Higher prevalence of geriatric depression, catastrophizing pain and sleep disorders in institutionalized elders: a cross-sectional study in Galle District, Sri Lanka.

BACKGROUND: Population aging is a significant social problem in the twenty first century. Recent economic and social changes lead increasing number of elders to spend their lives in elderly homes. Institutionalized elders have to face many physical and psychological problems which negatively impact their quality of life. Geriatric depression (GD), catastrophizing pain (CP) and sleep disorders (SD) are some common problems among them. METHODS: Present study was designed to assess the prevalence of GD, CP and SD and their correlations in institutionalized elders. A descriptive cross-sectional study was conducted in elderly homes (n = 20) in the Galle district of Sri Lanka enrolling 310 subjects. GD, CP and SD were assessed using validated Sinhala versions of Geriatric Depression Scale (GDS), Pain Catastrophizing Scale (PCS) and Pittsburgh Sleep Quality Index (PSQI) respectively. Data were analyzed using SPSS version 25.0 for windows by using descriptive statistics, the Pearson's chi-square test and Pearson's bivariate correlation (p < 0.05). RESULTS: Among the participants (response rate: 95.7%), 34.8% (n = 108) and 65.2% (n = 202) were males and females respectively. Age range of the subjects was 60-103 years with the mean age of 74.97 years (SD 8.852). Most of the study subjects (n = 234, 75.5%) had spent five or less than 5 years in elderly homes at the time of the study and 52.8% (n = 164) of them were unmarried. GD was present in 76.5% (95% CI: 71.7-81.2) of subjects and of them 44% had moderate to severe depression. PCS revealed that 29% (95% CI: 24.0-34.1) had CP. SD were identified in 55.5% (95% CI: 49.5-61.0) of elders and according to PSQI, 86% (95% CI: 82.3-90.0) had poor quality sleep. Positive correlations between GD and CP (r = 0.24, p < 0.01), GD and SD (r = 0.13, p = 0.02), CP and SD (r = 0.32, p < 0.01) were statistically significant. CONCLUSIONS: Prevalence of GD, CP and SD were significantly higher in this sample of institutionalized elders who were apparently healthy. Findings highlighted the importance of early screening of physical and psychological problems in institutionalized elders to assure better quality of life and to reduce the burden to health care system of the country.

Age-related trends and reference intervals of cross-linked C-telopeptide of type I collagen and procollagen type I N-propeptide from a reference population of Sri Lankan adult women.

Refer ence values of bone turnover markers (BTMs) are determined by factors that are country-specific. In Sri Lanka, unavailability of BTM reference data has led to their non-use in management of osteoporosis. The results of this study can be used as reference data for women in Sri Lanka. INTRODUCTION: This study was performed to establish age-related reference intervals for bone resorption marker; cross-linked C-telopeptide of type I collagen (CTX) and bone formation marker; procollagen type I N-propeptide (PINP) in a group of Sri Lankan adult women. METHODS: Adult women (n = 347) aged 20-70 years were recruited using age-stratified random sampling technique and categorized into age groups by decades. Serum CTX and PINP concentration were measured using enzyme-linked immunosorbent assay (ELISA). The geometric mean (95% confidence interval) and 2.5th and 97.5th percentiles were calculated. ANOVA was used to compare the means between groups. RESULTS: Mean CTX levels were relatively low and remained unchanged between 20 and 49 years. After the age of 49 years, mean CTXconcentration elevated significantly until the age of 70 years (43%, p < 0.001). Mean PINP concentrations were not significantly different between age categories (p > 0.05). Reference intervals of CTX and PINP were based on 2.5th and 97.5th percentile values. Reference intervals of CTX for the age groups of 20-29, 30-39, 40-49, 50-59, and 60-70 years were 0.19-0.97 ng/mL, 0.18-0.95 ng/mL, 0.20-1.29 ng/mL, 0.17-2.20 ng/mL, and 0.17-2.85 ng/mL respectively. Reference intervals of PINP for the same age groups were 118-810 pg/mL, 119-772 pg/mL, 116-645 pg/mL, 108-684 pg/mL, and 108-715 pg/mL respectively. CONCLUSION: In Sri Lanka, bone turnover markers are not used in evaluating patients mainly due to lack of normative data. These values can be used as reference data for women in this age group.

Urinary iodine and thyroid determinants in pregnancy: a follow up study in Sri Lanka.

BACKGROUND: Iodine deficiency and thyroid dysfunction during pregnancy is associated with number of adverse outcomes that includes mental and physical disabilities creating a huge human and economic burden in later life. Several indicators are used to assess the iodine status of a population: thyroid size by palpation and/or by ultrasonography, urinary iodine excretion and the blood thyroid hormone profile. METHODS: This prospective study was designed to assess the iodine nutrition during the course of pregnancy with reference to urine iodine concentration (UIC) and thyroid determinants among 425 pregnant women from Galle district, Sri Lanka. UIC was estimated in all three trimesters and thyroid functions were assessed in first and third trimesters. RESULTS: Median (inter-quartile range IQR) UIC was 170.9 (100.0-261.10) µg/L, 123.80 (73.50-189.50) µg/L and 105.95 (67.00-153.50) µg/L in the first, second and third trimesters respectively (p < 0.001). Median thyroid stimulating hormone (TSH) level in the first trimester was 1.30 (0.80-1.80) µIU/mL. This value significantly increased (p < 0.001) to 1.60 (1.20-2.10) µIU/mL at the 3rd trimester even though it was maintained within the reference range (0.3 - 5.2 µIU/mL). In the assessment of thyroid gland, 67 (16.0 %) women had palpable or visible goitres and 55 (13.1 %) had a goitre that was palpable but not visible. The median thyroid volume of the sample was 5.16 mL (4.30; 6.10 mL) as measured by ultra sound (US) scanning. In multiple regression analysis after controlling for other independent variables (anthropometric, demographic and biochemical parameters); initial body mass index (BMI), goitre size, thyroid volume and parity had significant correlations with the third trimester urinary iodine levels. The thyroid volume accounted for 4.5 % of the urinary iodine variation. CONCLUSIONS: Even though iodine status was progressively worsening with the advancement of pregnancy and iodized salt consumption has not met with the increasing demand for iodine, it was not reflected in the serum TSH level. Therefore, it is worthwhile to assess the long term effects of rising TSH levels and inadequate iodine nutrition during pregnancy on the offspring to prevent even mild iodine deficiency.