Risk factors of hip fracture among Thai female patients.

A case-control study on hip fracture among female patients, aged 50 years and over, were conducted from 1995 to 1996. A consecutive series of newly admitted female patients with hip fracture (n = 60) and 60 age-matched controls were recruited. Four independent risk factors of hip fracture were identified, including "type of principle occupation as sedentary or housework", "low number of pregnancies", "low serum albumin" and "low bone mass density at inter-trochanter of the femur". When all univariate factors except bone density variables were entered into a multiple logistic regression analysis, four independent factors were identified including "no intake of milk regularly", "low number of pregnancies", "thin body appearance", and "low serum calcium". The study confirms the role of calcium intake as a preventive measure of hip fracture. Women with low weight-bearing work and housewives should have regular weight-bearing exercise.

Prevalence estimation of dementia among Thai elderly: a national survey.

OBJECTIVE: To determine the prevalence of dementia and its associated factors among Thai elderly. DESIGN: A one-stage cross-sectional national survey. SETTING: National communities in Thailand. SUBJECTS: 4,048 elderly subjects aged 60 and above. RESULTS: There were 668 (16.5%) elderly with a CMT score below 15. Among these elderly, 132 were dependent as to certain aspects of self-care. According to the definition of dementia used in this one-stage survey design (i.e. subjects with a low CMT score and self-care dependence), 3.3 per cent of Thai elderly (95% confidence interval = 2.7-3.8) were classified as having dementia. After adjusting to geographic and municipal area, the prevalence rate was 3.4 per cent (95% confidence interval = 2.8-4). Age-specific prevalence rate increased dramatically from 1.0 per cent in the 60-64 age-group to 31.3 per cent in the 90+ age-group. The prevalence rate of dementia among Thai elderly found in this study did not differ from the prevalence rates among the elderly in other Asian and developed countries. Using a logistic regression analysis, 3 independent factors associated with dementia were age, literacy (writing) and geographic area. CONCLUSION: With a one-stage survey design for determining the prevalence of dementia, the prevalence rate and age-specific prevalence rate among the Thai elderly did not differ from those found in other Asian and developed countries.

Dependence and active life expectancy of the elderly population living in the central region of Thailand.

OBJECTIVE: To determine the prevalence and the independent socio-economic factors with respect to the dependence status of the Thai elderly population living in the central region and to calculate the active life expectancy (ALE) based on the results of this survey and abridged life tables for Thailand. DESIGN: A cross-sectional mulitistage random sampling survey. SETTING: Communities in the central region, Thailand. SUBJECTS: 723 elderly subjects. RESULTS: Mean age and its standard deviation (SD) of the 723 recruited subjects were 69.9 and 7.3 years, respectively. Forty three per cent of the subjects were men. Mean values (SD) of the BAI score and the CAI score were 18.78 (2.6) and 6.47 (2.4), respectively. Except for housework, elderly women had a higher prevalence rate of dependence on activities of daily living (ADL) compared with elderly men. Seven univariate factors of the BAI and the CAI were demonstrated. According to the multiple linear regression analysis by entering all univariate factors of the BAI and the CAI except "working status", independent factors of both the BAI (adjusted R2 = 0.051) and the CAI (adjusted R2 = 0.146) were age, sex and writing ability. The prevalence rate (95% confidence interval) of dependence regarding self-care activities of daily living was 5.9 per cent (4.2-7.6%). The rate of dependence increased with age. The female elderly were more dependent on self care than their male counterparts. Although the elderly women live longer than the elderly men, they spend more years in a severely dependent state. Findings on ratios between health and life expectancy demonstrate that Thai men spend more proportional time leading a healthy life than Thai women. CONCLUSION: Prevalence rates of dependence regarding activities of daily living among the Thai elderly living in the Central region were rather high showing the health of elderly women to be worse than that of elderly men. The elderly women spend more years in a severely dependent state although they live longer than the elderly men.

Consequences of hip fracture among Thai women aged 50 years and over: a prospective study.

OBJECTIVES: To compare post-discharge outcomes of hip-fractured Thai women aged 50 and over with age and sex-matched controls. SUBJECTS AND METHOD: From 1995 to 1997, 60 Thai women aged 50 years and over with hip fracture who had been admitted to the King Chulalongkorn Memorial Hospital and their age and sex-matched controls (n = 60) were recruited in a case-control study. These 120 patients were followed for at least 1 year after discharge from the hospital by telephone and/or mailed questionnaire to obtain information about outcomes including death, dependency status and new fracture. Relatives of missing subjects were contacted and interviewed about the outcome status of the patients. RESULTS: The mean age (SD) of those with and without hip fracture was 71.7 (7.6) and 71.2 (8) years, respectively. Of these 120 subjects, 3 cases and 3 controls could not be contacted. The longest follow-up period was 32 months. Means periods (SD) of follow-up among cases and controls were 18.8 (6.7) and 18.1 (6.6) months, respectively. Eleven cases and 5 controls died during the follow-up period. Seven cases and 3 controls died within 1 year after hospitalisation. The survival rate of the cases clearly separated from that of the controls after 1 year. There was a statistical significance of survival between the cases and controls (p < 0.05). The mean (SD) BAI and CAI scores one year after discharge of hip fractured subjects (n = 50) were 17.3 (3.4) and 5.5 (2.3), respectively. The mean (SD) BAI and CAI scores one year after discharge of the control subjects (n = 54) were 16.9 (5) and 5.3 (2.5), respectively. There was no statistically significant difference between dependency status among the two groups. Three (5.2%) cases and one (1.8%) control had new fractures during the follow-up period (no statistical significance). CONCLUSION: This study showed that appropriate management of hip fracture could maintain the dependency status of hip-fractured women for one year. However, Thai women aged 50 years and over with hip fracture had a higher mortality rate than those without hip fracture which suggests that hip fracture might be a sign of poor health status among these elderly women.

Healthy life expectancy of Thai elderly: did it improve during the soap-bubble economic period?

Healthy life expectancy (HLE) of Thai elderly was studied to clarify the health benefit for the elderly population in Thailand during the soap-bubble economic period by comparing their HLE and life expectancy (LE) in 1986 and 1995. The information on the perceived health status of Thai elderly, aged 60 and over, from two national surveys in 1986 and 1995 and the life tables of correspondent years were used for calculating healthy life expectancy. Both life expectancy (LE) and healthy life expectancy (HLE) of Thai elderly have markedly increased between 1986 and 1995. Regardless of sex, the HLE-LE ratios of nearly all age groups increased from 1986 to 1995. This suggests that the unhealthy life duration had been compressed. Women spend more years than men both active and inactive at every age; however, the proportion of life that is expected to be active is less for women. In conclusion, health and well-being of Thai elderly population significantly improved during the soap-bubble economic period (1989-1996) of Thailand.

Syphilitic seroreactivity among the Thai population aged 50 years and above: value of mass screening.

The present study is concerned with the evaluation of routine serologic screening for syphilis among the general population aged 50 and above living in a suburban area of Bangkok, Thailand. Among 941 subjects aged 50 years and above recruited in a cohort study named the CERB study, blood of 798 subjects was obtained and their sera were tested for syphilis using the passive particle agglutination test for detection of antibodies to Treponema pallidum (TPPA) and the rapid plasma reagin (RPR). Of 798 subjects, 132 (16.5%) were reactive to serum TPPA. Their mean age (standard deviation) was 61.4 (8.4) years. Fifty-six subjects (42.4%) were male. Prevalence of syphilitic seroreactivity increased with age (p = 0.004). Prevalence of syphilitic seroreactivity among male and female subjects was 18.3% and 15.4% respectively (p = 0.001). Prevalence of syphilitic seroreactivity among subjects with formal education (14.4%) was significantly lower than that among subjects without formal education (26.5%) (p = 0.001). Of 132 subjects, 10 (7.6%) had and a rapid plasma reagin (RPR) titer of 1:16 or higher. None of them reported symptoms of primary or secondary syphilis during the initial survey. Of 125 subjects who were interviewed in depth during the revisit survey, 24 subjects had known about their syphilitic infection prior to this study. Among these 24 subjects, 4 had not received any treatment for syphilis and 1 used herbal medicine. Therefore, 106 subjects (84.4%) were untreated or inadequately treated. These findings suggest the value of mass screening for syphilis among the Thai population aged 50 years and above.

Validity of clinical use of the clock-drawing test in Thai elderly patients with memory problems.

Forty eight elderly Thai patients, 12 demented, 36 non-demented who consecutively attended a geriatric clinic, at Chulalongkorn University Hospital, with a memory problem were recruited in the study which aimed to determine the validity of the clock-drawing test (CDT) and Chula mental test (CMT). Subjects took the Chula Mental Test (CMT) and were asked to draw a clock on a preprinted 12 centimeters circle showing the time of 11:10. Clocks were scored using the Chula Clock-drawing Scoring System (CCSS). Ten subjects voluntarily participated and completed the WAIS test. The best cutoff score of the CMT and the CDT using diagnosis of dementia as a gold standard were 15 and 7 respectively. Sensitivity and specificity for detecting dementia by the CDT were 100 per cent and 94.1 per cent respectively. Sensitivity and specificity for detecting dementia by the CMT were 83.3 per cent 91.7 per cent. The likelihood ratio (95% confidence interval) of the CMT and the CDT were 10 (3.3-30.4) and 17 (4.4-65.2) respectively. There was a good correlation of the CDT score and the CMT score with the WAIS score. Although the CDT was better than the CMT in literate patients, the CDT had limitation of use among illiterate patients but not the CMT. The benefits of simultaneously application on dementia screening was shown. This study showed that the CDT was a valuable, brief method of dementia screening in elderly Thai patients with memory problems.

Factors associated with state hospital utilisation among Thai elderly who had illnesses which needed hospitalisation.

Of the 4,480 elderly subjects in a multistage random sampling household survey of a National Survey of the Welfare of the Elderly in Thailand (SWET), 669 (14.9%) reported that they had been hospitalised during the last year and were recruited in an analysis which aimed to examine associated factors of state hospital utilisation among Thai elderly. Seventy eight per cent had been admitted once during the last year. Mean (standard deviation) duration of hospital stay during the last year was 11.9 (20.1) days. For the last period of hospitalisation, 532 elderly (79.5%) were admitted to state hospitals. One hundred and nineteen elderlies (17.8%) used private hospitals. Only 18 elderly (2.3%) used both state and private hospitals. According to the causes of hospitalisation, the elderly who used state hospitals were not more severely ill than those who used private hospitals. Nine univariate factors associated with state hospital utilisation were entered in a logistric regression model in which five independent determinants were identified including 'do not have electricity', 'heads of the family are not their children', 'do not have own savings', 'live in rural area', and 'have heard about free health care programme'. The Ministry of Public Health and organisations which are concerned with the elderly should allocate more resources to advertising a free health care programme for Thai elderly.

Effectiveness and cost analysis of community-based rehabilitation service in Bangkok.

This paper aimed to clarify the effectiveness and the cost of the community-based rehabilitation service in Klong Toey slum after a three year study period. One hundred and seventy eight patients used community-based rehabilitation during the three year period. One hundred and fifty-seven patients (86.5%) reported that their problems/conditions were cured or improved. Only nine patients (5.1%) reported that they stopped using community-based rehabilitation because their problems/conditions did not improve. A statistically significant improvement in pain level and walking velocity assessment, in 105 and 78 patients respectively, was demonstrated. Total cost and cost per patient-day of the community-based rehabilitation were Bt 559,920 and Bt 111.1 respectively. Cost per-patient-day of this community-based rehabilitation service was compared with an estimated cost per patient-day of using rehabilitation services at Chulalongkorn University Hospital and was found to be cheaper. This study supported the role of community-based rehabilitation in Thailand. The need for a health service study in rural areas was also noted.

Outcomes and predicting factors of mortality among newly admitted female medical inpatients.

Outcomes and predicting factors of mortality were studied in a consecutive series of 190 female medical patients admitted with acute illness to the Department of Medicine. Most of the patients were admitted from the Emergency Department. Twenty seven patients (14.2%) died. Seventy per cent of the patients who died, died during the first week of hospitalisation. Nearly 10 per cent of the patients who did not die, stayed in the hospital for longer than 4 weeks. At the time of home discharge, 20 patients (12.3%) had a Barthel ADL Index score less than 12, 19 patients (11.7%) had urinary incontinence, 16 patients (9.8%) had faecal incontinence, and only 103 patients (63.2%) could walk independently. The elderly patients had a significantly higher disability level at the time of home discharge than the younger patients. Independent predicting factors of mortality among this population study were "history of acute confusion", "systolic blood pressure < 100", "hematocrit < 30 per cent", "platelet < 100,000", and "a low Chula Mental Test score". Implementation of auditing and quality assurance in every acute-care hospitals is recommended.

Long-bone measurement for height estimation in Thai adult subjects.

Four hundred medical inpatients admitted to Chulalongkorn University Hospital between February 1994 and January 1995 were recruited in a study which aimed to compare a number of long-bone measurements, in both the erect and supine position, with height and to reveal clinical appropriateness of long-bone measurements for predicting height and BMI in the Thai adult population. Armspan in both supine and erect positions, halfspan in both supine and erect position, and knee-to-floor height correlated best with height. The armspan and halfspan were shown to be reliable as a direct estimate for height in Thai adult subjects. The BMIs calculated from the armspan or 2 x halfspan differed slightly from the BMI of height and were appropriate for nutritional assessment in clinical practice. For frail patients whose armspan and halfspan was not able to be measured, the knee-to-floor height is an alternative long-bone measurement for height prediction.

A randomised controlled trial of regular surveillance in Thai elderly using a simple questionnaire administered by non-professional personnel.

To test the benefits of regular surveillance of the elderly at home using a simple-questionnaire, 142 randomly selected subjects aged 70 years or over and living in a slum area of Bangkok were recruited and were designated as cases (n = 70) and controls (n = 72). At the beginning of the study period all subjects were visited and their characteristics, including morbidity data, activities of daily living (Barthle ADL Index, Chula ADL Index) and number of falls during the last three months, were collected. Over three years the cases were visited every three months, in their own home, by non-professional personnel. They and/or their care-givers were interviewed using a short questionnaire designed for the home visiting programme. The elderly who had problems according to the criteria were visited and assessed by nurses and/or a geriatrician. Appropriate management was provided to these elderly. After three years, all subjects were visited and outcome data were collected. Rates of service use among the cases were higher than among the controls but there was not a statistically significant difference. The rate of declining in Chula ADL Index score of the cases was significantly less than that of the controls. (p < 0.05) There was no statistically significant difference between other main outcomes of the case and control groups. However, regular home visiting of old people at home by non-professional personnel using a simple questionnaire is a practical way for community care of the elderly population living in poor areas.

Falls and their associated factors: a national survey of the Thai elderly.

Of the 7,713 subjects aged 50 and over in a multistage random sampling national survey of Thailand, 4,480 Thai elders aged 60 and over were interviewed in a study which aimed to determine rate, characteristics and the associated factors of falls in the last six months. Eight hundred and thirty-six elders (18.7%) had one or more falls. Female elders (21.5%) fell more often than their male counterparts (14.4%). There was no association between age and falls among Thai elder population. Most of the falls occurred outside (65%) and during the day time (85%). Multiple regression analysis showed that independent factors associated with falls among male elder were a bad or fairly bad health, reported hypertension, problems with walking in the house, problems with crouching and a lack of electricity in the house. Independent factors associated with falls among female elders were a bad or fairly bad health, joint problems, illness which made her unable to have normal activities during the last year, problems with crouching, going to buy food everyday, very lonely feeling, having less than 3 meals a day, a lack of electricity in the house and living in a Thai style house or hut. This study revealed that environmental and intrinsic health factors which affected balance and gait were the main factors associated with falls among Thai elders. Nutritional status as a contributing factor to falling among elderly women was also suggested.

Urinary incontinence in Thai elderly living in Klong Toey slum.

Seven hundred and three non-institutionalized Thai elderly living in Klong Toey slum were interviewed at home about their urinary symptoms and 114 cases of established urinary incontinence were identified. The prevalence of established urinary incontinence was 16.2 per cent. The commonest type is pure urge incontinence (58.8%). 24.4 per cent of male subjects with established incontinence had symptoms of outlet obstruction. 54.4 per cent of subjects were classified as severely incontinent. More than 50 per cent had at least one psychological impact and 7.9 per cent reported that their social lives were severely affected. Only 8.8 per cent had sought medical help before and only 30 per cent were willing to attend a specialist at a university hospital. The attitude of the elderly, the carers and medical doctors toward urinary incontinence has to be corrected. Urinary incontinence should be a public health issue in Thailand and there may be considerable scope for the provision of incontinence service at the primary health care level.

Use of drugs and adverse reactions in medical inpatients.

An one-day survey of 111 medical inpatients admitted to four wards of the Department of Medicine, Chulalongkorn University Hospital was conducted. Its aim was to examine the differences in medication use patterns and incidence of adverse reaction to medication between young and old patients. The mean age and its standard deviation were 43.5 and 18.2 years respectively. Common medications used by these patients were antibiotics, paracetamol, parenteral fluid, peptic ulcer and gastritis remedies, vitamin and mineral supplements, and diuretics. Compared to the young patients, the elderly patients received more prescriptions for cardiovascular drugs and diuretics while receiving fewer prescriptions for vitamin and mineral supplements. Thai elderly medical inpatients had a higher rate of adverse reaction when compared to their young counterparts. Patients who received 6 medications or more were more likely to have an adverse reaction than those who received less than 6 items. The discipline of geriatric medicine may have a role in caring for the elderly patients in medical wards. A cohort study with a larger sample for determining causes or factors associated with adverse drug reactions is needed.

Mini-Mental Status Examination: is it appropriate for screening in Thai elderly?

Appropriateness of using the Mini-Mental Status Examination with Thai elderly was examined in three samples of fifty elderly subjects living in contrasting locations in Thailand. Literacy, age, gender, principle occupation and place of residence were each associated with MMSE score. Multiple regression analysis, demonstrated that literacy and place of residence had strong independent effects on MMSE. Result of this study suggests that use of the MMSE as a screen for cognitive impairment in Thailand may be inappropriate. New screening tests that are not influenced by literacy and place of residence are needed.

Factors associated with one-year mortality of the Thai elderly living in a community.

A prospective study that aimed to identify the risk factors of one-year mortality among 703 Thai elderly living in a community was conducted. High age, having no work, low Barthel ADL index score, low Chula ADL index score and high OPCS disability score are univariate risk factors of death. Having no work and low BAI score were independent risk factors identified by logistic regression analysis using survival status as the dependent factor. Direct effect of working on mortality is suggested from the result of the study.

A controlled clinical trial of multidisciplinary team approach in the general medical wards of Chulalongkorn Hospital.

The benefits and acceptability of a strengthened physician-nurse collaboration and a multidisciplinary team approach are demonstrated in the medical wards of a Thai acute-care hospital (Chulalongkorn University Hospital). The strengthened physician-nurse collaboration should be introduced or strengthened in all medical wards. Because of the lack of appropriately trained personnel, concentrating resources into a small unit or ward may be the appropriate measure at present if a multidisciplinary team approach is to be integrated into the medical ward of acute-care hospitals in South East Asia.

Body temperature in medical inpatients: what is the meaning of fever?

A study which aimed to determine the appropriate body temperature level for diagnosing fever was conducted in 160 medical inpatients admitted to the medical wards of Chulalongkorn University Hospital. Both objective and subjective findings were used as criteria for fever. This study demonstrates that the most appropriate cutoff levels for oral, axillary and rectal body temperature measurement in clinical practice are 37.8, 37.5 and 38.3 Celsius respectively. The oral body temperature is better than the axillary and rectal body temperature for fever diagnoses in medical inpatients.

Disability among Thai elderly living in Klong Toey slum.

Forty three per cent of the elderly in Klong Toey slum had BAI score less than 20. One point six per cent were moderately severe or severely disabled and needed special care. Around one-third of them caused by stroke. Locomotion, reaching and stretching, dexterity, continence and seeing are common significant types of disability among this population study. Perceived health status, age and working status are independent factors related to disability level. The Barthel ADL index is suitable for using as a tool for a disability survey among Thai elderly. The ODS questionnaire may be applied after considerable modification of the questions concerning behavior and intelligence dimensions.