Frailty and polypharmacy in the community-dwelling elderly with multiple chronic diseases.

BACKGROUND: Both multi-morbidity (MM) and polypharmacy (PP) are common in the elderly and pose a challenge for health and social care systems. However, high-quality patient-centred care requires context-bound understanding of the patterns and use of medications in those with MM. Therefore, the aim of this study was to investigate the prevalence of PP in community-dwelling elderly, and the factors associated with MM, PP, excessive polypharmacy (EPP), and the types of drugs used. METHODS: We analysed data of 164 community-dwelling subjects aged ≥60 years from January to December 2020 at a general hospital in a rural area of Taiwan. MM was defined as >4 diagnoses of chronic health conditions. Non-polypharmacy (NP), PP, and EPP were defined as <5, 5-8, and >8 prescriptions, respectively. Other variables including basic activities of daily living (BADL), severity of frailty, depressive mood, screening for intellectual impairment, and nutritional status were also analysed. RESULTS: Of the 164 participants, 34.8% had >4 diagnoses, 66.5% had PP, and 26.2% had EPP. The patients with >4 diagnoses had worse performance in BADL, higher levels of frailty, and more prescriptions than those with fewer diagnoses. The EPP group had worse performance in BADL, a higher level of frailty, more comorbidities, and higher prevalences of diabetes mellitus and chronic kidney disease compared to the NP and PP groups. After adjusting for covariates, we further found a higher number of medications associated with having more comorbidities, and a higher level of frailty associated with having a greater number of medications. CONCLUSION: We found relationships between frailty and PP, and between PP and MM, but frailty did not associate with MM. Since frailty, PP, and MM may be viewed as an inevitable trinity of ageing, reducing PP could be a method to both prevent frailty and disentangle this trinity in the elderly.

Gastric cancer in the young.

BACKGROUND/AIMS: Gastric cancer in the young is relatively uncommon, but it carries important clinical significance. This study was designed to determine the clinicopathological characteristics of young patients who underwent a gastrectomy for gastric cancer in order to improve clinical management. METHODOLOGY: From January 1977 to December 1994, 997 patients underwent surgical treatment for gastric cancer in the Department of Surgery of the National Taiwan University Hospital. All of these patients were classified into 6 groups based on their age at the time of surgery. Of these, 52 patients (5.2%) were 35 years of age or younger. The clinicopathological data of these patients were reviewed and compared to the data of the other age groups. RESULTS: There was a female predominance, with a male:female ratio of 1:1.36. In the majority of patients, the time period from the onset of symptoms to the time of diagnosis was less than one year (76.9%). Epigastralgia was the most common complaint (65.4%). Six patients (11%) were diagnosed as having a benign peptic ulcer during the first endoscopy. Histologically, there were more diffuse (65.4%) and scirrhous types of gastric cancer in the young group. Half of the patients (49.9%) were at TNM stage III or IV at the time of surgery. Curative resections were performed on 49 patients. The cumulative 5-year survival rate was 36.1% among the young patients, which was no different from the survival rates of the other age groups. While the 5-year survival rate of patients with stage I gastric cancer was 90% in the young age group, of the 26 patients with stage III or IV, only one survived more than 5 years. Four female patients (13.3%) were found to have metastases to the ovaries during follow-up. CONCLUSION: The clinicopathological characteristics of young patients with gastric cancer are as follows: 1) female dominance; 2) more diffuse and scirrhous types of gastric carcinoma; 3) the prognosis after surgery depends on the stage rather than the age; 4) free use of endoscopy and clinical alertness are important for the early diagnosis of malignancy in young patients.