Strengths, weaknesses, opportunities, and threats analysis of the national program for health care of the elderly

Background: The National Program for the HealthCare of the Elderly (NPHCE) was adopted by the Ministry of Health and Family Welfare in 2010 to provide promotional, preventive, curative, and rehabilitative health-care services for the fast-growing older population in India. As literature about the assessment of NPHCE is lacking, the present study was conducted to perform a strengths, weaknesses, opportunities, and threats (SWOT) analysis of the program. Methods: The SWOT of the NPHCE program is analyzed using available literature and relevant documents. Results: Although this program embraces strategies to provide specialized training and services at primary health center, community health center, and district levels, including dedicated bedded wards, equipment, consumables, and pharmaceuticals but home-based care for the elderly, and the role of caregivers is overlooked in this program. NPHCE program can utilize the framework and take support of various ongoing healthy aging initiatives of international agencies to augment the health-care strategies for the elderly in India. Integrating schemes developed by the government for the upliftment of the elderly and the inclusion of traditional medicine systems in the program can serve as an opportunity for meeting unmet needs and improving the quality of life and well-being of the elderly. However, the growing elderly population, rise in nuclear families, and dual disease burden are significant threats to the program’s implementation. Conclusion: This program can be more effective in providing comprehensive health care to the elderly if more emphasis is given to community participation, home‑based care, and integrating digital health technologies and other existing welfare schemes.

A scoping review of community-based geriatric assessment and screening tools used in South Asia

Background: Home-based comprehensive assessment and integrated care of the older people could be a key to relieve the pressure on the already overburdened health system. This review summarizes evidence on validated community-based geriatric assessment tools in South Asia. Methods: Guided by Arksey and O扢alley抯 five?stage scoping review framework, a total of 46 studies were included in the scoping review after searching from electronic databases and reference lists using the predefined eligibility criteria. Data were extracted on the main characteristics of included studies, identified instruments, and their psychometric properties of the tools. This review was reported in accordance with preferred reporting items for systematic reviews and meta-analyses-ScR guidelines. Results: Among the 46 included studies, 10 reported on instruments for medical assessment, 12 on tools for psychological conditions, 13 on tools for functional issues, 2 on social well-being, and 9 on tools with multiple domains of health. Most studies included participants from both gender and different social classes. Majority used measurements that were both self-reported or measured by the investigator, whereas only two instruments were designed to be used by clinicians. In the existing geriatric health assessment tools, environmental domain was neglected completely, and not a single tool considered in this review covered all 5 domains which influence regular life of the elderly. Conclusion: There are no validated tools available that can be used for comprehensive geriatric assessment in South Asia. There is a need to develop and validate culturally sensitive tools that can be used for assessing all the geriatric health domains.

Health care network model for older adults: a co-creation and participatory action research approach / Modelo assistencial à saúde do idoso em rede: uma abordagem de cocriação e pesquisa-ação participativa

OBJECTIVE: To develop a collaborative, multidisciplinary care model for older adults that improves interdisciplinary teamwork and increases access to specialized services for frail patients, helping solve management problems in the Brazilian Unified Health System. In the state of Bahia, the health care network for older adults requires better interaction and integration with the Unified Health System and the Unified System of Social Assistance to improve patient flow in the network. METHODS: We used a co-creation and participatory action research approach based on reflection, data collection, interaction, and feedback with participants and stakeholders. Data was collected from health professionals, representatives of health agencies, and older adults through collective and individual interviews, reflective diaries, and direct communication. RESULTS: An action plan involving members of the older adult care network was developed to put the new model into practice. A pilot study with a multidisciplinary team allowed adjustments and implementation of the model at our institution. CONCLUSIONS: The new model improved both the internal management of the State Reference Center for Older Adult Health Care (Centro de Referência Estadual de Atenção à Saúde do Idoso - CREASI) and its interaction with primary care, optimizing patient flow and establishing rules for shared management between CREASI and primary care institutions. In view of this, restructuring the care model reorganized relations between the agencies, expanding CREASI's role in the management and systematization of older adult health.

OBJETIVO: Desenvolver um modelo assistencial colaborativo, multiprofissional e centrado na pessoa idosa para melhorar o trabalho em equipe interdisciplinar e o acesso de idosos frágeis ao serviço especializado, ajudando na resolução de problemas com o gerenciamento do idoso no Sistema Único de Saúde (SUS). A rede de assistência à saúde do idoso na Bahia requer avanços na interação e na integração entre os órgãos do SUS e do Sistema Único de Assistência Social para melhorar o fluxo dos pacientes na rede. METODOLOGIA: Foi realizada uma pesquisa-ação participativa e cocriação baseadas na reflexão, coleta de dados, interação e feedback com participantes e partes interessadas. A coleta dos dados foi realizada com os profissionais de saúde, representantes dos órgãos de saúde e idosos por meio entrevistas coletivas e individuais, diários reflexivos e registros de comunicação direta. RESULTADOS: Foi elaborado um plano de ação com participação dos membros da rede de assistência ao idoso para colocar em prática o novo modelo. Realizou-se um piloto com uma equipe multidisciplinar que possibilitou ajustes e a implementação do modelo na instituição. CONCLUSÕES: O novo modelo favoreceu tanto o gerenciamento interno do Centro de Referência Estadual de Atenção à Saúde do Idoso (CREASI) como a interação com a atenção básica, otimizando o fluxo de pacientes e estabelecendo regras de gerenciamento compartilhado entre CREASI e atenção básica. Diante disso, a reestruturação do modelo assistencial representou uma reorganização das relações entre os órgãos, ampliando o papel do CREASI no gerenciamento e na sistematização da saúde do idoso.

Correlación entre las fórmulas de medición de filtrado glomerular Cockcroft-Gault, MDRD-4 y CKD-EPI, y la depuración de creatinina de 24 horas / Relation between Cockcroft-Gault, MDRD-4 and CKD-EPI formulas, compared with the 24-hour creatinin depuration

Resumen Introducción: es evidente que en los últimos tiempos la pirámide poblacional ha tenido cambios significativos, siendo cada vez más estrecha su base. El aumento en el número de personas adultas mayores trae consigo nuevos retos a nivel del ámbito médico, tales como la adaptación y la adecuación de fórmulas y parámetros que permitan prestar una atención medica eficiente y efectiva. De este modo, la determinación de la tasa de filtración glomerular se vuelve un parámetro de vital importancia dada su relación con el aumento del riesgo cardiovascular y la morbilidad general en este grupo de pacientes. Objetivo: comparar las diferentes fórmulas para calcular la tasa de filtrado glomerular con el estándar diagnóstico de depuración de creatinina de 24 horas en pacientes mayores de 85 años de edad, sin enfermedad renal crónica conocida, a fin de establecer la mejor correlación entre las fórmulas MDRD, CKD-EPI y Cockcroft-Gault. Materiales y métodos: estudio prospectivo, observacional, descriptivo y transversal realizado en 25 pacientes que ingresaron al servicio de Geriatría del Hospital Juárez de México entre Junio de 2017 y Junio de 2018. Al ingreso se midieron los niveles séricos de creatinina, se recolectó la orina de 24 horas y se realizaron los diferentes cálculos de tasa de filtrado con las fórmulas MDRD, CKD-EPI y Cockcroft-Gault. Resultados: la tasa de filtrado glomerular promedio medida por depuración de creatinina en 24 horas fue 48,35 mL/min/1,73 m2; según la fórmula de Cockcroft-Gault, 41,49 mL/min/1,73 m2; según MDRD, 64,98 mL/min/1,73 m2, y según CKD-EPI, 57,0 mL/min/1,73 m2, siendo significativamente menores estas dos últimas. De esta forma, se estableció que hay una correlación directa entre los distintos tipos de fórmulas; sin embargo, la que tiene mayor poder estadístico y reciprocidad es la Cockcroft-Gault, siendo estadísticamente significativa. Conclusiones: en pacientes mayores de 85 años de edad las estimaciones medidas por las diferentes tasas de filtrado glomerular no son intercambiables, pero la fórmula Cockcroft-Gault tiene gran ventaja al mostrar resultados estadísticamente significativos (p<0,05); sin embargo, es necesario realizar estudios más amplios en población geriátrica para tener una estimación más precisa.

Abstract Introduction: It is currently evident that the population pyramid has undergone significant changes in recent times. The increase in the number of older adults brings with it new challenges at the medical level, such as the adaptation and adaptation of formulas and parameters that allow efficient and effective medical care to be provided. Among them, the determination of the glomerular filtration rate becomes a parameter of vital importance given its relationship with increased cardiovascular risk and general morbidity in this group of patients. Objective: To compare, in patients over 85 years without known chronic kidney disease, different formulas for calculating the glomerular filtration rate with diagnostic standard 24-hour creatinine clearance, in order to establish the best correlation between MDRD, CKD-EPI and Cockcroft-Gault. Materials and methods: A prospective, descriptive, cross-sectional observational study including 25 patients admitted to the Geriatrics service of the Juarez Hospital in Mexico, in the period from June 2017 to June 2018, serum creatinine levels were measured upon arrival, with 24-hour urine collection and performed filtering rate calculations with the CKDEPI, MDRD and Cockcroft Gault formulas. Results: the average glomerular filtration rate measured by creatinine clearance in 24 hours was 48.35 ml / min / 1.73 m2; according to the formula of Cockcroft and Gault was 41.49 ml / min / 1.73 m2, significantly lower than with MDRD and CKD-EPI 64.98 ml / min / 1.73 m2-57.0 / ml / min / 1.73 m2 respectively. There is a direct correlation between the different types of formulas; however, the one with the greatest statistical power and reciprocity is Cockcroft and Gault being statistically significant. Conclusions: In elderly patients, the formulas for the measurement of glomerular filtration rate are not interchangeable, showing an advantage for Cockcroft and Gault, being statistically significant (P <0.05), however, it is necessary to perform more extensive studies in geriatric population, to have a more accurate estimate.

Cardiopatía en el paciente anciano / Cardiovascular disease in the elderly

Las enfermedades cardiovasculares son muy frecuentes en la población anciana (pacientes mayores de 75 años). El enfrentamiento y manejo de ellas es distinto al indicado en pacientes jóvenes. Son escasos los estudios que incluyen población mayor de 75 años, con evidencia acerca de las diferencias que existen en la respuesta terapéutica en comparación al paciente joven. El anciano tiene mayor fragilidad y múltiples comorbilidades, con reserva cardiaca disminuida, lo que obliga a un manejo integral y acucioso. Los cambios propios de la edad repercuten tanto en riñón, cerebro, hígado, musculatura y corazón, lo que los hace pacientes más proclives a presentar complicaciones de la terapia farmacológica o intervencional. El objetivo de este artículo es resumir las recomendaciones sobre el manejo de las cardiopatías más frecuentes en el anciano, incluyendo insuficiencia cardiaca crónica, cardiopatía coronaria, hipertensión arterial, estenosis aórtica valvular y fibrilación auricular no valvular.

Cardiovascular diseases are very common in the elderly population, and their management is different. There are few studies that include population older than 75 years, with little evidence about the differences in the therapeutic response compared to the young patient. The elderly have greater fragility and multiple comorbidities, with diminished cardiac reserve, which requires a comprehensive and careful management. Changes due to advanced age, in kidney, brain, liver and musculature (among others), make them more vulnerable to complications of the pharmacological or interventional treatment. The objective of this article is to summarize the recommendations on the management of the most frequent heart diseases in the elderly, including chronic heart failure, coronary heart disease, arterial hypertension, valvular aortic stenosis, and non-valvular atrial fibrillation.

Outcomes of Pharmacotherapeutic Intervention Provided by Hospital Pharmacists for Geriatric Health Service Facility Users / 医薬品情報学

Objective: The number of pharmacists regularly working at geriatric health service facilities is limited, but many users of such facilities have multiple chronic conditions and receive continuous pharmacotherapy, simultaneously using numerous different types of oral drugs. We examined the outcomes of pharmacotherapeutic intervention provided by hospital pharmacists for geriatric health service facility users.Methods: We examinedthe outcomes of active pharmacotherapeutic intervention providedby hospital pharmacists for 154 facility users.Results: After the intervention, there were significant decreases in the mean number of types and price of drugs used, as they decreased from 7.38 to 6.17 and 368.3 to 309.2 yen/day, respectively. The number of prescription drugs changed was 300, and 206 of these changes were proposedby the pharmacists. The efficacy-basedcategories that these drugs belongedto widely ranged. The most frequent reasons for change were the “disappearance of symptoms”, “based on indications”, and “suspected adverse events”. Adverse events variedfrom mildto those that may leadto severe conditions.Conclusion: Pharmacotherapeutic interventions by pharmacists may optimize pharmacotherapy, reduce polypharmacy, and reduce the financial burden on geriatric health service facilities.

A community based cross sectional study on morbidities and social problems among geriatric population

Background: In India, in the last one and half decades longevity of the people has increased due to decline in mortality rate, better medical and health care facilities and improvements in overall quality of life of people. Presently India has the second largest geriatric population in the globe. In 2001, geriatric population was 77 million in India and it is estimated that in India total number of elderly will rise to 150 million by 2025 and by the year 2050 the number would rise to about 324 million.4 Methods: A community based cross sectional study was conducted in an urban slum located in Secunderabad. Almost 225 subjects more than 60 years were included in study after giving oral consent. People with severe morbidity and unable to give consent were excluded from study. Results: Majority (70%) of the resident experienced verbal abuse followed by physical abuse (13%) at least one time. About 11% felt they were being neglected by their family members. Daughter-in-law was the major person involved in the elder abuse accounting for 45.9%, followed by son 24.3%. Abuse from relatives accounted for 21.6%. Spouse and daughter were involved in elder abuse in about 5.4% and 2.7% cases respectively. Conclusions: As recently said by Financial Minister in Parliament of India, old age population growing drastically in India, especially in south India. Increasing geriatric population leading to increase in need of health care and psychological assistance.

Analysis on influencing factors of the frailty of the elderly / 中华疾病控制杂志

Objective To explore influencing factors of the elderly's frailty. Methods Eight communities were randomly selected from Dalang Town, Dongguan City, and all the eligible elderly people were investigated using the self-developed frailty index. Univariate analysis was performed using the 2 test, and multivariate analysis was performed by ordinal multi-class Logistic regression. Results Univariate analysis showed that there were significant differences in the distribution of frailty conditions among different demographic characteristics, family relationships, economic situation and lifestyle (all P<0.05). Multivariate analysis showed that younger age (OR=0.13, P<0.001), male (OR=0.65, P=0.012), and daily exercise (OR=0.76, P=0.049) were protective factors for frailty of the elderly. Illiterate (OR=2.42, P<0.001), fewer times to see children per month (OR=1.82, P=0.035), pension funds as the main economic source (OR=1.59, P<0.001), low level of physical activity (OR=2.18, P<0.001) and none social participation (OR=1.41, P=0.004) were risk factors of frailty. Conclusion Age, gender, education level, times to see children per month, economic source, exercise frequency, physical activity level and social participation are the influencing factors of frailty of the elderly.

A Clinical Analysis of patients seen in a Geriatric Mental Health Camp organized in Mumbai

Background: Geriatric mental health is a neglected domain of mental health and many cases remainundetected in the community. Community programs have often helped to detect many cases of the elderlywith psychiatric problems and help them access care. The current paper aims to present an analysis ofpatients seen in a geriatric health camp from a psychiatric perspective.Methods: 103 elderly attended the geriatric camp and were assessed clinically for psychiatric problems. Theywere also administered the Adenbrooke’s Cognitive Examination Revised (ACE-R) Hindi version, Barthel’sIndex for Activities of Daily Living and 3.Hwalek-Sengstock Elder Abuse Screening Test (H-S/EAST). Theresults were analyzed statistically and presented.Results: The mean age of the subjects in the study was 66.05 ± 7.9 years. 83 subjects (79%) out of the 105were female. The mean BIADL score of the sample was 19.52 ± 1.9 and on the basis of scores on the ACER they were classified as having cognitive impairment (n=67) and not having cognitive impairment (n=27).The cognitively impaired group differed from the non-cognitive impairment on all subscales of the ACE-R.55 (52.4%) reported the presence of elder abuse but had taken no action against it. The BIADL scores showeda significant correlation on all aspects of ACE-R scores.Conclusions: Geriatric health camps can serve as a useful arena for the detection of geriatric mental healthproblems. Further studies in larger populations are needed to corroborate the findings seen in the geriatrichealth camp reported in this study

Profile of elderly inmates of old age homes of Patan district, Gujarat, India: a cross sectional study.

Background: Population aging is both a medical as well as a social problem. The situation of the elderly still worsens when there is presence of chronic diseases, physical incapacity and financial stringency. An exceptional increase in the number and proportion of older adults in the country, rapid increase in nuclear families, and contemporary changes in psychosocial matrix and values often compel this segment of society to live alone or in old age homes. The objective of study was to know the medico-social profile of the inmates of an old age homes. Methods: A descriptive cross sectional study was conducted from January to December 2014 to assess the socio-demographic profile, pattern of morbidities and quality of life of elderly residing in old age homes. Total 4 old age homes and 203 elderly people were included in the study after taking verbal and written consent of the elderly people and permission from the managers of all the old age homes. A semi structured and pretested questionnaire was prepared to collect information on socio-demographic characteristics and morbidity pattern. Data was collected and analyzed by appropriate statistical software. Results: Around 65% of elderly people were in the age group of 65 to 79 years. 58% of the males and 39.1 % of the females were suffered from cataract, whereas 39.8 of the males and 39.1 % females were suffered from hypertension. Next common morbidity was diabetes present in 28.4 of the males and 18.3 % of the females followed by joint pain present in 20.5% of the males and 23.5% of the females. No significant difference was found among morbidities of the males and females (x2=2.85, p=0.35). 30.8% of the males and 28.75% of the females were hypertensive. Around 27% of the males and 36% of the females were obese and 18% of males and females were pre-obese according to BMI value. There was no significant difference in the BMI among males and females. Conclusions: The study highlighted a high prevalence of morbidity and health related problems in old age group.

Validity and Reliability of Korean Version of International Physical Activity Questionnaire Short Form in the Elderly / 가정의학회지

BACKGROUND: Estimation of physical activity contributes to early screening and prevention of decrease in body function. This study was conducted to examine the reliability and validity of the International Physical Activity Questionnaire (IPAQ) short form in elderly people. METHODS: A total of 55 outpatients of 65 years old or older participated in this study. Physical activity over the last seven days was recorded on the IPAQ short form. Responses were converted to metabolic equivalent task minutes per week. The IPAQ short form was validated against accelerometer measurements as a gold standard. The test-retest method was performed over a two-week interval to examine the reliability of the IPAQ. RESULTS: The more physically active by the IPAQ short form, the higher the measured value of the accelerometer (P < 0.001). Pearson's correlation coefficient was 0.43 for the correlation between the results of two measurements. Spearman Rho coefficients and Kappa values of test-retest reliability in five elements (vigorous days, vigorous minutes, moderate days, moderate minutes, and walk days) were 0.299-0.605 and 0.307-0.418, respectively. CONCLUSION: The validity of the IPAQ short form was proven, but the reliability was found to be low. Nevertheless, IPAQ short form seems worthwhile tool for the measurement of physical activity levels, concerning daily variation in physical activity of the elderly.

Geriatric health: Need to make it an essential element of primary health care.

Within the next few decades, we will see an extraordinary increase in the number of older people worldwide. The public health benefit of preventive medicine in old age comes from the compression of the time spent in dependency to a minimum. A community-based, cross-sectional study was conducted to assess the morbidity profile of the geriatric population in a rural area of Maharashtra. A total of 214 subjects, of age 60 years and above, were examined. Data were collected by structured interviews and clinical and laboratory examinations. Out of the total of 214 subjects, 190 were suffering from some or the other diseases and the major morbidities were visual (56%), musculoskeletal (38.3%), respiratory (32.7%), and hypertension (28%). Anemia was present in 62.6%, 5.61% had Diabetes Mellitus and 22.5% were found to be overweight. The average morbidity load was 2.61. The rising morbidities clearly showed that a regular, complete health checkup of the elderly should be embedded in the essential elements of the Primary Health Care. This would reduce the morbidity, improve the quality of life, and facilitate 'Active Aging'.

Prevalence and determinants of blindness, low vision, deafness and major bone fractures among elderly Omani population of Nizwa Wilayat (Nizwa elderly population study – 2005).

Aim: We conducted a survey in 2005 to estimate the prevalence and determinants of visual and hearing impairment in a population aged 60 years and above, from the Nizwa Wilayat of Oman. We also correlated them with major bone fracture. Study Design: Cross-sectional survey. Materials and Methods: Vision was tested on Snellen's 'E' chart. Persons with vision less than 20/200 were reexamined by an ophthalmologist to find cause of impairment. Hearing was tested by a screening audiometer. Self-reported information on fracture of major bones was confirmed by review of case records. The prevalence, 95% confidence intervals (CI), and number of visually impaired individuals were calculated. Statistical Analysis: Univariate method and parametric tests were used for analysis. Results: We examined 1,639 (80.3%) Omani persons aged 60 years and above. The prevalence of blindness (vision less than 20/200 in the better eye) was 37.4% (95% CI 35.7–39.1). Blindness was significantly higher in females (Odd's Ratio = 2.1) but was similar in urban and rural Nizwa (OR = 0.73). The prevalence of vision impairment (20/60 to 10/200) was 36.0% (95% CI 34.3–37.7). Cataract was the principal cause in 50% of the blind. The prevalence of glaucoma, corneal opacity, and chronic trachoma was 3.1%, 66.8%, and 53.2%, respectively. Among participants, 36.1% had diabetes. Hearing impairment was noted in 33.5% and profound hearing loss was noted in 3.6% of participants. In the past year, 1.4% of participants had a major bone fracture. Conclusion: Visual and hearing impairment and blinding eye diseases were common among senior Omani citizens.

Propriedades psicométricas de um protocolo neuropsicológico breve para uso em populações geriátricas / Psychometric properties of a brief neuropsychological protocol for use in geriatric populations

CONTEXTO: O aumento na expectativa de vida e na proporção de idosos na população tem acarretado elevação nas taxas de prevalência de demências. O diagnóstico correto da demência é muito importante para o tratamento clínico e para um melhor prognóstico. Por isso, é necessário adaptar e desenvolver instrumentos para o diagnóstico diferencial entre os processos de envelhecimento normal e patológico. OBJETIVO: Avaliar as propriedades psicrométricas e a estrutura fatorial de um protocolo neuropsicológico usado para avaliação geriátrica. MÉTODO: Pacientes (n = 69) com queixas cognitivas heterogêneas foram avaliados no Núcleo de Geriatria e Gerontologia do Hospital das Clínicas da Universidade Federal de Minas Gerais, a partir de um protocolo composto pelo Miniexame do Estado Mental, Desenho do Relógio, Cubos de Corsi, Fluência Verbal, Span de Dígitos e Token Test. A análise estatística incluiu análise fatorial dos resultados dos testes, correlação de Pearson entre o fator obtido e a idade, escolaridade, anos de educação formal e a Classificação Clínica das Demências (CDR) e a área sob a curva ROC. RESULTADOS: A análise fatorial dos escores do teste mostrou um fator geral representativo que teve associação moderada e significativa com o CDR (r = -0,672; p < 0,001) e anos de educação formal (r = 0,455; p < 0,001). Esse fator teve fraca, mas significativa, correlação com a idade (r = -0,282; p < 0,05). CONCLUSÃO: Esses resultados apontam para uma boa validade de construto e de critério do protocolo na avaliação do declínio cognitivo de idosos. Estudos futuros sobre aplicabilidade e normas populacionais são necessários para aprimorar o uso clínico desse protocolo de avaliação.

BACKGROUND: The increase in life expectancy and proportion of elderly in the population is causing an increase in dementia prevalence rates. The correct, early dia gnosis of dementia is very important to clinical treatment and to improved prognosis. Therefore, it is necessary to adapt and develop assessment tools for the differential diagnosis between pathological and normal aging processes. OBJECTIVE: Assess the psychometric properties and the factorial structure of a neuropsychological protocol used in geriatric assessment. METHOD: Subjects (n = 69) with heterogeneous cognitive complaints were assessed at the Geriatric and Gerontologic Clinic at the Clinical Hospital of the Federal University of Minas Gerais using a protocol composed of the Mini-Mental State Examination, Clock Drawing, Corsi Blocks, Verbal Fluency, Digit Span and Token Test. Statistical analyses included factorial analyses of test results, Pearson's correlation between obtained factor, age, years of formal education and Clinical Dementia Rating (CDR) and area under the ROC curve. RESULTS: The factorial analyses of test scores showed a general representative factor that had moderate and significant association with CDR (r = -0.672; p < 0.001) and years of formal education (r = 0.455; p < 0.001), respectively. This factor had weaker and less significant correlation with age (r = -0.282; p < 0.05). DISCUSSION: These results point to the protocol's good construct and criteria validity in assessing cognitive decline in the elderly. Future works concerning applicability and populational norms are needed to improve the clinical use of this assessment protocol.

The Diagnosis Distribution in Health Examination of Old Aged People and Associated Sociodemographic Factors

BACKGROUND: According as old aged people have an increased interest in early detection of disease and health promotion, old aged people who take health examinations are increased. So this study is aimed to survey common problems about geriatric health in community and their frequency by way of investigation on diagnosis in health examination data and to evaluate the effects of health risk factors on each disease patterns. METHODS: The medical records of the clients who have taken health examinations for the first time from March 1995 to February 2000 at a health examination center of a university hospital in Seoul were reviewed. The category and number of judged diagnosis, sociodemographic factors are compared and analyzed. RESULTS: The selected medical records accounted to 22,393. The study subjects consist of 11,544(51.6%) male. Mean age is 52.0+/-10.5 years(range 16~90). 65 years or more old aged people of them are 2,612(11.7%), the number of judged diagnosis per one old person is 4.84+/-2.22(range 0~9) and young people took less diagnosis is 35.7%, functional diagnosis is 7.9%. The common diagnoses are liver disease(7.07%), decreased physical strength(6.68%), hyperlipidemin(6.53%),obesity(5.90%), osteoporosis or postmenopausal syndrome(4.72%), need for immunization against viral hepatitis(4.69%), hypertension(4.20%) functional gastrointestinal disease(3.93%). The number of total diagnosis and organic diagnosis is larger in older age, no exercise, female,smoker, no-spouse, lower education(p<0.05). The number of other diagnosis is larger in no exercise, smoker, female, younger age(p<0.05). CONCLUSION: According to health examination, total diagnosis and organic diagnosis are more in old aged group than in young. Functioinal diagnosis and other diagnosis is less in old aged group than in young.