Clinical improvements in temporospatial gait variables after a spinal tap test in individuals with idiopathic normal pressure hydrocephalus.

Idiopathic Normal Pressure Hydrocephalus (iNPH) is a neurological condition that often presents gait disturbance in the early stages of the disease and affects other motor activities. This study investigated changes in temporospatial gait variables after cerebrospinal fluid (CSF) removal using a spinal tap test in individuals with idiopathic normal pressure hydrocephalus (iNPH), and explored if the tap test responders and non-responders could be clinically identified from temporospatial gait variables. Sixty-two individuals with iNPH were recruited from an outpatient clinic, eleven were excluded, leaving a total of 51 who were included in the analysis. Temporospatial gait variables at self-selected speed were recorded at pre- and 24-h post-tap tests which were compared using Paired t-tests, Cohen's d effect size, and percentage change. A previously defined minimal clinical important change (MCIC) for gait speed was used to determine the changes and to classify tap test responders and non-responders. A mixed model ANOVA was used to determine the within-group, between-group, and interaction effects. Comparisons of the data between pre- and post-tap tests showed significant improvements with small to medium effect sizes for left step length, right step time, stride length and time, cadence, and gait speed. Gait speed showed the largest percentage change among temporospatial gait variables. Within-group and interaction effects were found in some variables but no between-group effect was found. Tap test responders showed significant improvements in right step length and time, stride length and time, cadence, and gait speed while non-responders did not. Some individuals with iNPH showed clinically important improvements in temporospatial gait variables after the tap test, particularly in step/stride length and time, cadence, who could be classified by gait speed. However, gait-related balance variables did not change. Therefore, additional treatments should focus on improving such variables.

The association between sarcopenia, defined by a simplified screening tool, and long-term outcomes.

BACKGROUND: Sarcopenia and frailty are frequently observed in older adult patients and linked to unfavorable postoperative outcomes. Identifying low muscle mass and function is primary for diagnosing sarcopenia. The simpler screening, which excludes muscle mass measurement, exhibited strong predictive capabilities in identifying sarcopenia. This research explored the association between sarcopenia, as defined by the C3 formula, and long-term outcomes in older adult cancer patients who underwent surgery. METHODS: Surgical cancer patients aged 60 and older were enrolled. Sarcopenia was identified using the C3 formula, assessing muscle strength through handgrip strength, physical performance via a 6-m walk test, and nutrition status via the Mini Nutritional Assessment-Short Form. Long-term outcomes were evaluated with the Barthel Index for activities of daily living (B-ADL) at 3 months, as well as 1-year mortality rates. RESULTS: The study enrolled 251 patients, with 130 classified as sarcopenic according to the C3 formula. Compared with nonsarcopenic patients, patients with sarcopenia exhibited a higher frequency of moderate to severe disability (B-ADL ≤70) 3 months postdischarge (19.5% vs 5.2%; P = 0.001) and elevated 1-year mortality rates (29.5% vs 14.9%; P = 0.006). No significant differences were observed in infection rates, hospital stay duration, or in-hospital mortality. Distant organ metastasis (HR = 3.99; 95% CI = 2.25-7.07) and sarcopenia defined by the C3 formula (HR = 1.78; 95% CI = 1.01-3.15) were identified as independent risk factors for 1-year mortality. CONCLUSION: The simplified sarcopenia screening tool was associated with increased rates of moderate to severe disability 3 months postdischarge and higher 1-year mortality rates compared with nonsarcopenic patients.

Risk Factors for Sarcopenia in Thai Patients with Rheumatoid Arthritis.

BACKGROUND: Sarcopenia is a common condition that can occur in people with chronic inflammatory diseases, including rheumatoid arthritis (RA). The aim of this study was to determine the prevalence and factors associated with this condition in patients with RA. METHODS: This prospective cross-sectional study was conducted on 182 adult patients with RA. They were diagnosed with sarcopenia using the Asian Working Group's 2019 update on sarcopenia diagnosis. The body composition was estimated using a body impedance analyzer. Physical performance and muscle strength were evaluated with six-meter walk test and hand grip dynamometer, respectively. The Disease Activity Score (DAS) 28 and the Health Assessment Questionnaire (HAQ) were used to assess disease activity and functional status, respectively. RESULTS: The majority (87.4%) were female with a mean age (SD) of 59.2 (10.2) years. They had been suffering from RA for a long time (median disease duration [Interquartile range (IQR)] 11 [6-16] years) and had mildly active disease [mean DAS28 (SD) 2.61 (0.83)] with slightly functional disability [median HAQ (IQR) 0.34 (0-0.65)]. Of these, 26.4% had sarcopenia. Advanced age [relative risk (RR) 1.07 (95% confidence interval (CI) 1.02-1.11), p = 0.002], low body mass index (BMI) [RR (95% CI) 0.81 (0.72-0.90), p < 0.001], high disease activity [RR (95% CI) 1.64 (1.22-2.12), p = 0.045], and depression [RR (95% CI) 1.18 (1.01-1.37), p = 0.04] were independently associated with sarcopenia. CONCLUSIONS: Sarcopenia was found to be common in Thai RA, and its independent risk factors are age, disease activity, BMI, and depression. Well-controlled disease activity may be beneficial for preventing or minimizing sarcopenia and improving patient outcomes.

Effect of the COVID-19 Pandemic on the Self-Perceived Change of Caregivers' Burden in Providing Care for People With Dementia.

Objectives: To explore how the COVID-19 pandemic affects caregiver (CG) burden, the quality of care provided to people with dementia (PwD) and their perceived changes between before and during the pandemic. Methods: A cross-sectional study surveyed primary CGs about burden and self-perceived change in multidimensional domains and compared these before and during the pandemic. Results: About 135 primary CGs of PwD were enrolled at Siriraj Hospital's Geriatric Clinic in Thailand and assessed using various online platforms. About 13.8% of CGs had a "mild to moderate" burden. The NPI-Q score and level of functional capacity of the PwD declined during the COVID-19 pandemic (p-value .001 and .001, respectively). The CG-associated factors that related to a higher CG burden were younger age (mean age of 54.2 years old), female (76.3%), and high educational level (80.7%). Conflict between CG and PwD was associated with an increase in CG burden (p-value .004; 95% CI [1.19, 6.12]). Regarding the COVID-19-related factors, there was no association between CG burden and the PwD's characteristics or COVID-19-related concerns. Conclusions: The COVID-19 pandemic was associated with a higher CG burden. Identifying the related factors in an unusual situation may help reduce the CG burden and improve the care of PwD.

Immunogenicity and Reactogenicity of Messenger RNA Coronavirus Disease 2019 Vaccine Booster Administered by Intradermal or Intramuscular Route in Thai Older Adults.

BACKGROUND: Intradermal (ID) vaccination may alleviate COVID-19 vaccine shortages and vaccine hesitancy. METHODS: Persons aged ≥65 years who were vaccinated with 2-dose ChAdOx1 12-24 weeks earlier were randomized to receive a booster vaccination by either ID (20 µg mRNA-1273 or 10 µg BNT162b2) or intramuscular (IM) (100 µg mRNA-1273 or 30 µg BNT162b2) route. Anti-receptor-binding domain (RBD) immunoglobulin G (IgG), neutralizing antibody (NAb), and interferon gamma (IFN-γ)-producing cells were measured at 2-4 weeks following vaccination. RESULTS: Of 210 participants enrolled, 70.5% were female and median age was 77.5 (interquartile range, 71-84) years. Following booster dose, both ID vaccinations induced 37% lower levels of anti-RBD IgG compared with IM vaccination of the same vaccine. NAb titers against ancestral and Omicron BA.1 were highest following IM mRNA-1273 (geometric mean, 1718 and 617), followed by ID mRNA-1273 (1212 and 318), IM BNT162b2 (713 and 230), and ID BNT162b2 (587 and 148), respectively. Spike-specific IFN-γ responses were similar or higher in the ID groups compared with IM groups. ID route tended to have fewer systemic adverse events (AEs), although more local AEs were reported in the ID mRNA-1273 group. CONCLUSIONS: Fractional ID vaccination induced lower humoral but comparable cellular immunity compared to IM and may be an alternative for older people. CLINICAL TRIALS REGISTRATION: TCTR20220112002.

Dietary diversity predicts the mortality among older people: Data from the fifth Thai national health examination survey.

OBJECTIVE: To examine the association between dietary diversity (DD) and mortality among Thai older people and to investigate whether age, sex, and nutritional status modify this association. METHODS: The national survey conducted from 2013 to 2015 recruited 5631 people aged >60 years. Dietary diversity score (DDS) was assessed for the consumption of eight food groups using food frequency questionnaires. The Vital Statistics System provided the data on mortality in 2021. The association between DDS and mortality was analyzed by Cox proportional hazard model and adjusted for the complex survey design. Interaction terms between DDS and age, sex, and BMI were also tested. RESULTS: The DDS was inversely associated with mortality (HRadj 0.98, 95%CI: 0.96-1.00). This association was stronger in people aged >70 years (HRadj 0.93, 95%CI: 0.90-0.96 for aged 70-79 years, and HRadj 0.92, 95%CI: 0.88-0.95 for aged >80 years). Inverse association between DDS and mortality was also found in the underweight older population (HRadj 0.95, 95%CI: 0.90-0.99). A positive association was found between DDS and mortality in the overweight/obese group (HRadj 1.03, 95%CI: 1.00-1.05). However, the interaction between the DDS with sex to mortality was not statistically significant. CONCLUSION: Increasing DD reduces mortality among Thai older people, especially in those above 70, and underweight. In contrast, an increase in DD also meant an increase in mortality among the overweight/obese group. Focus should be placed on the nutritional interventions aimed to improve DD for those 70 and over and underweight to reduce mortality.

Effect of Dysphagia on the Older Adults' Nutritional Status and Meal Pattern.

INTRODUCTION/OBJECTIVES: Dysphagia is a widespread clinical condition among older adults. Although known as a risk factor for nutritional status and dehydration, dysphagia also affects meal patterns. This study aimed to determine the relationship between dysphagia and undernutrition, as well as dietary consumption patterns in older adults. METHODS: 268 older adults (144 women, 124 men) were included in the study. Mini Nutritional Assessment (MNA), dysphagia assessment (EAT-10), oral examination, and Semi-quantitative Food Frequency Questionnaire (SFFQ) were used for collecting data. Odds ratio and Chi square were used to compare independent variables in subjects with and without undernutrition as well as those who intake texture modified and non-texture modified diet. RESULTS: Mean age of the undernutrition and normal nutrition groups was 68.9 ± 6.1 and 68.8 ± 6.0 years, respectively. The undernutrition group's activities of daily living (ADL) were 19.7 ± 0.9, and the normal nutrition group was 19.8 ± 0.7. Older adults with dysphagia were 4.8 times more likely to experience undernutrition than older adults without dysphagia (95% CI = 1.75-13.13, P = .002). There was a statistically difference between the meal patterns among the dysphagic older adult group and the normal-swallowing older adults' group at the .05 level. CONCLUSIONS: According to this study, dysphagia was associated with the nutritional status of older adults and dietary patterns. The study results suggested some recommendations for dental health personnel on oral care related to dietary consumption and dietary patterns in older adults.

Dietary diversity associated with risk of cardiovascular diseases among community-dwelling older people: A national health examination survey from Thailand.

Background: Cardiovascular diseases (CVD) are the common comorbidities in older people. Healthy diet is an essential strategy to alleviate the risk of developing CVD. Dietary diversity (DD) is an indicator of diet quality. Currently, limited research exists regarding DD and CVD in older people in developing countries, such as Thailand, despite rapid growth of older population. Therefore, this study aims to determine associations of DD with the risk of CVD and the cardiometabolic risk factors among Thai older people. Methods: This cross-sectional study used the sub-sample of the fifth Thai National Health Examination Survey conducted from 2013 to 2015. A total of 6,956 older people aged 60 years and older and no pre-existing CVD were included.Dietary diversity score (DDS) was assessed the consumption of eight food groups using food frequency questionnaires. Each food group was scored from 0 to 4. The DDS was calculated as the sum of the scores (0-32). The risk of CVD was calculated by using a Thai cardiovascular (CV) risk score. The cardiometabolic risk factors included hypertension, diabetes mellitus (DM), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG) levels. Data were adjusted for a complex survey design and analysed using linear and logistic regression models. Results: In the adjusted model, DDS had a significant negative association with log-Thai CV risk score, with adjusted ß (95% CI) values of -0.01 (-0.01, -0.01). Regarding the cardiometabolic risk factors, DDS had a significant negative association with hypertension, DM and log-TG levels, with adjusted OR (95% CI) values of 0.97 (95% CI 0.97, 0.98) for hypertension, 0.94 (0.93, 0.95) for DM, and adjusted ß (95% CI) values of -0.002 (-0.004, -0.001) for log-TG level. DDS was positively associated with TC and LDL-C, with adjusted ß (95% CI) values of 0.59 (0.38, 0.80) for TC and 0.59 (0.38, 0.79) for LDL-C levels, while DDS was not associated with HDL-C level. Conclusion: Higher DD was associated with a lower risk of CVD among Thai older people. The nutritional policies or interventions should encourage a diverse food intake for the prevention of CVD in this population.

Association between Gut Microbiota with Mild Cognitive Impairment and Alzheimer's Disease in a Thai Population.

BACKGROUND: Mild cognitive impairment (MCI) and Alzheimer's disease (AD) are common in older adults. Much recent work has implicated the connection between the gut and the brain via bidirectional communication of the gastrointestinal tract and the central nervous system through biochemical signaling. Altered gut microbiota composition has shown controversial results based on geographic location, age, diet, physical activity, psychological status, underlying diseases, medication, and drug use. OBJECTIVES: This study aimed to investigate the relationships of gut microbiota with MCI and AD. METHODS: 16S metagenome profiles from stool collection of participant groups (normal; n = 20, MCI; n = 12, AD; n = 20) were analyzed. The diagnosis of cognitive conditions was made by standard criteria consisting of clinical interviews, physical examinations, cognitive assessments, laboratory examinations, and neuroimaging by both structural neuroimaging and amyloid positron emission tomography scans. Correlations between medical factors with food frequency and the fecal microbiome were elucidated. RESULTS: A significant difference at the operational taxonomic unit level was observed. The significantly higher abundance of bacteria in nondementia patients belonged to the Clostridiales order, including Clostridium sensu stricto 1 (p < 0.0001), Fusicatenibacter (p = 0.0007), Lachnospiraceae (p = 0.001), Agathobacter (p = 0.021), and Fecalibacterium (p < 0.0001). In contrast, Escherichia-Shigella (p = 0.0002), Bacteroides (p = 0.0014), Holdemanella (p < 0.0001), Romboutsia (p = 0.001), and Megamonas (p = 0.047) were the dominant genera in the AD group. Left and right hippocampus and right amygdala volumes were significantly decreased in the AD group (p < 0.001) and significantly correlated with the groups of bacteria that were significantly different between groups. CONCLUSION: There was a relationship between the composition of the gut microbiome and neurodegenerative disorders, including MCI and AD. Reduction of Clostridiaceae and increases in Enterobacteriaceae and Bacteroides were associated with persons with MCI and AD, consistent with previous studies. The altered gut microbiome could be potentially targeted for the early diagnosis of dementia and the reduction of AD risk.

Effects of water-soluble mangosteen extract on cognitive function and neuropsychiatric symptoms in patients with mild to moderate Alzheimer's disease (WECAN-AD): A randomized controlled trial.

Introduction: The water-soluble mangosteen pericarp extract's (WME) effect was investigated in Alzheimer's disease (AD). Methods: The participants received 4 mg/kg/day of WME for 24 weeks (low dose, n = 33), 4 mg/kg/day for 12 weeks and then 8 mg/kg/day for 12 weeks (high dose, n = 33); or a placebo (n = 42). The outcomes were neuropsychiatric test scores, safety, tolerability, and the blood 4-hydroxynonenal level. Results: The proportion of participants who achieved the minimum clinically important difference for the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog; -2.6 points) at 24 weeks was significantly higher in the low-dose group (and a trend in the high-dose group) than in the placebo group. WME appeared safe and well tolerated. At 24 weeks, the 4-hydroxynonenal level declined in both intervention groups. The participants with a 5% reduction in this level showed greater ADAS-Cog improvements. Conclusion: WME is a safe and well-tolerated cognitive enhancer in AD with varying benefits across individuals based on antioxidative response.

Prevalence and risk for malnutrition in older Thai people: A systematic review and meta-analysis.

BACKGROUND AND OBJECTIVES: Malnutrition is potentially preventable in older people, but with varied reported prevalence. We assessed its prevalence, assessment methods, and risk factors in older Thai people. METHODS AND STUDY DESIGN: Studies published from January 1, 2000, to September 30, 2020 were searched in Medline, EMBASE, Google Scholar, and local databases. A random-effects model was used to calculate pooled prevalence with subgroups analysis (setting of the patient, region). Forest plots displayed sensitivity and specificity for all nutritional screening tools validated against Mini Nutritional Assessment (MNA) with tests for heterogeneity. Publication bias was tested by funnel plot and Egger's test. RESULTS: 71 studies (total 23,788 subjects) were included where mean age was 65.5 to 78.3 years. The pooled prevalences of malnutrition were 10.4%, 6.1%, and 5.7% by body mass index (BMI), MNA, and MNA-Short Form (MNA-SF), respectively. At-risk of malnutrition prevalence was 42.6% using the MNA and 37.8% using the MNA-SF. The pooled prevalence of malnutrition by BMI <18.5 kg/m2 was 10.4% (95% CI 8.7-12.4). The pooled prevalence of malnutrition based on MNA was 6.1% (95% CI 3.8-9.4). It was highest among hospitalized patients and lowest in community-dwelling elders by both measures. Factors associated with malnutrition were female sex, advanced age, low education, living alone, living in rural areas, comorbidities, eating problems, and geriatric conditions. CONCLUSIONS: The pooled prevalence of elder malnutrition was 6-10%, depending on assessment method and study setting. Hospitalized older people were at increased risk of malnutrition. It might be ameliorated through community directed food systems.

Socio-demographic characteristics associated with the dietary diversity of Thai community-dwelling older people: results from the national health examination survey.

BACKGROUND: Dietary diversity (DD) is an indicator of nutrient intake and is related to health outcomes in older people. Currently, limited research exists regarding factors associated with DD in older people in developing countries, such as Thailand, despite rapid growth in this population. Therefore, this study aims to examine the association between socio-demographic characteristics and DD in Thai older people. METHODS: A cross-sectional study based on the fifth Thai National Health Examination Survey (NHES-V) conducted between 2013 and 2015 was performed. A total of 7,300 nationally representative older participants aged ≥ 60 years were included. The individual-level dietary diversity score (DDS) was assessed as the frequency of consumption of eight food groups using food frequency questionnaires. Each food group was scored from 0 to 4 according to the frequency of consumption. The DDS was calculated as the sum of the scores, ranging from 0 to 32. Socio-demographic characteristics, including age, sex, highest education level, wealth index, living conditions, and residential area, were assessed. Data were analyzed using multiple linear regression and adjusted for complex survey design. RESULTS: The participants had a mean age of 69.7 (SD 7.6) years. The mean DDS of participants was 18.4 (SD 3.9). In the adjusted model, a higher educational level, a higher wealth index, and living in an urban area were positively associated with DDS, with adjusted ß (95% CI) values of 1.37 (1.04, 1.70) for secondary education or higher, 0.81 (0.55, 1.06) for the richest group, and 0.24 (0.10, 0.44) for living in an urban area. Nevertheless, living alone had negative associations with DDS, with a ß (95% CI) of - 0.27 (- 0.53, - 0.00). CONCLUSIONS: This study showed that a higher educational level, a higher wealth index, and living in an urban area had a positive association, whereas living alone had a negative association with DD among Thai older participants. Interventions aiming to improve dietary diversity among older people might benefit from targeting more vulnerable groups, particularly those with less education and wealth, those living alone, or those in rural areas.

A simpler screening tool for sarcopenia in surgical patients.

BACKGROUND: Sarcopenia is defined as decreased skeletal muscle mass and muscle functions (strength and physical performance). Muscle mass is measured by specific methods, such as bioelectrical impedance analysis and dual-energy X-ray absorptiometry. However, the devices used for these methods are costly and are usually not portable. A simple tool to screen for sarcopenia without measuring muscle mass might be practical, especially in developing countries. The aim of this study was to design a simple screening tool and to validate its performance in screening for sarcopenia in older adult cancer patients scheduled for elective surgery. METHODS: Cancer surgical patients aged >60 years were enrolled. Their nutritional statuses were evaluated using the Mini Nutrition Assessment-Short Form. Sarcopenia was assessed using Asian Working Group for Sarcopenia (AWGS) criteria. Appendicular skeletal muscle mass was measured by bioelectrical impedance analysis. Four screening formulas with differing combinations of factors (muscle strength, physical performance, and nutritional status) were assessed. The validities of the formulas, compared with the AWGS definition, are presented as sensitivity, specificity, accuracy, and area under a receiver operating characteristic curve. RESULTS: Of 251 enrolled surgical patients, 84 (34%) were diagnosed with sarcopenia. Malnutrition (odds ratio [OR]: 2.89, 95% CI: 1.40-5.93); underweight status (OR: 2.80, 95% CI: 1.06-7.43); and age increments of 5 years (OR: 1.78, 95% CI: 1.41-2.24) were independent predictors of preoperative sarcopenia. The combination of low muscle strength and/or abnormal physical performance, plus malnutrition/risk of malnutrition had the highest sensitivity, specificity, and accuracy (81.0%, 78.4%, and 79.3%, respectively). This screening formula estimated the probability of sarcopenia with a positive predictive value of 65.4% and a negative predictive value of 89.1%. CONCLUSION: Sarcopenia screening can be performed using a simple tool. The combination of low muscle strength and/or abnormal physical performance, plus malnutrition/risk of malnutrition, has the highest screening performance.

Relationship between F-18 florbetapir uptake in occipital lobe and neurocognitive performance in Alzheimer's disease.

PURPOSE: To determine the association between occipital amyloid-PET uptake and neurocognitive performance in Alzheimer's disease (AD). MATERIALS AND METHODS: Fifty-eight participants with normal aged, mild cognitive impairment (MCI) due to AD and AD subjects who underwent F-18 florbetapir brain PET/CT scans were divided into four groups (A, normal; B, MCI; C, mild AD; and D, moderate/severe AD). Semiquantitative analyses of SUVR images were performed. The differences between groups and the correlations between florbetapir uptake and Thai Mental State Examination (TMSE) scores were determined. Significant differences were defined using a P < 0.001, uncorrected, or a P < 0.05, FWE for the voxel-based analyses with Statistical Parametric Mapping (SPM). RESULTS: There was a slightly higher florbetapir uptake in the precuneus, parietal, and occipital association cortices in Group B > A. The occipital florbetapir uptake in Groups C and D was significantly higher than in Group A, in addition to the precuneus, anterior cingulate, posterior cingulate, temporoparietal, and frontal cortices. There was a strong negative correlation between TMSE scores and florbetapir uptake in the occipital lobe. CONCLUSIONS: Occipital amyloid uptake is associated with clinically advanced AD, and is inversely correlated with neurocognitive performance and may be useful for evaluating AD severity.

The benefits of a novel chicken-based oral nutritional supplement for older adults: A double-blind randomized controlled trial.

BACKGROUND AND OBJECTIVES: A considerable proportion of older adults are lactose intolerant. The aim of this study was to investigate the clinical safety, efficacy, and tolerability of a chicken-based oral nutritional supplement (ONS). METHODS AND STUDY DESIGN: Double-blind randomized controlled trial. Subjects in the intervention group received chicken-based ONS, and those in the control group received a similarly flavored oral fluid placebo. All subjects were followed-up every two months for a total of 6 months. RESULTS: Thirty-eight older adults aged ≥70 years were recruited. The mean age and BMI were 81.5±5.6 years and 19.6±2.5 kg/m2. At the end of this trial, there was no statistically significant change in sarcopenia-related variables in the intervention group. However, the higher-level physical activity (PA) group within the intervention group had a significantly improved usual gait speed (UGS) compared to the lower-level PA group (p=0.04). The adjusted mean differences in UGS between the high and low level PA groups in the intervention and placebo groups were 0.149 m/sec and 0.083 m/sec, respectively. Significant difference was observed for changes in two bone markers between the intervention and placebo groups. CONCLUSIONS: The chicken-based ONS evaluated in this study was well-tolerated. No improvement of sarcopenia-related components was shown by the study ONS. Up to nearly an 80% increase in adjusted mean difference in UGS between the high and low level PA groups was observed in the nutritional intervention group compared to the zero-protein calorie placebo group. Significant improvement in age-related bone resorption was the earliest advantage of taking our ONS.

Exploring the Experience and Determinants of the Food Choices and Eating Practices of Elderly Thai People: A Qualitative Study.

Over the past decade, Thailand has experienced a rapid increase in its elderly population. Many unfavorable health outcomes among elderly people are associated with nutrition. Nutrition in elderly people is affected by physical, mental, and social factors. This study explored the food choices and dietary practices among community-dwelling elderly people in Thailand from the perspective of both caregivers and the elderly people themselves. Six focus group discussions and six semistructured interviews were conducted in the Samut Sakhon Province of Thailand. Deductive thematic analyses were conducted based on the "food choice process model framework." The results show that physical and mental factors and societal factors are important determinants of food choices. Moreover, a changing food environment and economic factors were found to affect food choices. Issues of trust in food safety and food markets were highlighted as growing issues. Therefore, fostering healthy food choice interventions that consider both environmental and societal aspects is necessary.

Characteristics and Real-Life Outcomes of Dementia and Cognitive Impairment at a Geriatric Clinic.

BACKGROUND: Various patterns of dementia care have been developed in different settings, depending on the availability of healthcare resources and facilities. The purpose of this study was to examine the epidemiology and characteristics of dementia care at a geriatric clinic, a field that has been subject to little prior evaluation. METHODS: A retrospective chart review was undertaken of cohort patients with cognitive impairment who had received a diagnosis and were still on active follow-up at a geriatric clinic. A total of 892 patients were included. In addition, 203 geriatric patients with no cognitive impairment who attended the clinic during the study period were sampled as a control. RESULTS: The main diagnoses of dementia were Alzheimer's disease (AD) (40.1%), vascular dementia (16.9%), unspecified dementia (16.3%), mixed dementia (9.0%), AD with cerebrovascular disease (8.7%), and Parkinson's disease dementia (6.1%). Atypical dementia was presented in 3.0% of cases. There were 178 patients with mild cognitive impairment, 20 with vascular cognitive impairment, and 18 with subjective cognitive decline. Other comorbidities were found in 97% of the subjects. Patients with cognitive impairment had a higher total number of other geriatric syndromes and higher percentages for delirium, falls, immobility, loss of appetite, and incontinence. Potentially reversible causes of dementia were found in 11.3% of the cases. Acetylcholinesterase inhibitors were administered to 61%, whereas 23.5% received an NMDA receptor antagonist. The need for a change in the antidementia medication was identified for 10.7% of the subjects; the major cause was adverse drug side effects. Nonpharmacological therapy only was administered to 52.4% of the people with dementia who had behavioral and psychological symptoms. CONCLUSIONS: Mixed brain pathologies, comorbidities, and the coexistence of other geriatric syndromes are common at geriatric clinics. Holistic, integrated, and continuous care are needed to improve the outcomes of patients with more complicated comorbidities.

The prevalence of cognitive frailty and pre-frailty among older people in Bangkok metropolitan area: a multicenter study of hospital-based outpatient clinics.

OBJECTIVES: To identify the prevalence of, and factors associated with, cognitive frailty and prefrailty, and to investigate correlation between frailty tools. METHODS: One hundred and ninety five older adults were recruited from the medical outpatient clinics of 3 tertiary hospitals in Bangkok metropolitan region. The data collected were demographic information, lifestyle factors, functional status, mood assessment, and cognitive and frailty assessments. The frailty tools used were Frailty Phenotype and FRAIL scale. RESULTS: The prevalence of pre-frailty, frailty, mild cognitive impairment (MCI), cognitive pre-frailty and cognitive frailty was 57.4%, 15.9%, 26.2%, 14.4% and 6.7%, respectively. A multivariate analysis showed that age ≥70 years (OR 5.34; 95% CI 2.06-12.63), and education at primary school or under (OR 4.18; 95% CI 1.61-10.82) were associated with cognitive frailty and cognitive pre-frailty. The correlation between physical frailty rated by the Modified Fried Frailty Phenotype and the FRAIL scale was good (Kappa coefficient = 0.741). CONCLUSIONS: The prevalence of cognitive frailty is not uncommon which requires screening and interventions. Age and a low educational level were related to cognitive frailty/prefrailty. The FRAIL scale yielded a high correlation with Frailty phenotypes, implying its benefit in routine clinical use in primary care practice, where there is limited time and resources.