Factors determining hospital admission of Thai elderly by a mailed survey.

OBJECTIVE: To study risk factors of hospital admission among older Thai adults. MATERIAL AND METHOD: Nationwide observational cross-sectional survey by mailed questionnaires. 1801 older adults who attended senior citizen clubs organized by local hospitals from 66 provinces of Thailand. RESULTS: 28.1% of subjects had been admitted to a hospital. Independent factors determining hospital admission were lung disease (adjusted OR 2.13), history of fall (adjusted OR 1.73), poor global self-rated health (adjusted OR 1.62), taking calcium tablets (adjusted OR 1.61), preferring fatty food (adjusted OR 1.59), being former smokers (adjusted OR 1.56), low body mass index (adjusted OR 1.52), hypertension (adjusted OR 1.37) and poor mobility ability (adjusted OR 1.16). CONCLUSION: Prevention of hospital admission among the elderly should involve preventing cigarette smoking, promoting healthy dietary habit, fall prevention and screening for hypertension.

The efficacy and effectiveness of influenza vaccination among Thai elderly persons living in the community.

OBJECTIVE: To determine the efficacy and cost-effectiveness of influenza vaccination in the Thai elderly living in an urban community. MATERIAL AND METHOD: The study design was a stratified, randomized, double blind, placebo-controlled trial. A total of 635 participants aged 60 years and older living in an urban community was randomized to receive an influenza vaccine or tetanus toxoid as a placebo injection. All participants were followed up 4-6 weeks in the community for influenza-like illness and treatment received, hospitalization and death for one year. A hemagglutination inhibition (HI) test for influenza virus antibody of all participants was done on the day of vaccination as well as 1 month, 5 months, and 12 months after the vaccination. Main outcome measures were immune response rate and protective titer, influenza-like illness, serological influenza, treatment received for influenza-like illness and their expenses, hospitalization and death during the study period. RESULTS: The immune response rate of vaccinations was 97.1% and protective titer for A (H1N1) and A (H3N2) strains were 96.4 and 98.6%, respectively. The incidence of influenza-like illness was 4.83% in the vaccine group compared with 10.88% in the placebo group. The relative risk reduction was 56% (95% CI = 14 to 77%). The survival analysis also showed that vaccinations significantly reduced the incidence of influenza (p = 0. 009). The number needed to prevent one episode was 17 persons (95% CI = 9 to 71 persons). The adverse reactions of vaccinations were mild and tolerable. However, the number of treatments received for influenza-like illness and their cost were not significantly different between the two groups. None of the subjects had pneumonia nor needed hospitalization during the study period. Seven participants died during the year of follow up, but not from influenza. CONCLUSION: In Thai elderly living in the community, influenza vaccination reduced the incidence of influenza-like illness by half, but not the number of treatments received for influenza-like illness, their cost, and its serious complications. In the year of the study, considering the cost of vaccines and the numbers needed to prevent one episode of infection from the provider's viewpoint, it may not be cost-effective to recommend that all Thai older persons living in the community should receive influenza vaccination annually. Vaccination recommendation for the elderly should be promptly implemented in expectation of a severe epidemic in Thailand.

A grandma with two years of fever and agony.

A 72 year old woman living in Namuen District, Nan Province, was referred from a local hospital for having two years of fever and back pain. Her symptoms started with feeling malaise, intermittent fever with chills and body ache. All the symptoms got worse at night making her unable to sleep. She also experienced back pain all day night in additon to anorexia. She had no cough, petechia or abnormal bleeding. After having had medical consultations at a local hospital, no definite cause of her suffering was found. She then underwent various further investigations including a bone marrow examination at a local university hospital which did not reveal any malignant conditions. She was referred back to her home town hospital. However, she still suffered from recurrent high pyrexia, anorexia, progessive weight loss, etc. leading to many more hospital admissions. One year later, her symptoms, including fever and back pain, seemed to get worse and she was once again admitted to the hospital. The laboratory tests at that time revealed hematocrit 27%, white blood cell count 21,600 / mL, neutrophil 95%, lymphocyte 5%, platelet 563,000 /mL, ESR 120 mm/hr., Ca 7.6 mg/dl, phosphorus 4.5 mg/dl, BUN 14 mg/dl, Cr 0.9 mg/dl, Coomb\'s test megative. T3 179 ng/dl, TSH 1.27 mU/ml. Echocardiography showed LVEF 66% without evidence of infective endocarditis. An abdominal ultrasound revealed a mild degree of renal parenchymal disease, normal size liver with homogeneous parenchymal disease and a normal-appearing spleen. Gastroscopy was also performed without any significant finding. Because the clinical scenario was so obscure, she was referred to Siriraj Hospital Medical School for further management on May 6, 2003. There was no significant chronic medical condition prior to this agonic episode. She neither smoked nor drank alcohol. Her adult children ran a family business within her home so she was closely looked after by her daughter and did not have any financial difficulties.

Nationwide survey of the health status and quality of life of elderly Thais attending clubs for the elderly.

Thailand is seen as a developing Southeast Asian country with a fast-growing number of senior citizens. Meanwhile, they are also encouraged to attend a local club for the elderly for the sake of health promotion and disease prevention. Knowledge of the quality of life as well as the health status of elderly people in this setting would be invaluable for further planning. 1811 individuals from 66 provinces, who attended clubs for the elderly were recruited. Structured questionnaires with detailed instructions were distributed to clubs for the elderly nationwide. 61.4 per cent had a good quality of life. The independent factors determining poor quality of life were as follows: not living with a spouse, poor financial status, no regular exercise, sleeping or hearing difficulty, not taking milk regularly, suffering from joint pain or diabetes mellitus, history of a fall within the last 6 months and a poor mobility score and score of instrumental activities of daily living. No regular exercise had the highest adjusted odds ratio (2.38: 95% CI: 1.61-3.51). The main factors determining a poor quality of life in any region of the country were socioeconomic background in the northern region, having less exercise and joint pain in the eastern part and diabetes mellitus in the western region. Conclusion: All these factors should be part of the geriatric assessment among elderly Thais. Socioeconomic factors could be employed to screen for those who are at risk while the other reversible factors should be highlighted and treated properly in order to reduce the outcomes of poor quality of life in those attending clubs for the elderly.

Risk factors for falls in the Thai elderly in an urban community.

BACKGROUND: Instability or falls in the elderly are a health condition meeting all criteria for prevention i.e. high frequency, evidence of preventability and a high burden of morbidity. The consequences of a fall affect not only the elderly per se such as fractures and various kinds of physical and mental impairment, but also the family and the society as a whole in terms of the financial expenditure involved. The need for a comprehensive study to identify the risk factors for falls among the Thai elderly is, therefore, crucial for further management. OBJECTIVE: To identify the significant risk factors for falls among the Thai elderly for further prevention and management. METHOD: A cross-sectional study in the urban community around Siriraj Hospital, Bangkok. 1,043 community-dwelling people aged > or = 60 years were recruited. A structured questionnaire, including mental test and physical examinations as well as various laboratory tests, were used to identify the risk factors for falls between faller and control groups. RESULTS: The overall prevalence of falls among elderly Thais in an urban area was 19.8 per cent during a period of 6 months. However, the prevalence was 24.1 per cent in women but only 12.1 per cent in men. Older people who were likely to fall also had a lower bone mass which predisposed them to future fractures. The independent risk factors for falls after multiple logistic regression analysis were: female gender, hypertension, deafness, poor memory, poor self-perceived health status, poor performance in the instrumental activities of daily living, kyphoscoliosis, use of spectacles, rapid pulse rate after a 5 minute rest, higher serum transferrin and poor nutrition in terms of low lean body mass and reduced serum albumin level. CONCLUSIONS: Special sense, activity of daily living, nutritional status, kyphoscoliosis, hypertension and cognitive ability were six important factors determining the likelihood of fall among the elderly in an urban area.

An electrocardiographic survey of elderly Thai people in the rural community.

Electrocardiographic findings in the elderly reflect both common cardiac diseases and physiologic ageing change. This cross-sectional population-based study explored the prevalence of various abnormalities in the electrocardiograms of active older people and those who are free from any cardiac pathology and determined their relationship to age and gender in a rural area of Thailand. Nine hundred and sixty three people aged 60 years or more were recruited. The electrocardiographic prevalence of ischemic heart disease, atrial fibrillation, left axis deviation and conduction defect were 5.5 per cent, 2.2 per cent, 2.5 per cent and 3.1 per cent respectively. After excluding diseases potentially affecting the heart, the prevalence of atrial fibrillation, left axis deviation and conduction defect decreased to 1.3 per cent, 2.0 per cent and 2.2 per cent. The prevalence of atrial fibrillation and ischemic heart disease were significantly less (p = 0.015 and 0.003) in the 80+ year old group. Regarding gender difference, only left axis deviation was found significantly more frequently in older men with an odds ratio of 5.23 (95% confidence interval, 1.28-30.29) in those who were free from diseases potentially affecting the heart. IN CONCLUSION: Atrial fibrillation should not be regarded as degenerative change, but the result of cardiac pathology instead. The most common electrocardiographic abnormality in normal older men was left axis deviation and was found consistently more often than in older women. Therefore, it is appropriate to investigate for any reversible causes of atrial fibrillation while it is not so for left axis deviation in older men.

Strategy to prevent falls in the Thai elderly: a controlled study integrated health research program for the Thai elderly.

Instability or falls are one of the important warning symptoms of underlying serious illness among the elderly, so many studies have concentrated on the risk factors for falls. However, a study involving a strategic method to reduce the incidence of falls is the next step and is the main objective of this study. 1,043 elderly subjects living in the urban area around Siriraj Hospital Medical School, Bangkok, were recruited, 585 of them were allocated to the study group and 458 subjects to the control group. A leaflet containing information on important risk factors of falls within their community was enclosed with a follow-up postcard in the study group only. In addition, this particular group was allowed free access to the geriatric clinic at Siriraj Hospital if there was any health problem. All of them received a postcard asking about any falls which had occurred over the previous 2 months on 6 occasions and a telephone call if the postcards were not returned to the team. The percentage of elderly who kept in contact was 92.5 per cent, 90.6 per cent, 89.3 per cent, 89.2 per cent, 86.2 per cent and 85.45 per cent for the first to final follow-up respectively. After one year of longitudinal study, the overall incidence of falls was 6.6 per cent in the study group and 10.1 per cent in the control group. The incidence of falls began to show a statistically significant difference between the two groups at the fourth and sixth episodes of follow-up (P = 0.002 and 0.004). The Kaplan-Meier survival analysis also revealed a statistically significant difference in the incidence of falls between the two groups (P =0.01). In conclusion, the incidence of falls was significantly reduced in the study group and a repeated campaign to alert the elderly to the risk of falling is a cost-effective way of fall prevention among the healthy elderly in the community.

Body mass index of the elderly in rural area of central part of Thailand.

Body mass index (BMI) is an indicator for nutritional status which correlates with mortality. Studies in the past indicated that undernutrition was one of the major nutritional problems in elderly Thais especially in the rural area. The objective of this study is to determine the BMI of the elderly who live in rural areas of central Thailand. Random sampling of volunteers age > 60 years in 3 districts of Samut Songkram and Rajaburi provinces was done. One hundred and ninety-three elderly people, 77 men and 116 women, age 60-87 years old, were included in the study. BMI of male and female participants was 22.76 + 3.81 and 24.51+ 3.94 kg/m2 respectively. Women had significantly higher BMI than men. When used a BMI of <18.5 kg/m2 as cut-off point, 13.0% of male and 6.9% of female were suffering from under-nutrition. However, grade III malnutrition was found in only 1.5% of the participants of the study. In contrary, overweight and obesity was found 20.8% and 2.6% in male subjects and 33.6% and 11.2% in female subjects respectively. The prevalence of over-nutrition has increased during the past decade. A survey of over-nutrition related diseases is required and further surveillance in this population is essential to verify the impact of increasing BMI on morbidity and mortality in elderly people.