Malnutrition Prevalence and Nutrient Intakes of Indonesian Older Adults in Institutionalized Care Setting: A Systematic Review of Observational Studies.

INTRODUCTION: Data on the prevalence of malnutrition and nutrient intakes among Indonesian older aduls in institutionalized care setting are scattered and scarce. Thus, we conducted a systematic review of published and grey literature to estimate (1) the prevalence of malnutrition, (2) the level and distribution of habitual energy and nutrient intakes, and (3) the prevalence of inadequacy of energy and nutrient intakes among hospitalized and institutionalized older adults in Indonesia. METHODS: This systematic review was written following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist. The population of this review was Indonesian older adults in institutionalized care settings, including hospital ward, orphanages, nursing homes, residential facilities, and rehabilitation centers . Malnutrition was assessed using body mass index, the mini nutritional assessment (MNA) score, or the subjective global assessment (SGA) score. The dietary intakes (from food recalls, food records, or food frequency questionnaire) were compared with the Indonesian recommended daily allowances (RDAs) for people aged 65 to 80. The prevalence of inadequacy was calculated using two-thirds of the RDA as a proxy for the estimated average requirement (EAR). RESULTS: The search yielded 330 studies from electronic databases, resulting in fifteen eligible studies. One report was obtained from an unpublished study. Based on the JBI criteria, most studies had low risk of bias and represented the target population. The prevalence of malnutrition in hospital, nursing home, and other institutionalized care ranged from 6.5%-48.3% in hospitals and 3.2%-61.0% in other institutionalized care units. In the hospital setting, there was a high prevalence of inadequacies for all nutrients, particularly protein (20%), calcium (more than 90%), and vitamin D intakes (more than 50%). In nursing homes, these proportions were exceptionally high for protein (66%) and calcium and vitamin D intakes (almost 100%). CONCLUSION: The high risk of malnutrition Indonesian older adults in institutionalized care setting is pronounced, along with poor intakes of macronutrients and micronutrients in both settings.

Comparisons of Characteristics and Nutritional Inadequacies in Indonesian Older Adults Consuming or Refraining from Dairy Products.

BACKGROUND: Milk consumption in the Indonesian elderly population is among the lowest in the world, and two-thirds of the population are lactose intolerant. This might have an impact on energy and nutrient intakes. However, data on the prevalence of nutrient intake inadequacies in dairy users versus non-dairy users, as well as population characteristics, are lacking. Therefore we obtained data comparing nutritional inadequacies and characteristics of Indonesian older adults consuming or refraining from dairy products. METHODS: A cross-sectional study was conducted in 2021 as a part of the INA LACTASE study, involving 194 community-dwelling older adults in the outpatient geriatric clinic at Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia. We collected data on demographic and clinical characteristics as part of a routinely performed comprehensive geriatric assessment. A structured questionnaire was developed to categorize participants as dairy-or non-dairy users based on habitual dairy intake. Food records were collected to assess nutrient intakes. The prevalence of inadequacies of energy, macronutrients, and a selection of micronutrients (calcium, vitamin D, and vitamin B12) was calculated by comparing the reported mean intakes to the recommended dietary intakes of the Indonesian population (Indonesian RDA). Prevalence ratios were calculated to measure the association between dairy product consumption and the prevalence of nutrient inadequacies. RESULTS: We recruited 194 eligible participants. This study found that dairy users had a higher proportion of women, a higher monthly income, but a lower proportion of hypertension, diabetes mellitus, and dyslipidaemia in older adults consuming dairy products. We observed wide variability in energy and nutrient intakes, as well as a high prevalence of inadequacies for all dietary intake parameters, particularly micronutrients. Dairy users had a lower prevalence of micronutrient inadequacies than non-dairy users. The prevalence of vitamin D inadequacies in dairy users versus non-dairy users was 91.6% vs. 99.3% in men and 71.9% vs. 98.0% in women, respectively. Inadequate vitamin B12 intake was found in 60.6% of dairy users vs. 89.4% of non-dairy users in men and 65.5% vs.. 68.4% of women, respectively. The most pronounced difference was found in the prevalence of calcium intake inadequacies in dairy users vs. non-dairy users, which was 64.8% vs. 99.5% in men and 89.9% vs. 99.8% in women. We found statistically significant differences in the prevalence of calcium, vitamin D, and vitamin B inadequacies between dairy and non-dairy users. CONCLUSION: This study identified that dairy users had a higher monthly income and had a lower proportion of hypertension, diabetes mellitus, and dyslipidemia. In addition, we discovered a high prevalence of nutrient intakes inadequacies in Indonesian older adults, particularly among non-dairy users. Micronutrient inadequacies are major sources of concern, with statistically significant difference in calcium, vitamin D, and vitamin B12 prevalence of inadequacies.

Malnutrition Prevalence and Nutrient Intakes of Indonesian Community-Dwelling Older Adults: A Systematic Review of Observational Studies.

Background: Malnutrition and inadequate nutrient intake are associated with functional decline, frailty, and bad clinical outcomes among community-dwelling older adults. Despite the growing proportion of the elderly population in Indonesia, data on the prevalence of malnutrition and adequacy of macronutrient and micronutrient intakes among Indonesian older adults are scattered and vary between studies. Therefore, our study aims to obtain data on malnutrition prevalence, level and distribution of nutrient intakes, and prevalence of macronutrient and micronutrient inadequacies in Indonesian community-dwelling older adults. Methods: We carried out a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and registered in PROSPERO. A systematic electronic database search of MEDLINE, CENTRAL, EMBASE, ProQuest, HINARI, IMSEAR, GARUDA, and Indonesian Publication Index was undertaken. Additional searches were conducted in gray literature sources, hand-searching, retrospective searching, and personal communication with authors of the relevant publication. Observational studies presenting the malnutrition prevalence of habitual dietary intakes of older adults (60 years or older) were included. The risk of bias of studies was assessed using the Joanna Briggs Institute critical appraisal form. Sex-specific mean (and standard deviation) habitual macronutrient and a selection of micronutrients (calcium, vitamin D, and vitamin B12) intakes were extracted from each article to calculate the percentage of older people who were at risk for inadequate micronutrient intakes using a proxy of estimated average requirement (EAR) cut-point method, which is calculated from the national guideline of recommended dietary allowance (RDA). Prevalence of malnutrition, based on body mass index (BMI) categories and mini-nutritional assessment (MNA) criteria. and the population at risk of malnutrition were presented descriptively. Results: Nine studies retrieved from electronic databases and gray literature were included in the pooled systematic analysis. According to BMI criteria, the underweight prevalence ranged from 8.0 to 26.6%. According to the MNA, the prevalence of malnutrition ranged from 2.1 to 14.6%, whereby the prevalence of at risk of malnutrition amounted to 18-78%. Our systematic review identified a high prevalence of nutrient inadequacies, most markedly for protein, calcium, vitamin D, and vitamin B12. Conclusion: We signal a high risk of malnutrition along with poor macronutrients and micronutrients intakes among Indonesian community-dwelling older adults. These findings provide important and robust evidence on the magnitude of malnutrition and nutrient inadequacy concerns that call for appropriate nutrition, as well as public health policies and prompt intervention. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018102268.

Prevalence of lactose intolerance and nutrients intake in an older population regarded as lactase non-persistent.

BACKGROUND AND AIMS: Energy and nutrient intakes of community-dwelling older adults in Indonesia are inadequate whereby milk consumption is among the lowest in the world. Lactose intolerance is probably one of the reasons for such low milk consumption, but information on the burden of this problem and its consequences for dietary intake is lacking. We obtained data on the prevalence of lactose intolerance and dietary intakes in Indonesian older outpatients, thereby comparing dairy users and non-dairy users. METHODS: A cross-sectional study was conducted in 2019 involving 103 community-dwelling older adults in the outpatient geriatric clinic, Dr. Cipto Mangunkusumo Hospital, Jakarta. A structured questionnaire was used to categorize participants as dairy- or non-dairy users. Food records were collected to assess nutrients intake from the diet. The prevalence of lactose intolerance (LI) was estimated based on the results of the hydrogen breath test (HBT) and on symptoms of lactose malabsorption. The difference in LI prevalence between dairy- and non-dairy user group was presented as a prevalence ratio (with 95% confidence interval). Chi-square tests, t-test, and Mann-Whitney tests were used to evaluate differences in demographic and clinical characteristics, as well as in nutrient intake profiles between dairy and non-dairy users. RESULTS: The prevalence of lactose intolerance amounted to 66% (57-75%), 54% (37-70%), and 73% (61-84%) in the total population, dairy- and non-dairy users, respectively. Lactose intolerance tended to be higher among non-dairy users (PR 1.36 95% CI 0.99-1.89). On the other hand, we found no pronounced differences in symptoms of lactose intolerance between dairy and non-dairy users. The overall mean protein, calcium, vitamin D, and vitamin B12 intakes of the older adults were low. Intakes of protein, calcium, vitamin D and vitamin B12 were higher among dairy than among non-dairy users. CONCLUSIONS: This study uncovered the large size of the lactose intolerance problem in Indonesian older adults. Especially in non-dairy users, the intakes of proteins and some micronutrients are a concern. Strategies to tackle lactose intolerance are most relevant as to open the door for more nutrient-dense foods in the diet of Indonesian older adults.

Streptococcus pneumoniae carriage and antibiotic susceptibility among Indonesian pilgrims during the Hajj pilgrimage in 2015.

The Hajj is an annual pilgrimage to Mecca and one of the largest gathering of people in the world. Most Indonesian pilgrims are senior adults and elderly adults, who are more prone to acquire infections during the Hajj ritual. The aims of this study are to investigate the dynamics of Streptococcus pneumoniae colonization and to investigate antibiotic susceptibility of pneumococcal strains in Indonesian pilgrims. This was a prospective multi-site longitudinal study in Indonesian hajj pilgrims aged >18 years old in the year 2015. Nasopharyngeal swabs were collected from the same subject before departure and upon arrival at the airport. S. pneumoniae was identified using conventional and molecular approach, while antibiotic susceptibility was determined using a disk diffusion method. Among 813 Hajj pilgrims who were enrolled from five sites in this study, the prevalence of S. pneumoniae carriage rates before- and after-the Hajj were 8.6% (95% CI 6.7-10.5%) and 8.2% (95% CI 6.4-10.1%), (p value: 0.844) respectively. Serotype 16F, 6A/6B, 3, 18, and 23F were the five most prevalent serotypes before Hajj, whereas serotypes 3, 34, 13, 4, and 23F were the most prevalent serotypes after Hajj. Serotype 3 was identified as most acquired serotype during Hajj in Indonesian pilgrim. There was an increase in the percentage of isolates susceptible to co-trimoxazole after Hajj (42.9% versus 57.4%). The study provided an overview of the change of dynamics of S. pneumoniae serotype acquisition in Indonesian Hajj Pilgrims. Along with data of vaccination serotypes coverage and antimicrobial susceptibility, these findings may contribute to recommendation of vaccination and treatment policies in the future.

The Role of Fragmented QRS (fQRS) As A Predictor of Major Adverse Cardiac Event within 30 days in Acute Coronary Syndrome Patients: A Retrospective Cohort Study.

BACKGROUND: some studies show fragmanted QRS (fQRS) as a marker of myocardial scar, ventricular arrhythmia, ventricular remodelling and worse coronary collaterals flow, which can increase the incidence of major adverse cardiac event (MACE) after infarction. This study aimed to identify the role of fQRS as one of the risk factors for MACE (cardiac death and reinfarction) in acute coronary syndrome patients within 30 days observation. METHODS: a cohort retrospective study was conducted using secondary data of acute coronary syndrome patients at Intensive Cardiac Care Unit Cipto Mangunkusumo Hospital from July 2015 to October 2017. Multivariate analysis were done by using logistic regression with GRACE score (moderate and high risk), low eGFR (< 60 ml/min), low LVEF (< 40%), diabetes mellitus, age more than 45 years and hypertension as confounding factors. RESULTS: three hundred and fifty three (353) subjects were included. Fragmented QRS was found in 60,9 % subjects. It was more frequent in inferior leads (48.8% ) with mean onset of 34 hours. Major adverse cardiac events were higher in fQRS vs. non-fQRS group (15.8% vs. 5.8 %). Bivariate analysis showed higher probability of 30 days MACE in fQRS group (RR 2.72; 95%CI 1.3 -5.71p=0.08). Multivariate analysis revealed adjusted RR of 2.79 (95% CI: 1.29 - 4.43, p<0.05). Low eGFR was a potential confounder in this study. CONCLUSION: persistent fQRS developed in ACS during hospitalization is an independent predictor of 30 days MACE cardiac death and re-infarction.

Evaluation of the role of near-peer teaching in critical appraisal skills learning: a randomized crossover trial.

OBJECTIVES: The study sought to evaluate near-peer tutors' teaching of critical appraisal skills to medical students as an aspect of Evidence-based Medicine. METHODS: In a randomized crossover trial, 241 students completing a Clinical Epidemiology and Evidence-based Medicine (CE-EBM) module in the Faculty of Medicine Universitas Indonesia (FMUI) were randomly assigned to intervention or control groups. During tutorial sessions, intervention group participants were assigned to near-peer tutors, who were newly graduated doctors, and those in the control groups were assigned to staff tutors. After two tutorial sessions, intervention and control groups exchanged tutors for the next two sessions. Outcomes were measured using written knowledge and skills multiple choice questions (MCQ) test, the Evidence-based Practice Confidence Scale (EPIC) and a student attitude questionnaire, along with student evaluation of tutors to evaluate the process. RESULTS: On completion of the module, the written test scores of intervention group students were similar to those of the control group (t(239) = 1.553, p=0.122), as well as overall Evidence-based Practice Confidence Scale scores (F(2/170) = 0.179, p = 0.673) and attitude scores (t(219) =-0.676, p = 0.085). In the tutor evaluations, the students rated their near-peer tutored sessions as better than those tutored by staff in most respects. CONCLUSIONS: Near-peer tutors were as effective as and more readily accepted than staff tutors in teaching critical appraisal skills. These findings support the broader implementation of peer-teaching in other areas of medical education.

Gallbladder Wall Thickening for Early Detection of Plasma Leakage in Dengue Infected Adult Patients.

BACKGROUND: plasma leakage is defined as ≥20% elevation of hematocrit from baseline or decrease in convalescence or evidence of plasma leakage such as pleural effusion, ascites or hypoproteinaemia/hypoalbuminaemia. These signs of plasma leakage, in the early phase, are usually difficult to ascertain by physical examination and laboratory tests where the patient is only reflecting a mild degree of plasma leakage. This study aimed to investigate whether gallbladder wall thickening (GBWT) in the early phase of the disease can be used to detect the occurrence of plasma leakage in dengue patients. METHODS: a diagnostic study was conducted among dengue patients. Patients with fever less than 3 days, positive results of non-structural protein 1 antigen dengue and RT-PCR examination were included consecutively. Laboratory tests and chest and abdominal ultrasonography examination were also performed daily from day-3 to day-7 of fever to confirm the occurrence of plasma leakage using WHO 1997 criteria during treatment. RESULTS: there were 69 patients included in this study. Male patients were found more frequently (52.2%), average age was 24.2 years, and 46 patients (66.7%) presented with secondary dengue infection. On the third day of fever, 37 patients presented with GBWT, 30 of which showed plasma leakage during treatment. Out of 46 patients found to have plasma leakage during treatment, 12 patients had presented with plasma leakage on the third day of fever. Sensitivity and specificity of GBWT on the third day of fever were 65% (95% CI: 0,51-0,79) and 70% (95% CI: 0.51-0.88); PPV and NPV were 81% (95% CI: 0.68-0.94) and 50% (95% CI: 0.33-0.67); LR (+) and LR (-) were 2.14 (95% CI: 1.12-4.12) and 0.5 (95% CI: 0.31-0.81), respectively. CONCLUSION: gallbladder wall thickening in the early phase of the disease can be used to detect the occurrence of plasma leakage in adult dengue infected patients.

Riedel's Lobe: Clinical Importance of a Rare Variant in Liver Morphology.

Riedel's lobe is a normal variant form of right liver lobe rarely found. Here we report a case of 38 years old female with an incidental finding not revealed in physical examination, but then known to have hepatomegaly by gynecological ultrasonography. Diagnosis of Riedel's lobe was strengthened by similar results on hepatobiliary ultrasonography, abdominal MRI, and diagnostic laparoscopy. Our patient was discharged and had follow up examination three months later. Knowledge regarding this anomaly is essential to be understood because the finding of accessory liver lobe does not always remain asymptomatic as in our patient, but rather can be related to significant clinical complication.

Effect of Nigella sativa Seed Extract for Hypertension in Elderly: a Double-blind, Randomized Controlled Trial.

BACKGROUND: Nigella sativa (NS) seed extract shows diuretic activity, inhibits sympathetic nervous system overactivity and increases the production of Nitric Oxide in in vivo studies, thus it has a potential use as an adjuvant antihypertensive for elderly population. This study aimed to determine the effect of Nigella sativa seed extract to systolic blood pressure (SBP) and diastolic blood pressure (DBP) of elderly patients with hypertension. METHODS: a double-blind, randomized controlled trial was conducted on elderly subjects with hypertension in three outpatient clinics in Cipto Mangunkusumo National Hospital Jakarta Indonesia from June to September 2011. Subjects were divided into intervention group given 300 mg Nigella sativa seed extract twice daily for 28 days and into another group which was given placebo. Blood pressure were measured on day 1 and 28. Intention to treat analysis using unpaired t-test to compare blood pressure after intervention between the two groups was performed. RESULTS: of a total of 85 patients, 76 subjects fulfilled the study criteria and were randomized into 2 groups, with 38 subjects in each group. Both groups were comparable in all important prognostic factors. The mean systolic blood pressure of the NS group was decreased from 160.4 (SD 15.7) mmHg to 145.8 (SD 19.8) mmHg, and from 160.9 (16.3) mmHg to 147.53 (SD 22.0) mmHg in the placebo group (p=0.36). The mean diastolic blood pressure in the NS group was decreased from 78.3 (SD 11.9) to 74.4 (SD 8.2) mmHg, and from 79.0 (SD 12.4) to 78.2 (SD 8.9) in the placebo group (p=0.35). Reported adverse events include dyspepsia in 6 subjects (15.7%), nausea in 3 subjects (7.8%), and constipation in 2 subjects (5.2%). No electrolyte abnormalities, liver and renal toxicities, or orthostatic hypotension were observed. CONCLUSION: although a trend towards a slight decrease in blood pressure was observed, Nigella sativa has not been proven to be effective in reducing blood pressure in elderly patients with hypertension.

Thyroid Dysfunction in Type 2 Diabetes Mellitus Patients.

BACKGROUND: thyroid dysfunction is more likely to occur in diabetes mellitus patients than general population. Until now, no study has been done to find prevalence of hypothyroidism and hyperthyroidism in Indonesian diabetics. This study aimed to find the proportion and characteristics of thyroid dysfunction in Indonesian type 2 diabetes mellitus patients. METHODS: a cross-sectional study was conducted in Endocrine and Diabetes Polyclinic, Department of Internal Medicine, Cipto Mangunkusumo Hospital from July to September 2015. This study include type 2 diabetes mellitus patients, age ≥ 18 year-old, willing to undergo thyroid laboratory testing. In this study, hypothyroidism defined as TSH more than 4.0 mIU/L, while hyperthyroidism is defined as TSH less than 0.4 mIU/L with eCLIA. RESULTS: from 364 subjects who were recruited from Endocrine and Diabetes Polyclinic, Cipto Mangunkusumo Hospital, 303 subjects underwent this study until analysis. Two hundred and three (273) subjects (90.1%) were euthyroid, 7 subjects (2.31%) were hyperthyroid, and 23 subjects (7.59%) were hypothyroid. Majority of the patients had subclinical hypothyroidism (56.5% based on Zulewski and Billewicz Score and 65.2% based on fT4 laboratory result), while 42.9% and 71.4% subjects had clinical hyperthyroidism based on clinical appearance and fT4 laboratory result respectively. CONCLUSION: proportion of hypothyroidism was 7.59% and hyperthyroidism was 2.31%, while the proportion of total thyroid dysfunction was 9.9% among diabetics. It is suggested that screening for thyroid dyscfunction can be done in high risk condition as a part of comprehensive management in type 2 diabetes mellitus patients.

Impact of Frailty on Cardiovascular Disease (and the Other Way Around).

Cardiovascular disesase has been identified as the most frequent cause of death, while frailty has been identified as one of geriatric giants characterized by decreased physiological reserves and increased vulnerability. Despite of aggressive treatment for cardiovascular diseases such as invasive methods,frail patients who undergo these procedures tend to experience undesirable effects compared to non frail patients. As the population of elderly patiens worldwide is growing larger, these issues lead to major health problems that we have to overcome. Association between frailty and cardiovascular disease is still debatable. Cardiovascular disease accelerates frailty. On the other hand, frail patients have higher risk of cardiac mortality and major cardiac events due to their complex health status. However, by doing good risk prediction and assessment, interventional treatment can be performed safely in selected older patients. To date, only a few studies have been conducted to investigate relationship between these two major health problems in elderly. Therefore, in this edition we highlight a study which investigate association between frailty and major adverse cardiac events in patients who underwent invasive intervention. Further researches are still needed to establish evidences between these two geriatric major health problems.

Hepatocellular Carcinoma in a Tertiary Referral Hospital in Indonesia: Lack of Improvement of One-Year Survival Rates between 1998-1999 and 2013-2014.

BACKGROUND: The survival of hepatocellular carcinoma (HCC) patients is usually low due to late diagnosis. Cipto Mangunkusumo Hospital as the largest tertiary referral hospital in Indonesia, has recently improved its modalities for advanced HCC management, but there has not been any evaluation on any improvement in HCC patient survival. MATERIALS AND METHODS: A retrospective analysis on 114 HCC patients in 2013-2014 were conducted and compared with the database for 77 HCC patients in 1998-1999. Clinical characteristics and treatment received were recorded and the survival of both groups was analyzed using the Kaplan-Meier method and compared using the log-rank test. RESULTS: The percentage of HBV positive patients had increased after fifteen years from 32.5% to 67.5%. Only two patients (1.8%) in 2013-2014 were diagnosed with HCC during surveillance program. Proportions of Barcelona Clinic Liver Cancer A, B, C, and D in 2013-2014 were 1.8%, 42%, 28.1%, and 28.1%, respectively. There was an increase in the use of potentially curative treatment, such as surgical resection or combination of loco-regional therapies. The one-year survival rate increased from 24.1% in 1998-1999 to 29.4% in 2013-2014, while the median survival decreased from 146 days to 138 days, but the difference was not statistically significant (p=0.913). CONCLUSIONS: There was no improvement in the median survival of HCC patients after fifteen years because most continued to present at late stages. There is an urgent need for a nationwide implementation of a hepatitis screening program and HCC surveillance education.

Nasopharyngeal carriage of Streptococcus pneumoniae in adults infected with human immunodeficiency virus in Jakarta, Indonesia.

This study investigated the distribution of serotype and antimicrobial susceptibility of Streptococcus pneumoniae carried by adults infected with human immunodeficiency virus (HIV) in Jakarta, Indonesia. Specimens of nasopharyngeal swab were collected from 200 HIV infected adults aged 21 to 63 years. Identification of S. pneumoniae was done by optochin susceptibility test and PCR for the presence of psaA and lytA genes. Serotyping was performed with sequential multiplex PCR and antibiotic susceptibility with the disk diffusion method. S. pneumoniae strains were carried by 10% adults with serotype 6A/B 20% was common serotype among cultured strains in 20 adults. Most of isolates were susceptible to chloramphenicol (80%) followed by clindamycin (75%), erythromycin (75%), penicillin (55%), and tetracycline (50%). This study found resistance to sulphamethoxazole/trimethoprim was most common with only 15% of strains being susceptible. High non-susceptibility to sulphamethoxazole/trimethoprim was observed in S. pneumoniae strains carried by HIV infected adults in Jakarta, Indonesia.

Relationship between metformin and frailty syndrome in elderly people with type 2 diabetes.

AIM: to explore the possibility of metformin protective effect on frailty syndrome. METHODS: this was a case control study conducted in subjects' ≥60 years old who visited the Geriatrics and Diabetes outpatient clinic of Cipto Mangunkusumo National Referral Hospital between March and June 2013. Diagnosis of frailty was established using the FI-40 item criteria. Statistical analysis was done with chi-square method for bivariate and logistic regression method in multivariate analysis, all data was accompanied with 95% confidence interval. RESULTS: frailty syndrome was found in 25% of subjects (n = 59), with median age of 72 years old (SD 6.27) and median of FI-40 item score was 0.18 (SD 0.085). Metformin was found to have a significant relationship with frailty syndrome in the elderly diabetics, which retained significant value after multivariate analysis (adjusted OR 0.043; 95% CI 0.019-0.099; p < 0.001). CONCLUSION: metformin was shown to have protective effect against frailty syndrome in elderly diabetics.

Profile of food and nutrient intake among Indonesian elderly population and factors associated with energy intake: a multi-centre study.

AIM: to obtain profile of food and nutrient intake in Indonesian elderly population and factors associated with energy intake. METHODS: multi-center cross sectional study in 13 hospitals across Indonesia was conducted among 387 elderly who had attended geriatric clinics. Data collected including demographic characteristics, functional status, cognitive status, mental status, nutritional status, food intake, present activities, and data on chronic diseases. Chi square and logistic regression tests were performed to analyze the data. RESULTS: most of subjects (58.4%) were women and had educational background senior high school or higher degree (61.1%). The average of energy intake was 1266.74 (336.51) kilocalories. Calcium and protein intake were below the recommended of dietary allowance. female sex (OR 0.23; 95% CI 0.139-0.390) and osteoporotic subjects (OR 0.48; 95% CI 0.25-0.93) have lower risk for having <80% RDA daily energy intake, while lower educational level (OR 1.96; 95% CI 1.21-3.18) has higher risk for having <80% RDA daily energy intake. CONCLUSION: total energy intake were inadequate in the elderly. Female sex and osteoporotic subjects have lower risk for having <80% RDA daily energy intake, while lower educational level has higher risk for having <80% RDA daily energy intake.

Risk factors for depressive symptom changes in Indonesian geriatric outpatient.

AIM: to determine risk factors for depressive symptom changes in geriatric outpatients. METHODS: a prospective cohort study was conducted on 106 geriatric outpatients at Integrated Geriatric Clinic Cipto Mangunkusumo Hospital, Jakarta in 2010. A structured questionnaire was applied to obtain independent variable such as age, sex, educational level, chronic diseases (diabetes mellitus, chronic kidney diseases, hypertension, dyslipidemia, and osteoarthritis), functional status (WHO-Unescap score), nutritional status (body mass index), health related quality of life (Eq5D score), hospitalization within 6 months, and total calorie intake. Depressive symptom as dependent variable was assessed using Geriatric Depression Scale. The association between aforementioned various factors with depressive symptom changes were analyzed using multiple logistic regression analysis. RESULTS: most of subjects were women (63.2%), aged 70 years old and older (71.0%) and had hypertension (82.1%). There were 22.6% subjects with increase in GDS score during 6-month follow-up. Bivariable analysis showed that diabetes mellitus and chronic kidney diseases were significantly associated with depressive symptom changes. Multiple logistic regression showed that variable which independently associated with depressive symptom changes was uncontrolled chronic kidney disease (OR 3.390; 95% CI 1.07-10.76. CONCLUSION: uncontrolled chronic kidney disease is risk factor for depressive symptom changes in geriatric outpatients.

Human ß-defensin 2 concentration of respiratory tract mucosa in elderly patients with pneumonia and its associated factors.

AIM: to identify HBD2 peptide in sputum of patients with pneumonia; to obtain mean concentration difference of HBD2 between elderly patients and the younger adults with pneumonia; and to find any association between age, nutritional status, smoking habits, diabetes mellitus, and chronic obstructive pulmonary disease (COPD) and the concentration of HBD2 in patients with pneumonia. METHODS: a cross-sectional study with consecutive sampling technique was conducted in 23 elderly patients and 38 younger adults with pneumonia who were hospitalized in Cipto Mangunkusumo Hospital, Jakarta. Patients with pulmonary and respiratory tract malignancy, taking long-term corticosteroid and/or immunosuppressant therapy were excluded. The sputum of patient was taken spontaneously or by sputum induction technique and prepared for identification by dissolving with dithiothreitol (DTT) solution. The presence of HBD2 was identified by using SDS-PAGE and immunoblotting; while the concentration was measured by ELISA. The mean difference of HBD2 concentrations between elderly patients and the young adults was analyzed using t-test. Chi-square test was performed to analyze the association between several risk factors and HBD2 concentrations in the sputum. RESULTS: the mean concentration of HBD2 in the sputum of all subjects was 178.98 (SD 49.55) pg/ml. There was no mean concentration difference of HBD2 between elderly and younger adult patients with pneumonia. Age, nutritional status, smoking habit and diabetes mellitus were not associated with HBD2 concentration; however, COPD was associated with HBD2 concentration (p-value = 0.014). CONCLUSION: there is no mean concentration difference of HBD2 in the sputum of elderly and younger adult with pneumonia. There is association between COPD with HBD2 concentrations in the sputum of patients with pneumonia.