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1.
Article | WPRIM | ID: wpr-831646

ABSTRACT

Background@#There is a controversy whether it is safe to continue renin-angiotensin system blockers in patients with coronavirus disease 2019 (COVID-19). We analyzed big data to investigate whether angiotensin-converting enzyme inhibitors and/or angiotensin II receptor blockers have any significant effect on the risk of COVID-19. Population-based cohort study was conducted based on the prescription data from nationwide health insurance records. @*Methods@#We investigated the 1,374,381 residents aged ≥ 40 years living in Daegu, the epicenter of the COVID-19 outbreak, between February and March 2020. Prescriptions of antihypertensive medication during the year before the outbreak were extracted from the National Health Insurance Service registry. Medications were categorized by types and stratified by the medication possession ratios (MPRs) of antihypertensive medications after controlling for the potential confounders. The risk of COVID-19 was estimated using a difference in difference analysis. @*Results@#Females, older individuals, low-income earners, and recently hospitalized patients had a higher risk of infection. Patients with higher MPRs of antihypertensive medications had a consistently lower risk of COVID-19 than those with lower MPRs of antihypertensive medications and non-users. Among patients who showed complete compliance, there was a significantly lower risk of COVID-19 for those prescribed angiotensin II receptor blockers (relative risk [RR], 0.751; 95% confidence interval [CI], 0.587–0.960) or calcium channel blockers (RR, 0.768; 95% CI, 0.601–0.980). @*Conclusion@#Renin-angiotensin system blockers or other antihypertensive medications do not increase the risk of COVID-19. Patients should not stop antihypertensive medications, including renin-angiotensin system blockers, because of concerns of COVID-19.

2.
Article | WPRIM | ID: wpr-836507

ABSTRACT

Background@#Reducing the total anticholinergic burden (AB) in older adults is recommended owing to the several peripheral and central adverse effects. This study aimed to identify the AB status of patients admitted to geriatric centers for assessing the influence of the pharmacist-involved multidisciplinary geriatric team care on reducing the AB. @*Methods@#We retrospectively reviewed the medical records of 328 older patients hospitalized in geriatric centers from July 1, 2018 to June 30, 2019, who received comprehensive geriatric assessment and pharmaceutical interventions from a multidisciplinary geriatric team. We measured the total AB scores for the medications at the time of admission and upon hospital discharge using the Korean Anticholinergic Burden Scale (KABS). The pre-admission factors associated with high AB (KABS score ≥3) at the time of admission were identified. @*Results@#The proportion of patients with high AB significantly decreased from 41.8% (136/328) at the time of admission to 25.0% (82/328) on discharge (p<0.001). The pre-admission AB of patients transferred from skilled nursing facilities (odds ratio[OR]: 2.85, 95% CI: 1.26- 3.75), taking more than 10 medications (OR: 3.70, 95% CI: 1.55-8.82), suffering from delirium (OR: 2.80, 95% CI: 1.04-7.50), or depression (OR: 2.78, 95% CI: 1.04-7.41) were significantly high. Antipsychotics were the most frequent classes of drugs that contributed to the total KABS score at the time of admission, followed by antihistamines. @*Conclusions@#This study demonstrated that the multidisciplinary teams for geriatric care are effective at reducing AB in older adults. The factors associated with high AB should be considered when targeting pharmaceutical care in geriatric individuals.

3.
Article in English | WPRIM | ID: wpr-763377

ABSTRACT

BACKGROUND/AIMS: Nonalcoholic fatty liver disease (NAFLD) is becoming a worldwide epidemic, and is frequently found in patients with chronic hepatitis B (CHB). We investigated the impact of histologically proven hepatic steatosis on the risk for hepatocellular carcinoma (HCC) in CHB patients without excessive alcohol intake. METHODS: Consecutive CHB patients who underwent liver biopsy from January 2007 to December 2015 were included. The association between hepatic steatosis (≥ 5%) and subsequent HCC risk was analyzed. Inverse probability weighting (IPW) using the propensity score was applied to adjust for differences in patient characteristics, including metabolic factors. RESULTS: Fatty liver was histologically proven in 70 patients (21.8%) among a total of 321 patients. During the median (interquartile range) follow-up of 5.3 (2.9–8.3) years, 17 of 321 patients (5.3%) developed HCC: 8 of 70 patients (11.4%) with fatty liver and 9 of 251 patients (3.6%) without fatty liver. The five-year cumulative incidences of HCC among patients without and with fatty liver were 1.9% and 8.2%, respectively (P=0.004). Coexisting fatty liver was associated with a higher risk for HCC (adjusted hazards ratio [HR], 3.005; 95% confidence interval [CI], 1.122–8.051; P=0.03). After balancing with IPW, HCC incidences were not significantly different between the groups (P=0.19), and the association between fatty liver and HCC was not significant (adjusted HR, 1.709; 95% CI, 0.404–7.228; P=0.47). CONCLUSIONS: Superimposed NAFLD was associated with a higher HCC risk in CHB patients. However, the association between steatosis per se and HCC risk was not evident after adjustment for metabolic factors.


Subject(s)
Biopsy , Carcinoma, Hepatocellular , Fatty Liver , Follow-Up Studies , Hepatitis B virus , Hepatitis B, Chronic , Hepatitis, Chronic , Humans , Incidence , Liver , Liver Neoplasms , Non-alcoholic Fatty Liver Disease , Propensity Score
5.
Article in English | WPRIM | ID: wpr-49969

ABSTRACT

Falls and fall-related injuries are common in older populations and have negative effects on quality of life and independence. Falling is also associated with increased morbidity, mortality, nursing home admission, and medical costs. Korea has experienced an extreme demographic shift with its population aging at the fastest pace among developed countries, so it is important to assess fall risks and develop interventions for high-risk populations. Guidelines for the prevention of falls were first developed by the Korean Association of Internal Medicine and the Korean Geriatrics Society. These guidelines were developed through an adaptation process as an evidence-based method; four guidelines were retrieved via systematic review and the Appraisal of Guidelines for Research and Evaluation II process, and seven recommendations were developed based on the Grades of Recommendation, Assessment, Development, and Evaluation framework. Because falls are the result of various factors, the guidelines include a multidimensional assessment and multimodal strategy. The guidelines were developed for primary physicians as well as patients and the general population. They provide detailed recommendations and concrete measures to assess risk and prevent falls among older people.


Subject(s)
Accidental Falls , Aging , Developed Countries , Geriatrics , Humans , Internal Medicine , Korea , Methods , Mortality , Nursing Homes , Quality of Life
6.
Article in English | WPRIM | ID: wpr-225693

ABSTRACT

Little is known about the clinical significance of frailty and changes of frailty after dialysis initiation in elderly patients with end-stage renal disease (ESRD). We prospectively enrolled 46 elderly patients with incident ESRD at a dialysis center of a tertiary hospital between May 2013 and March 2015. Frailty was assessed by using a comprehensive geriatric assessment protocol and defined as a multidimensional frailty score of ≥ 10. The main outcome was the composite of all-cause death or cardiovascular hospitalization, as determined in June 2016. The median age of the 46 participants was 71.5 years, and 63.0% of them were men. During the median 17.7 months follow-up, the rate of composite outcome was 17.4%. In multivariate logistic regression analysis, after adjusting for age, sex, diabetes, body mass index (BMI), and time of predialytic nephrologic care, female sex, and increased BMI were associated with increased and decreased odds of frailty, respectively. In multivariate Cox proportional hazards analysis, after adjusting for age, sex, diabetes, BMI, and time of predialytic nephrologic care, frailty was significantly associated with the composite adverse outcome. In repeated frailty assessments, the multidimensional frailty score significantly improved 12 months after the initiation of dialysis, which largely relied on improved nutrition. Therefore, frailty needs to be assessed for risk stratification in elderly patients with incident ESRD.


Subject(s)
Aged , Body Mass Index , Dialysis , Female , Follow-Up Studies , Geriatric Assessment , Hospitalization , Humans , Kidney Failure, Chronic , Logistic Models , Male , Malnutrition , Prospective Studies , Risk Factors , Tertiary Care Centers
7.
Korean Circulation Journal ; : 365-373, 2016.
Article in English | WPRIM | ID: wpr-43729

ABSTRACT

BACKGROUND AND OBJECTIVES: Blood pressure variability (BPV) was recently shown to be a risk factor of stroke. White coat hypertension (WCH) used to be regarded as innocuous, but one long-term follow-up study reported that WCH increased stroke rate compared to normotension (NT). In this study, we aimed to evaluate the relationship between WCH and BPV. SUBJECTS AND METHODS: We analyzed 1398 subjects from the Korean Ambulatory Blood Pressure Registry, who were divided into NT (n=364), masked hypertension (n=122), white coat hypertension (n=254), and sustained hypertension (n=658) groups. RESULTS: Baseline characteristics were similar among groups. The average real variability (ARV), a highly sensitive BPV parameter, was highest in the WCH group, followed by the sustained hypertension, masked hypertension, and NT groups. The results persisted after being adjusted for covariates. The WCH vs. sustained hypertension results (adjusted mean±standard error) were as follows: 24-h systolic ARV, 22.9±0.8 vs. 19.4±0.6; 24-h diastolic ARV, 16.8±0.6 vs. 14.3±0.5; daytime systolic ARV, 21.8±0.8 vs. 16.8±0.6; and daytime diastolic ARV, 16.2±0.6 vs. 13.4±0.5 (p<0.001 for all comparisons). CONCLUSION: From the registry data, we found that subjects with WCH or masked hypertension had higher BPV than NT. However, long-term follow-up data assessing the clinical influences of WCH on stroke are needed.


Subject(s)
Blood Pressure Monitoring, Ambulatory , Blood Pressure , Follow-Up Studies , Hypertension , Masked Hypertension , Risk Factors , Stroke , White Coat Hypertension
8.
Article in English | WPRIM | ID: wpr-48491

ABSTRACT

BACKGROUND/AIMS: The fatigue, resistance, ambulation, illnesses, and loss of weight (FRAIL) scale is a screening tool for frailty status using a simple 5-item questionnaire. The aim of this study was to evaluate the clinical feasibility and validity of the Korean version of the FRAIL (K-FRAIL) scale. METHODS: Questionnaire items were translated and administered to 103 patients aged ≥ 65 years who underwent a comprehensive geriatric assessment at the Seoul National University Bundang Hospital. In this cross-sectional study, the K-FRAIL scale was compared with the domains and the multidimensional frailty index of the comprehensive geriatric assessment. We also assessed the time required to complete the scale. RESULTS: The participants' mean age was 76.8 years (standard deviation [SD], 6.1), and 55 (53.4%) were males. The mean overall frailty index was 0.19 (SD, 0.17). For K-FRAIL-robust, prefrail, and frail patients, the mean frailty indices were 0.09, 0.18, and 0.34, respectively (p for trend < 0.001). A higher degree of impairment in the K-FRAIL scale was associated with worse nutritional status, poor physical performance, functional dependence, and polypharmacy. The number of items with impairment in the K-FRAIL scale was positively associated with the frailty index (B = 3.73, p < 0.001). The K-FRAIL scale could differentiate vulnerability from robustness with a sensitivity of 0.90 and a specificity of 0.33. Of all patients, 75 (72.8%) completed the K-FRAIL scale within < 3 minutes. CONCLUSIONS: The K-FRAIL scale is correlated with the frailty index and is a simple tool to screen for frailty in a clinical setting.


Subject(s)
Aged , Cross-Sectional Studies , Diagnosis , Fatigue , Geriatric Assessment , Humans , Male , Mass Screening , Nutritional Status , Polypharmacy , Sensitivity and Specificity , Seoul , Walking
9.
Article in Korean | WPRIM | ID: wpr-202846

ABSTRACT

Falls and fall-related injuries are common amongst the elderly population and have deleterious effects on the quality of life or independence in daily living in the elderly. Falling is also associated with substantial morbidity, mortality, nursing home admission, and an increase in medical costs. Given that Korea has shown an extreme demographic shift with its population aging at the fastest pace among developed countries, assessment of fall risks and implementing intervention strategies to the high-risk population are getting more important. The guidelines for the prevention of falls were developed first by The Korean Association of Internal Medicine and The Korean Geriatric Society. These guidelines were developed by an adaptation process and the use of an evidence-based method; 4 guidelines were retrieved by systematic review and by the AGREE (appraisal of guidelines for research and evaluation) II process and 7 statements were made based on the grading of evidence, and these recommendations followed the GRADE (grades of recommendation, assessment, development, and evaluation) framework. Given that falls result from a various combination of many factors, the guidelines contain multidimensional assessment measures and multimodal strategies to prevent falls. These guidelines were developed not only for use by primary physicians but also for patients and the general population. Therefore, these guidelines provide detailed recommendations and concrete measures for the assessment of the risk of a fall and to prevent falls amongst the elderly population.


Subject(s)
Accidental Falls , Aged , Aging , Developed Countries , Humans , Internal Medicine , Korea , Mortality , Nursing Homes , Quality of Life
10.
Article in Korean | WPRIM | ID: wpr-104683

ABSTRACT

In Korea, the number of older adults, particularly of the very elderly people, is expected to be increasing for the upcoming years. This demographic change has profound implication for medical and health care systems. As more people live a longer life, it is important to understand the chronic diseases or health problems which affect the health status or quality of life among the older adults. It has been well established that cardio-cerebrovascular diseases have important roles and impacts on functional capacity and health status of older adults. Recently, many risk factors which increase the risk of cardio-cerebrovascular diseases have been identified. Among them, dyslipidemia is one of the most important risk factor for cardio-cerebrovascular disease. However, there remain several questions regarding the clinical importance of dyslipidemia in older adults, safety and efficacy issue in treating dyslipidemia with statin in older adults, and the relationship between genetic factors associated with lipid profile and longevity. In this review, I will discuss current evidence and data on the topic of dyslipidemia in older adults.


Subject(s)
Adult , Aged , Cardiovascular Diseases , Chronic Disease , Delivery of Health Care , Dyslipidemias , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors , Korea , Longevity , Quality of Life , Risk Factors
11.
Article in Korean | WPRIM | ID: wpr-104680

ABSTRACT

BACKGROUND AND OBJECTIVES: The aim of this study was to investigate the status of LDL-cholesterol level and its relationship with subsequent cardiovascular events in Korean patients with chronic stable angina. METHODS: The patients with stable angina were retrospectively and consecutively enrolled from out-patients clinic during 2007-2009. Mean follow-up duration was 3 years. Occurrences of major adverse cardio-cerebrovascular event (MACCE: a composite of death, myocardial infarction, unstable angina, coronary revascularization, cerebrovascular events, peripheral artery disease and aortic disease requiring hospital admission.) were compared by initial LDL-cholesterol levels using Cox proportional-hazards model. RESULTS: 1,683 subjects were enrolled from 9 hospitals. Initial median LDL-cholesterol by tertile was 62.2, 90.2, and 124.0mg/dL respectively, however, the differences in LDL-cholesterol level among initial 3 tertile groups became narrow at 3rd year (67.8, 85.0, and 91.6mg/dL, respectively). MACCE occurred in 138 (8.2%) subjects, including 127 coronary events, 9 cerebrovascular events and 2 peripheral artery disease during the 3-year follow-up. The adjusted hazard ratio for MACCE was 1.02 (95% confidence interval 0.64-1.64) in the middle tertile of LDL-cholesterol, 1.53 (p=0.063, 95% Confidence Interval 0.98-2.40) in the highest tertile of LDL-cholesterol. The newly diagnosed diabetes mellitus was more frequent in subjects with statin treatment than subjects without statin during the 3-year follow-up (1.5% vs 0.6%). CONCLUSION: Increased cardiovascular risk was observed in angina patients with higher initial LDL-cholesterol levels during the 3-year follow-up, although the differences were statistically insignificant.


Subject(s)
Angina, Stable , Angina, Unstable , Aortic Diseases , Cardiovascular Diseases , Diabetes Mellitus , Dyslipidemias , Follow-Up Studies , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors , Hypercholesterolemia , Korea , Myocardial Infarction , Outpatients , Peripheral Arterial Disease , Retrospective Studies , Secondary Prevention
12.
Article in English | WPRIM | ID: wpr-61312

ABSTRACT

We investigated the effects of weekend admission on adverse cardiac events in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Patients with NSTEACS treated with percutaneous coronary intervention (PCI) were divided into a "weekend group" and a "weekday group" according to the emergency room arrival time. The primary outcome was 30-day major adverse cardiac events (MACE) including cardiac death, recurrent myocardial infarction, repeat revascularization, and urgent PCI. Of 577 patients, 168 patients were allocated to the weekend and 409 patients to the weekday group. The incidence of 30-day MACE was significantly higher in the weekend group (Crude: 15.5% vs. 7.3%, P = 0.005; propensity score matched: 12.8% vs. 4.8%, P = 0.041). After adjustment for all the possible confounding factors, in Cox proportional hazard regression analysis, weekend admission was associated with a 2.1-fold increased hazard for MACE (HR, 2.13; 95% CI, 1.26-3.60, P = 0.005). These findings indicate that weekend admission of patients with NSTE-ACS is associated with an increase in 30-day adverse cardiac event.


Subject(s)
Acute Coronary Syndrome/complications , Adult , Aged , Death , Female , Humans , Male , Middle Aged , Myocardial Infarction/epidemiology , Patient Admission , Percutaneous Coronary Intervention/statistics & numerical data , Propensity Score , Proportional Hazards Models , Time Factors , Treatment Outcome
13.
Korean Journal of Medicine ; : 752-780, 2015.
Article in Korean | WPRIM | ID: wpr-46987

ABSTRACT

Falls and fall-related injuries are common in older population and have deleterious effects to the quality of life or independence of daily living in the elderly. Falling is also associated with substantial morbidity, mortality, nursing home admission and the increase of medical costs. Because Korea has shown extreme demographic shift with its population aging at the fastest pace among developed country, assessment of fall risks and intervention to high risk population are getting more important. The guideline for prevention of falls was developed first by The Korean Association of Internal Medicine and The Korean Geriatric Society. This guideline was developed by adaptation process as evidence-based method; four guidelines were retrieved by systematic review and the Appraisal of Guidelines for Research and Evaluation II process, seven statements were made with the grading of evidence and recommendations followed the Grades of Recommendation, Assessment, Development, and Evaluation framework. Because falls result from various combinations of many factors, the guideline contains multidimensional assessment and multimodal strategy to prevent falls. This guideline was developed for not only primary physician but also patients and general population, therefore it provides detailed recommendations and concrete measures to assess the risk and prevent falls in older people.


Subject(s)
Accidental Falls , Aged , Aging , Developed Countries , Humans , Internal Medicine , Korea , Mortality , Nursing Homes , Quality of Life
14.
Article in English | WPRIM | ID: wpr-216630

ABSTRACT

BACKGROUND/AIMS: The detection of white coat hypertension (WCH), treated normalized hypertension, and masked hypertension (MH) is important to improve the effectiveness of hypertension management. However, whether global cardiovascular risk (GCR) profile has any effect on the discordance between ambulatory blood pressure (ABP) and clinic blood pressure (CBP) is unknown. METHODS: Data from 1,916 subjects, taken from the Korean Multicenter Registry for ABP monitoring, were grouped according to diagnostic and therapeutic thresholds for CBP and ABP (140/90 and 135/85 mmHg, respectively). GCR was assessed using European Society of Hypertension 2007 guidelines. RESULTS: The mean subject age was 54.1 ± 14.9 years, and 48.9% of patients were female. The discordancy rate between ABP and CBP in the untreated and treated patients was 32.5% and 26.5%, respectively (p = 0.02). The prevalence of WCH or treated normalized hypertension and MH was 14.4% and 16.0%, respectively. Discordance between ABP and CBP was lower in the very high added-risk group compared to the moderate added-risk group (odds ratio [OR], 0.649; 95% confidence interval [CI], 0.487 to 0.863; p = 0.003). The prevalence of WCH or treated normalized hypertension was also lower in the very high added-risk group (OR, 0.451; 95% CI, 0.311 to 0.655). CONCLUSIONS: Discordance between ABP and CBP was observed more frequently in untreated subjects than in treated subjects, and less frequently in the very high added-risk group, which was due mainly to the lower prevalence of WCH or treated normalized hypertension.


Subject(s)
Adult , Aged , Blood Pressure , Blood Pressure Monitoring, Ambulatory , Chi-Square Distribution , Cross-Sectional Studies , Female , Humans , Logistic Models , Male , Masked Hypertension/diagnosis , Middle Aged , Multivariate Analysis , Observer Variation , Odds Ratio , Office Visits , Predictive Value of Tests , Prevalence , Registries , Reproducibility of Results , Republic of Korea/epidemiology , Risk Assessment , Risk Factors , White Coat Hypertension/diagnosis
15.
Korean Circulation Journal ; : 108-109, 2015.
Article in English | WPRIM | ID: wpr-154885

ABSTRACT

No abstract available.


Subject(s)
Cholesterol
16.
Article in Korean | WPRIM | ID: wpr-51692

ABSTRACT

As the population ages, more people are living with multiple medical conditions, and patients are suffering from functional decline or disabilities as part of multimorbidity. Multiple chronic diseases are the greatest challenge facing health-care systems, but we are still focused on individual disorders rather than multimorbidity. A new care model for these patients is required. First, we have to know that most clinical guidelines were developed in relation to single conditions, so following the guidelines without regard to a patient's multimorbidity should be avoided. Physicians should be encouraged to consider their patients as a whole person rather than focusing on the disease itself. Second, it is necessary to identify and listen to patients' priorities. Focusing on outcomes that come from a single-condition approach is the most important barrier to goal-oriented care. Third, comprehensive geriatric assessment and care can improve the functional outcome of older patients with multimorbidity. It is important to order the chaos of multiple chronic conditions and share the same therapeutic plan among doctors. Lastly, doctors must review patients' medication lists systematically before adding a new medication. Clearly, we should avoid prescription of potentially inappropriate medications and polypharmacy.


Subject(s)
Chronic Disease , Comorbidity , Geriatric Assessment , Humans , Patient-Centered Care , Polypharmacy , Prescriptions
17.
Article in Korean | WPRIM | ID: wpr-200617

ABSTRACT

BACKGROUND: Clinical trials are widely used to approve the efficacy and discover adverse reactions of new drugs. However, there has been much concern about the unjustified exclusion of the older adults in clinical trials. The purpose of this study was to assess ageism in clinical trials and to find solution to any discovered discrimination. METHODS: An online questionnaire was completed by 1,650 experts including doctors, pharmaceutical staff, and contract research organization members. An offline inquiry was conducted by 250 experienced professors from a single tertiary hospital and other allied professions. The questions covered the current state of elderly participation, possible reasons for under-representation, and plans for its solution. RESULTS: Among 1,900 subjects, 246 (12.9%) individuals completed the survey. We excluded the six subjects who did not answer more than 10 questions, and analyzed the remaining 240 respondents. They agreed that there are tendencies to exclude the aged from clinical trials (69.2%), and that under-representation would cause difficulties for doctors and geriatric patients. Most people (84.6%) thought that treating older adults with the results from trials which exclude aged participants is inappropriate. Because respondents had difficulties explaining the trial process and obtaining informed consent, they thought establishing a geriatric clinical trial team would be highly effective. Experts also believed that financial inducements and legal regulations are required to increase elderly enrollment. CONCLUSION: Because the elderly have a unique physiology, the participation of older adults in clinical research is indispensable for verifying efficacy and determining potential adverse reactions. Consequently, clinical research professionals should be concerned about the participation of older subjects, and the authorities must begin to care about age discrimination in research fields.


Subject(s)
Adult , Aged , Ageism , Surveys and Questionnaires , Discrimination, Psychological , Drug Approval , Ethics Committees , Humans , Informed Consent , Physiology , Social Control, Formal , Tertiary Care Centers
18.
Article in Korean | WPRIM | ID: wpr-216697

ABSTRACT

Multimorbidity is one of the common clinical characteristics in older patients and its occurrence rises with age. With the increase of older population, physicians should know the clinical significance of multimorbidity in managing older patients. Multimorbidity focuses on the findings of multiple diseases in a single patient and interactions between diseases and a patient. It has been reported that the prevalence of multimorbidity is over 50% in elderly people and co-occurrence of certain chronic diseases is often observed in patients with multimorbidity. Multimorbidity is significantly associated with higher mortality, increased disability, impaired quality of life, and increased medical costs. Unfortunately, current guidelines do not address enough for older patients with multimorbidity. Simple and fragmented approach for multiple medical conditions in older patients may lead to many clinical problems including polypharmacy, iatrogenic events, and increased medical cost. Accordingly, comprehensive geriatric assessment and multidimensional approach for this population should be encouraged.


Subject(s)
Adult , Aged , Chronic Disease , Geriatric Assessment , Humans , Mortality , Polypharmacy , Prevalence , Quality of Life
19.
Article in Korean | WPRIM | ID: wpr-16232

ABSTRACT

During the past decades, the world's population has continued on its remarkable transition from a state of high birth and death rates to low birth and death rates. As a result, the number of elderly people, and particularly of the very elderly people, is increasing throughout the world. This demographic change has profound implication for medical and health care systems. As more people live to advanced old age, it is important to understand the chronic diseases and health problems which affect them from a physiologic standpoint. It has been well established that nutritional status has an important role on functional capacity and health status of the elderly people. Recently, there has been momentous development in perspectives of the metabolic mechanism that associated with ageing. As person live longer, the function of organ system decrease and the functional reservoir against external stress is depleted simultaneously. The concept of nhomeostenosiso emerged to account for the changes, and it is characterized that progressive constriction of homeostatic reserve in every organ system. Comorbidities like hypertension, diabetes mellitus, dementia, depression, and physical limitations are very common in the elderly, and they are often troubled with decreased function of digestive systems and sensory organs. Furthermore, many elderly people have suffered from poverty and social isolation. Accordingly, the older are more prone to malnutrition or undernutrition. In addition, the combination of the mentioned problems with homeostenosis will lead to metabolic derangement, like insulin resistance and visceral fat accumulation. This process makes a deleterious effect on their comorbidities or physical function; consequentially it triggers and exacerbates frailty in the elderly. In this review, we describe the mechanism of metabolic change, and appropriate nutritional supply for the elderly.


Subject(s)
Aged , Chronic Disease , Comorbidity , Constriction , Delivery of Health Care , Dementia , Depression , Diabetes Mellitus , Digestive System , Homeostasis , Humans , Hypertension , Insulin Resistance , Intra-Abdominal Fat , Malnutrition , Metabolism , Mortality , Nutritional Status , Parturition , Poverty , Social Isolation
20.
Article in Korean | WPRIM | ID: wpr-33002

ABSTRACT

BACKGROUND: Beers criteria are used to identify the potentially inappropriate medications (PIMs) in elderly patients. However, the criteria have limitations such as lacking consideration of drug-drug and duplicated prescriptions. The aim of this study is to compare the efficacy of newly developed screening tool of older person's prescriptions (STOPP) with Beers criteria in identifying PIMs and adverse drug events (ADEs) in elderly patients. METHODS: We included 115 elderly patients older than 65 years who visited the outpatients' clinic or have been hospitalized for medical illness. Comprehensive geriatric assessments including medication review by the pharmacists were performed by the multidisciplinary team. Beers criteria and STOPP were used to find out PIMs. The association between PIMs defined by both criteria with ADEs was also evaluated. RESULTS: A total of 59 patients (50.4%) by Beers criteria and 76 patients (65.0%) by STOPP had been prescribed with PIMs. Compared with Beers criteria, STOPP had advantage in identifying more PIMs. In addition, STOPP could identify more ADEs related medications than Beers criteria. STOPP was also useful to detect duplicate drug class prescription and nonsteroidal anti-inflammatory drugs for renal impaired patients. CONCLUSION: STOPP criteria PIMs can detect more duplicated prescription and are significantly associated with avoidable ADEs in older individuals compared with that of Beers criteria PIMs.


Subject(s)
Aged , Beer , Drug-Related Side Effects and Adverse Reactions , Geriatric Assessment , Humans , Imidazoles , Mass Screening , Nitro Compounds , Pharmacists , Prescriptions
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