis identified male sex, younger age, and living with spouse as the significant predictors of good QOL. Conclusion: Overall health-related QOL of the geriatric people living in rural areas of West Tripura district is poor, but younger male subjects of ethnic origin and living with spouses may enjoy relatively better QOL.
  1,135 202 -
Online course in geriatrics for final-year medical students
Arun N Bhatt, Gayatri Ganesh, Prabha Adhikari, Alka Ganesh
April-June 2021, 17(2):62-66
Background: The new competency-based MBBS undergraduate curriculum articulates 24 competencies in geriatrics. Acknowledging the dearth of faculty in the country, a group of geriatricians developed and conducted an online modular course for final-year medical students. Methods: This 6-week online course included 13 modules and the study materials were developed through a two-stage vetting process. The course was advertised to potential students through social media and was delivered over Google classroom platform. Students' learning was assessed by multiple-choice questions (MCQs), and the course was evaluated with comparison of pretest and posttest, feedbacks from students with both structured and open-ended questionnaires. Results: Out of 200 eligible students from 38 medical colleges who applied, 142 students joined the course. Out of 142 students joined, 98 (69%) completed the course with 80% attendance; 91 (64.1%) secured scores above 50%; and 46 (32.4%) secured scores above 80% in MCQ test. Posttest scores were significantly higher than pretest scores (P < 0.001) with medium Cohen's effect size. Median scores of feedbacks on 20-point Likert scale for all modules were 15 or 16. Content analysis of qualitative feedback showed appreciation for the structure and content of the course, praise for the expertise and commitment of the faculty in delivering it effectively, scope for further improvement, and positive change in attitude toward discipline of geriatrics. Conclusions: This endeavor shows that short online course will be helpful for motivated medical students to expand their knowledge in geriatrics.
  1,215 60 -
Geriatric dentistry during COVID-19 pandemic
Gaurav Singh, Kiran Kumari
July-September 2020, 16(3):130-132
Geriatric patients have different oral healthcare needs than young individuals; they need special infrastructure and training to deal with. During this ongoing pandemic, the geriatric patients' oral healthcare needs take a back seat because of the lockdown and because of the frail health status of the individuals. There is a need to find ways to deal with geriatric patients' unique oral healthcare needs during these testing times and tailored to individual needs.
  1,170 101 -
Massive splenomegaly as the presenting feature of multiple myeloma in an elderly man
Vaibhav Mishra, Abhishek Pandey, Deeksha Goyal, Sankha Shubhra Chakrabarti
January-March 2022, 18(1):37-40
A 70-year-old man presented with generalized weakness, easy fatigability, and early satiety of 2-month duration. On examination, he had severe pallor and massive splenomegaly. Hematological investigations revealed bicytopenia with hypergammaglobulinemia and acute kidney injury. Bone marrow aspiration cytology was suggestive of plasma cell dyscrasia. Monoclonal protein peak (due to heavy chain of IgG type) was found on serum protein electrophoresis, and lambda light chains and IgG heavy chains were elevated on immunofixation. The patient was diagnosed as a case of multiple myeloma and was started on bortezomib–lenalidomide–dexamethasone regimen. After 7 months of chemotherapy, his spleen had regressed, and the patient had become asymptomatic. Presentation with massive splenomegaly is usually a feature of Waldenstrom's macroglobulinemia. However, rarely multiple myeloma may have extramedullary manifestations such as splenomegaly as the primary presenting feature.
  1,201 66 -
Fall in elderly during COVID-19 pandemic: A case report and review
R Magesh, Phani Krishna Machiraju, Neetu Mariam Alex
July-September 2020, 16(3):133-135
Coronavirus disease-19 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 primarily affects the lung resulting in acute lung injury, which may progress to acute respiratory distress syndrome and rarely multiorgan dysfunction syndrome. Elderly are the worst affected among all age groups. Falls are one of the most common problems faced by the elderly. Since the outbreak of this pandemic, most hospital resources have been redirected to the care of COVID-19 patients, resulting in the postponement of many orthopedic elective surgeries. In this case report, we discussed managing a traumatic fall in the elderly who tested positive for COVID-19.
  1,160 104 -
Lethologica in aging: An analytical study
PC Girija, N P Fathima Shahal, Nayana Narayanan
January-March 2022, 18(1):9-14
Introduction: Lethologica is a phenomenon that is an early sign of aging. Lethologica refers to the inability to retrieve a specific word as a response to a visual, auditory, or tactile presentation. Need: Even though it is known that aging has a strong impact on cognitive language functions, it is not yet clear which aspect is most affected. Since naming is an important element of language functions, analysis of this aspect would aid in understanding the nature of deterioration of cognitive‒linguistic functions with age. Aim: The aim is to analyze the impact of aging on naming abilities in neurotypical individuals. Methods: One hundred and fifty neurotypical individuals of 30 individuals from each group between 30 and 80 years of age, i.e., 31–40 years, 41–50 years, 51–60 years, 61–70 years, and 71–80 years participated in the study. A tool was developed in Malayalam language to assess confrontation naming, responsive naming, generative naming, and contextual naming. A score of 1 was given for each correct response. Results: As age advances, all the naming abilities deteriorated. The effect was most prominent in the generative naming task as it demands the most cognitive involvement. The neuronal areas governing these cognitive aspects mainly include the prefrontal cortical regions which are highly susceptible to the aging process. Responsive naming and contextual naming were least affected as it gained the advantage of crystallized intelligence. The age-related decline is more prominent after the age of 60 years. Conclusion: Naming skills, even though being a language element also have strong foundations within the cognitive domain. Hence, any age-related neurobiological alterations can impact naming functions.
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Integrated care for older people (ICOPE)
Meenaxi Sharda
October-December 2021, 17(4):103-104
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Do medical interns have adequate training in geriatric medicine? A study on the knowledge and attitudes of interns toward older patients at a medical college in Kerala, South India
Steve Paul Manjaly, Anu Francis, Aaron David Kotturan
July-September 2020, 16(3):107-110
Introduction: With the exponential increase in India's elderly population, the medical students of today need to be well prepared for the demographic changes of tomorrow. Training and attitude of future physicians in elderly care should develop concurrently with the rise in qualifying medical graduates. Objectives: The aim of this study is to determine the knowledge and attitudes of medical students entering internships, toward older people at a teaching hospital in Thrissur, Kerala. Methodology: Medical students of a medical college in Kerala, who were to enter the residency program were enrolled in the study. Sixty-nine students, who voluntarily participated, were asked to complete two questionnaires, the Revised Facts on Aging Quiz, a 25-item multiple-choice test on aging, and the University of California at Los Angeles (UCLA) Geriatric Attitudes Scale, a 14-item questionnaire consisting of a mixture of positively and negatively worded questions answered on a five-point Likert scale. The data obtained were assessed using SPSS version 21. Results: The results indicate that although the medical students entering residency showed a moderately positive attitude (UCLA score 49.67 ± 5.02) toward older people, almost one-third (n = 20, 29%) of these 69 students had poor knowledge (25%–50% score), and the rest (n = 49, 71%) had minimal knowledge (51%–75% scores) on aging. Conclusion: These findings suggest that training in geriatrics is inadequate for MBBS students. More geriatric based content needs to be incorporated into the undergraduate curriculum to address the changing population demographics.
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Common clinical issues in older adults
Arvind Mathur
October-December 2020, 16(4):137-138
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