Physicians' attitudes and confidence toward dementia care: A cross-sectional study at primary healthcare facilities in the Eastern Province, Saudi Arabia.

BACKGROUND: Primary care physicians play an essential role in the health of older adults as they are frequently the first point of contact. Their positive attitude and knowledge influence the quality of care provided to patients with dementia and their caregivers. This study examined the attitudes of primary care physicians towards dementia care and their confidence in their own dementia-care skills. MATERIALS AND METHODS: This cross-sectional study was conducted among 316 primary care physicians working in Eastern Province of Saudi Arabia. Data were collected using a structured questionnaire that included questions related to demographic characteristics, Dementia Care Attitude Scale (DCAS) to assess attitudes towards dementia, and Confidence in Dementia Care Skills (CDCS) Scale to measure confidence. Data were analyzed using SPSS version 29; mean and standard deviation (SD) were computed for continuous and categorical variables were described using frequencies and percentages. Mann Whitney U test and Kruskal Wallis test were used to compare attitude and confidence scores by categorical variables. RESULTS: The mean DCAS score was 36.4 ± 5.41 out of 50. On a scale ranging from 15 to 75, the mean CDCS was 51.89 ± 10.20. A statistically significant (P < 0.05) relation was found between confidence and professional rank, knowing close relatives with dementia, and number of dementia and elderly patients treated. Overall, 78.9% of physicians lacked confidence to prescribe memory medications; 32% felt that dementia management was generally more frustrating than rewarding. CONCLUSION: Primary care physicians had a positive attitude toward caring for patients with dementia. However, they lacked confidence in their dementia care skills in several areas. The confidence in their diagnostic skills was higher than their management skills. Most challenging skills were recognizing and managing behavioral symptoms of dementia. Need to develop educational and training interventions that target healthcare providers to help improving dementia care in primary care settings.

Atraumatic Fractures in Multi-Morbid Older Adults: A Series of Five Cases and Review of Literature.

Atraumatic fractures (ATFs) are a fragility fracture subtype with occasional medicolegal issues. ATFs are defined as fractures because of a "low-energy mechanism that is usually considered incapable of producing a fracture." They are an underreported disorder, with epidemiological variations. ATF phenomena were previously reported not only in older adults, but also in children, young adults, older adults, and animals. This study is a short retrospective case series exploring atraumatic fractures in a tertiary care university hospital. Over a period of two years, a total of seven ATF cases were identified. However, only five fulfilled the inclusion criteria. Local causes of pathologic fractures (e.g., metastasis) and elder abuse or neglect were excluded. Comparison of the cases' clinical profile, fracture profile, and management was done. All five cases were frail females with significant osteotoxic burdens from medications and multi-morbidities. ATF presentations included typical (as pain) and atypical (as painless, loud crack, and sudden giveaway) symptomatology. One ATF had a coincident unexplained aseptic fever. Three cases had more than one fracture (fracture cascade), confirmed and followed up by x-rays. All the cases were managed conservatively except for one case that underwent hip hemiarthroplasty. Plans of care included managing the osteotoxic multi-morbidities burden, focusing on the whole body, not only on the fracture or bone. The study provided insights about challenges in presentations of ATF (as the bone fracture acute phase reaction: osteogenic aseptic fever). Risk factors are classically assumed to be osteoporosis, but it is usually systemic and multifactorial. A high risk of fracture warning sign could help decrease ATF occurrence or fracture cascades. Four ATF categories were detected to help healthcare systems identify high-risk patients and raise awareness among medical staff, families, and caregivers. Future studies of the at-risk groups are needed to understand ATF knowledge gaps, challenges, and the best treatments.

Assessment of Hydration Status and Blood Pressure in a Tertiary Care Hospital at Al-Khobar.

Background High blood pressure is a major cardiovascular risk factor. It is a leading cause of increasing morbidity and mortality worldwide. One-third of the adult population worldwide suffers from hypertension. Salt intake, obesity, decreased physical activity, and smoking are well known to increase blood pressure. Fluid retention is the main contributing factor to primary hypertension and adversely affects the cardiovascular system. The emerging evidence suggests a relationship between blood pressure and hydration status. Our study aims to assess the correlation between hydration status and blood pressure. We aim to assess the hydration status in subjects with normal and high blood pressure and to investigate the association of hydration status with hemodynamic measurement. Methodology This cross-sectional and observational study included adult (>18 years) male and female subjects who agreed to participate. In total, 235 subjects were recruited by convenience sampling from (1) patients and caregivers attending geriatric and internal medicine clinics, and (2) visitors coming to King Fahad University Hospital at Al-Khobar. There were five patients on oral diuretics who were excluded from the study. Data were collected from September 2021 to March 2022. Hydration status was measured by a bioelectrical impedance analyzer (Bioscan 920, Maltron International Ltd. Rayleigh, UK). Hemodynamic measurements included heart rate per minute, systolic blood pressure, diastolic blood pressure, pulse pressure (the difference between systolic and diastolic blood pressure), and mean arterial pressure calculated as blood diastolic pressure plus one-third of pulse pressure. Statistical analyses were performed using SPSS statistics for windows, version 28.0 (IBM Corp., Armonk, NY, USA). Descriptive data were reported using means with standard deviations for numerical data and relative frequencies (percentage) for categorical data. P-values of less than 0.05 were considered statistically significant. Comparison between groups was done using a one-way analysis of variance test. Results Extracellular water percentage was higher in hypertensive (45.0 ± 2) than prehypertensive (43.5 ± 3) or normotensive (43.0 ± 2) (p = 0.001) subjects. In contrast, intracellular water percentage and total body water percentage were significantly negatively related to hypertension status. Conclusions Our results have shown a strong association between hypertension status and hydration parameters. In our study, hypertensive subjects tended to have lower total body water percentage and intracellular water percentage (bioimpedance value) than normotensive subjects. This might promote more research regarding the relationship between hypohydration and cardiovascular disease pathophysiology. This outcome should raise awareness about proper hydration as hypohydration can be a causative factor for hypertension.

The Arabic Translation and Cross-Cultural Adaptation of the Bristol Activity of Daily Living Scale.

BACKGROUND: There are few Arabic language functional scales for patients with dementia. The Bristol Activity of Daily Living Scale (BADLS) was designed and validated for use in patients with dementia. OBJECTIVE: Our study aimed to translate, cross-culturally adapt, and validate the BADLS to the Arabic language for people with neurocognitive decline and dementia. METHODS: The original BADLS scale was translated to the Arabic language followed by face validity assessment through a pilot testing in five Arabic countries. The Arabic BADLS was assessed in a sample of 139 participants and their caregivers for concurrent and convergent validity. RESULTS: The Arabic BADLS had excellent internal consistency, Cronbach's alpha 0.95 (95% CI 0.93-0.96). Likewise, the Arabic BADLS had strong convergent validity with the Montreal Cognitive Assessment (r = -0.82, p < 0.001). CONCLUSION: The Arabic BADLS is a valid scale that can used to assess the functional performance of people living with dementia.

Assessment of Cerebrovascular Accident and Transient Ischemic Attack Risk Factors in Elderly vs. Non-Elderly Patients at a Tertiary Care Hospital in Eastern Province, Saudi Arabia.

Background The survivors of cerebrovascular accidents (CVA) or stroke are often left with several mental and physical disabilities which create a major social and economic burden. However, research addressing the risk factors of CVA and transient ischemic attacks (TIA), and their complications are insufficient.  Aim of the study To assess the CVA and TIA risk factors (hypertension, diabetes mellitus type 2, dyslipidemia, coronary artery disease, atrial fibrillation, obesity, hypercoagulopathy, anti-platelet and anticoagulant use, carotid artery stenosis, and hypothyroidism) and complications (pneumonia, urinary tract infection and deep venous thrombosis) among a sample of elderly patients compared to non-elderly adult patients receiving care at King Fahd Hospital of the University in Al-Khobar, Saudi Arabia. Methods A retrospective observational study was conducted at King Fahd Hospital of the University in Al-Khobar, Saudi Arabia. Multiple risk factors and complications of CVA and TIA were retrieved from the medical records of the studied patients that fulfilled the inclusion criteria of patients diagnosed with CVA and TIA aged ≥ 60 years (elderly sample) and 18-59 years old (comparison non-elderly sample), who were followed up by internal medicine, neurology, and geriatric medicine departments. The total participant size was 259 patients, of which 149 were elderly. Results The occurrence of risk factors was more common in the senior age group. Hypertension was the most frequent risk factor in both age groups, while dyslipidemia, atrial fibrillation, and obesity were significantly associated with the development of CVA and TIA in the elderly. Moreover, post-CVA and TIA complications were more frequent in the group with elderly patients, with urinary tract infections being the most reported complication. Conclusion This study concluded that the most frequent risk factors were hypertension and type 2 diabetes mellitus. The findings of this study call for providing extra preventive care for elderly patients with dyslipidemia, atrial fibrillation, and obesity, and for more aggressive prevention of post-CVA and TIA complications in older age groups.

Fahr's Syndrome Presenting With Hypocalcemia and Psychotic Features.

Fahr's disease is a rare genetic neurodegenerative disorder described as "bilateral striopallidodentate calcinosis" (BSPDC). It is characterized by calcium deposition crossing the blood-brain barrier and calcifying different brain areas. Here, we report a case of a 26-year-old Saudi young lady, known as a case of epilepsy since childhood, a major depressive disorder with psychotic features, and hypocalcemia related to hypoparathyroidism. CT brain showed extensive coarse calcifications involving the infra and supratentorial white matter, predominantly within the basal ganglia, thalami, and dentate nuclei of cerebellar hemispheres. This report will discuss the challenging presentation, clinical symptoms, and the multidisciplinary approach to manage Fahr's syndrome symptoms. In conclusion, this case emphasizes the importance of neuroimaging and metabolic workup when investigating the seizure's etiology. The goal of treatment in Fahr's syndrome is to manage the underlying conditions.

Validation of the Mini-Addenbrooke's Cognitive Examination in Mild Cognitive Impairment in Arabic Speakers.

INTRODUCTION: Mild cognitive impairment (MCI) represents a target for early detection and intervention in dementia, yet there is a shortage of validated screening tools in Arabic to diagnose MCI. The mini-Addenbrooke's Cognitive Examination (m-ACE) is a brief cognitive battery that is scored out of 30 and can be administered in under 5 min providing a quick screening tool for assessment of cognition. OBJECTIVE: We aimed to validate the m-ACE in Arabic speakers in Egypt with MCI to provide cut-off scores. METHODS: We included 24 patients with MCI and 52 controls and administered the Arabic version of the m-ACE. RESULTS: There was a statistically significant difference (p < 0.0001) on the total m-ACE score between MCI patients (mean 18.54, SD 3.05) and controls (mean 24.54, SD 2.68). There was also a statistically significant difference between MCI patients and controls on the total score and the fluency, visuospatial, and memory recall sub-scores of the m-ACE (p < 0.05). Performance on the m-ACE significantly correlated with both the Mini-Mental State Examination (MMSE) and the Addenbrooke's Cognitive Examination-III (ACE-III). Using a receiver operator characteristic curve, the optimal cut-off score for MCI on the m-ACE total score was 21 out of 30 (87.5% sensitivity, 84.6% specificity, and 85.5% accuracy). CONCLUSIONS: We validated the Arabic m-ACE in Egyptian patients with MCI and provided objective validation of it as a screening tool for MCI, with good sensitivity, specificity, and accuracy that is comparable to other translated versions of the m-ACE in MCI.

Validation of the Addenbrooke's Cognitive Examination-III in Mild Cognitive Impairment in Arabic Speakers in Egypt.

BACKGROUND AND AIMS: Mild cognitive impairment (MCI) represents an important point on the pathway to developing dementia and a target for early detection and intervention. There is a shortage of validated cognitive screening tools in Arabic to diagnose MCI. The aim of this study was to validate Addenbrooke's Cognitive Examination-III (ACE-III) (Egyptian-Arabic version) in a sample of patients with MCI, to provide cut-off scores in Egyptian-Arabic speakers. METHODS: A total of 24 patients with MCI and 54 controls were included in the study and were administered the Egyptian-Arabic version of the ACE-III. RESULTS: There was a statistically significant difference (p < 0.001) in the total ACE-III score between MCI patients (mean 75.83, standard deviation (SD) 8.1) and controls (mean 86.26, SD 6.74). There was also a statistically significant difference between MCI patients and controls in the memory, fluency, and visuospatial sub-scores of the ACE-III (p < 0.05) but not in attention and language sub-scores. Using a receiver operator characteristic curve, the optimal cut-off score for diagnosing MCI on the ACE-III total score was 81, with 75% sensitivity, 82% specificity, and 80% accuracy. CONCLUSIONS: The results of this study provide objective validation of the Egyptian-Arabic version of the ACE-III as a screening tool for MCI, with good sensitivity, specificity, and accuracy that are comparable to other translated versions of the ACE-III in MCI.

Validation of the Egyptian-Arabic Version of the Addenbrooke's Cognitive Examination III (ACE-III) in Diagnosing Dementia.

INTRODUCTION: The Addenbrooke's Cognitive Examination III (ACE-III) (2012) is a brief cognitive battery that assesses five sub-domains of cognition (attention and orientation, memory, verbal fluency, language, and visuospatial abilities) which are commonly impaired in dementia. OBJECTIVE: We aimed to validate the Egyptian-Arabic ACE-III in dementia patients, and to provide cut-off scores for the ACE-III in diagnosing dementia in Egyptian-Arabic speakers. METHODS: We included 37 patients with dementia (Alzheimer's disease, n = 25, vascular dementia, n = 8, and dementia with Lewy bodies, n = 4) and 43 controls. RESULTS: There was a statistically significant difference (p < 0.001) in the total ACE-III score between dementia patients (mean 49.81 ± 18.58) and controls (mean 84.84 ± 6.36). There was also a statistically significant difference between dementia patients and controls in all sub-score domains of the ACE-III (p < 0.001). Using a receiver operator characteristic curve, the optimal cut-off score for dementia on the ACE-III total score was 72, (89% sensitivity, 95% specificity, 92% accuracy). CONCLUSIONS: The results of this study provide objective validation of the Egyptian-Arabic version of the ACE-III as a screening tool for dementia, with high sensitivity, specificity, and accuracy comparable to other translated versions of the ACE-III.

Adaptation and Validation of the Mini-Addenbrooke's Cognitive Examination in Dementia in Arabic Speakers in Egypt.

BACKGROUND: The mini-Addenbrooke's Cognitive Examination (m-ACE) is a brief cognitive battery that assesses 5 subdomains of cognition (attention, memory, verbal fluency, visuospatial abilities, and memory recall). It is scored out of 30 and can be administered in under 5 min providing a quick screening tool for assessment of cognition. OBJECTIVES: We aimed to adapt the m-ACE in Arabic speakers in Egypt and to validate it in dementia patients to provide cutoff scores. METHODS: We included 37 patients with dementia (Alzheimer's disease [n = 25], vascular dementia [n = 8], and dementia with Lewy body [n = 4]) and 43 controls. RESULTS: There was a statistically significant difference (p < 0.001) on the total m-ACE score between dementia patients (mean 10.54 and standard deviation [SD] 5.83) and controls (mean 24.02 and SD 2.75). There was also a statistically significant difference between dementia patients and controls on all sub-score domains of the m-ACE (p < 0.05). Performance on the m-ACE significantly correlated with both the Mini-Mental State Examination (MMSE) and the Addenbrooke's Cognitive Examination-III (ACE-III). Using a receiver operator characteristic curve, the optimal cutoff score for dementia on the m-ACE total score was found to be 18 (92% sensitivity, 95% specificity, and 94% accuracy). CONCLUSIONS: We adapted the m-ACE in Arabic speakers in Egypt and provided objective validation of it as a screening tool for dementia, with high sensitivity, specificity, and accuracy.

Effects of age, education, and gender on verbal fluency in healthy adult Arabic-speakers in Egypt.

The objective of this study is to establish the effects of age, gender, and education and to provide preliminary normative data for letter and category fluency tasks in the Egyptian Arabic-speaking population. We evaluated 139 cognitively healthy volunteers aged 20-93 by adapting the letter and category verbal fluency tasks for the Egyptian population. On the letter fluency task, mean number of words generated in one-minute beginning with the Arabic letter "Sheen" (pronounced "sh") was 8.14 words per minute (SD = 3.25). Letter fluency was significantly influenced by education. On category fluency tasks, mean number of animal names generated in one minute was 14.63 words (SD = 5.28). Category fluency was significantly influenced by age and education. We were able identify that age significantly affects category fluency while education significantly affected both letter and category fluency. We were also able to provide preliminary normative data for both tasks in the Egyptian population.

Socio-demographic factors related to functional limitations and care dependency among older Egyptians.

AIM: This paper is a report of a study determining the relationship of socio-demographic factors to functional limitations and care dependency among older care recipients and non-care recipients in Egypt. BACKGROUND: The population is ageing in Egypt and age-related functional limitations are increasing. Age and gender influence this phenomenon, but its relationship to socio-economic status has not yet been demonstrated for Egypt. Functional limitations are an antecedent to care dependency, which also may be associated with these socio-demographic factors. METHOD: A cross-sectional study with a two-group comparative design was conducted in Greater Cairo. The sample was composed of 267 non-care recipients and 344 care recipients. Path analysis was used to determine the relationship between variables. Age, gender and acceptance of care were covariates in the multiple regressions. Analyses were conducted separately for care recipients and non-care recipients. RESULTS: Among non-care recipients, lower socio-economic status was related to more functional limitations and higher care dependency. This relationship was not found among care recipients. CONCLUSION: Older persons from low income groups are more likely to become care dependent but are less able to pay for required care. Currently, untrained volunteer groups of religious organizations try to support these older people in the poorer strata of Egyptian society. Training in the basics of care might help to make their work more effective.

Psychometric properties of the extended Care Dependency Scale for older persons in Egypt.

AIM: The aim of this study was to determine the validity and reliability of the modified Arabic Care Dependency Scale for self-assessment of older persons in Egypt and to compare these self-assessments to proxy assessments by care givers and family members. BACKGROUND: The Care Dependency Scale is an internationally used instrument to measure care dependency. The Arabic version may improve data collection on this phenomenon in the Middle East where the population is ageing. DESIGN: A cross-sectional study with a sample of 611 older persons living in Greater Cairo. Participants belonged to three groups: nursing home residents, home care recipients and non-care recipients; 459 participants were also rated by proxies and 171 repeated their self-assessment after two weeks. METHODS: The correlation between sum scores of the Care Dependency Scale and the Activities of Daily Living scale was calculated to establish criterion validity. Construct validity was determined by comparing care recipients and non-care recipients with regard to their Care Dependency Scale sum scores and by exploratory factor analysis. Intraclass coefficients were used to assess test-retest reliability of self-ratings for each item. Mean differences between self and proxy assessment were calculated. RESULTS: The Care Dependency Scale had a strong correlation to the Activities of Daily Living scale and is able to distinguish between care recipients and non-care recipients. Factor analysis revealed one factor for basic needs and one factor for psychosocial needs. ICC values were >0.7 for most items related to the factor for basic needs among care recipients. Proxy assessment yielded higher care dependency than self assessment. CONCLUSION: Care Dependency Scale items for basic needs are suitable to assess care dependency among Egyptian care recipients. RELEVANCE TO CLINICAL PRACTICE: Assessment of care dependency is useful to obtain data for appropriate resource allocation among care recipients.

Factors related to the acceptance of home care and nursing homes among older Egyptians: a cross-sectional study.

BACKGROUND: Socio-demographic changes may deprive older Egyptians from receiving care by family members and raise the question of how they react if they become dependent on help. OBJECTIVE: The objective of this study was to determine factors related to the acceptance of home care and nursing homes among older Egyptians. DESIGN: A two group comparative design based on self-reports. PARTICIPANTS: The sample was composed of 344 older persons receiving home care or staying in a nursing home and 267 non-care recipients. SETTING: The study was conducted in Greater Cairo. METHODS: Factors related to the acceptance of home care and nursing homes were determined separately for each group by logistic regression. RESULTS: Lesser feelings of shame while receiving care from non-family members were related to an increased acceptance of both kinds of care. For non-care recipients disagreement to the traditional idea of family care had a similar effect. For care recipients the experience made with a particular kind of care was strongly related to its acceptance. DISCUSSION: Home care is a new phenomenon in Cairo and in contrast to nursing homes it was unknown to most study participants. For this reason any conclusion about which kind of service is preferred by older Egyptians would be a premature one. CONCLUSION: Feelings of shame while receiving care from a non-family member are more important than functional limitations when older Egyptians are considering the options of home care and nursing homes.

Cultural adequecy of the care dependency scale for older persons in Egypt: a Delphi study.

PURPOSE: The aim of this study is to determine the cultural adequateness of the Arabic version of the Care Dependency Scale (CDS), an internationally used instrument to measure care needs by either self-reports or external assessment. METHOD: A Delphi study in two rounds about the Arabic version was performed with 37 panelists in Cairo. Acceptance of CDS items was rated on a 4-point Likert-type scale. RESULTS: Agreement among panelists in the second round was found for 11 CDS items, but 2 items had decreased acceptance after rephrasing and 2 were rejected. DISCUSSION: Rejected items seem to reflect a heterogeneous perception in the target population. Despite some limitations, the CDS is a promising instrument to detect care needs among older Egyptians.

Attitudes of older Egyptians towards nursing care at home: a qualitative study.

The aim of this study was to identify the attitudes of older Egyptians towards receiving nursing care at home and to identify the characteristics that allow differentiating between various types of these attitudes. The number of older persons in Egypt requiring nursing care is increasing. Care was traditionally provided by the family, but the social network is changing in bigger cities. Beside geriatric homes, older Egyptians can refer to private helpers and a small number of home care services. Structured guideline interviews were performed with 33 Egyptians above 60 years of age. Participants were chosen by purposeful sampling. Twelve of them received home care. Interviews were analyzed with qualitative content analysis according to Mayring. Participants could be classified under three main categories of care seeking types: (1) insufficient income, (2) sufficient income and family dependent decision about care, (3) sufficient income and independent decision about care. Variations under these categories were due to differences in the social network and the perceived self-help abilities. Examples for the influence of factors which explained variations were not identified in every category to the same extent. Some types of care seeking that exist in reality may be missing in this study. Findings suggest the hypothesis that care seeking of older Egyptians is related to their social status. Those with insufficient income seem to reject home care whereas independent personalities with sufficient income may be the main winners of this offer.

Attitudes of Egyptian nursing home residents towards staying in a nursing home: a qualitative study.

Aim. The aim of this study was to identify the attitudes of Egyptian nursing home residents towards staying in a nursing home and to differentiate between various types of these attitudes. Background. The number of older persons in Egypt who require nursing care is increasing. In response, nursing homes in bigger cities like Cairo were founded, although family care seems to be the prevalent norm. Methods. Semi-structured guideline interviews were performed with 21 residents from four different nursing homes in Cairo. Interviews were analyzed using qualitative content analysis. Findings. One category of resident was those who were sent to the nursing home by persons closely related to them. Another category made their own decision to move to a nursing home. Relationships with social networks and self-help abilities are factors of importance in influencing decision-making. Conclusion. Nursing homes in Egypt fulfil different functions for different types of older persons. Charitable institutions are a last resort for those with no income and a disrupted social network. For better-off older persons, nursing homes may provide the benefits of socialising with peers and receiving medical treatment.