Journal of the Indian Academy of Geriatrics

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Psychiatric presentations and factors associated with suspected organicity in elderly attending a tertiary care facility in South India
(The Indian Academy of Geriatrics, 2023-01) Srisudha, B; Nandyal, Munaf Babajan; Kolloju, Naveen; Joseph, Rachna George; Karuppusami, Reka; Kurian, Suja
Objectives: The objectives were to determine the proportion of elderly among the new psychiatry outpatient attendees, identify their sociodemographic profile and clinical presentations, and determine risk factors associated with suspected organic conditions in patients presenting with acute onset and chronic presentations. Methodology: This retrospective cross-sectional study focused on the elderly presenting with psychiatric symptoms to a psychiatric setting. The onset of symptoms at presentation was divided into acute and chronic conditions. Clinical symptom clusters and the risk factors associated with organic conditions were identified. The Chi‑square and Fisher’s exact test were used to find an association between factors and outcome (organic/functional). Results: Elderly seeking consultation constituted < 10% of total new case registration. Acute onset was seen in one-third and chronic presentation constituted nearly two-thirds of the group. The common clinical presentations with acute onset were acute psychosis, altered sensorium, and psychosis due to an organic etiology. The most common clinical presentation with chronic course was chronic psychosis. Nearly 40% had suspected organicity. Increasing age, structural abnormality in brain imaging, and the presence of stressors were risk factors for the onset of psychiatric presentation in the elderly (P = 0.001). Conclusion: Early detection of the clinical syndrome, identification of organic conditions, and appropriate and prompt referral to the general physician should be the rule for the care of the elderly presenting to a psychiatric facility.
Functional limitation among older adults in a rural area in South Kerala and its associated factors
(The Indian Academy of Geriatrics, 2023-01) Pillai, Rahul S; Paul, Sherin Susan
Background: A person is said to have a functional limitation when he/she does not have the physical or cognitive ability to independently perform the routine activities of daily living. If recognized at an early stage, these can often be improved greatly, helping them regain their functional abilities and independence. Objective: The objective of the study was to determine the prevalence of functional limitations among older adults in a rural area in south Kerala. Materials and Methods: The cross-sectional study was conducted among older adults residing in the field practice area of a rural health training center of a medical college in south Kerala for 3 months from October 2019 to December 2019. Data were collected by interview of the participants by the investigator. The modified Barthel Index for activities of daily living was used to determine the prevalence of functional limitations. Results: The overall prevalence of functional limitations among older adults in a rural area in south Kerala was 35.9%. The most common functional limitation experienced by the participants was difficulty in climbing stairs. Functional limitation was found to be significantly associated with the age, socioeconomic status, and type of family of the participants. Conclusion: There is an urgent need to focus on the functional limitation among older adults, especially among the oldest old and those in lower socioeconomic status with emphasis on the need to strengthen the health‑care facilities for them, with respect to early identification and management of their functional limitations.
Cognitive decline among older adults who developed acute coronary syndrome during hospitalization for non-cardiac illness
(The Indian Academy of Geriatrics, 2023-01) Vijayakumar, Priya; David, Arun; Vijayakumar, M
Background: Atypical presentations of acute coronary syndrome (ACS) delay its recognition and treatment in the elderly patients. Functional decline and delirium which are common to the elderly during hospitalization, leads to cognitive impairment and poor health outcomes. Steps taken for its prevention is usually not considered the top priority by the cardiologist. The present study was conducted to identify cognitive decline among elderly patients who developed ACS during hospitalization for noncardiac illness and their outcome. Materials and Methods: Three hundred and ten elderly patients above 60 years of age with ACS were included from June 26, 2020 to October 13, 2020. Subjects were divided into those admitted primarily due to an ACS (Group I, n = 94) and those developing ACS following admission for noncardiac illness (Group II, n = 216). Co-morbidities, medications, investigations, management, clinical outcome, and Montreal Cognitive Assessment scale were compared between the two groups at the time of admission, after 30 days and after 6 months. Results: Majority of the subjects were admitted due to acute kidney injury (27.1%) in Group II and had a non-ST elevation ACS (90.2%). Optimum management was given to a lesser extent due to the clinical condition of these patients. Poor clinical outcome, cognitive impairment during hospitalization and cognitive decline during follow-up was more in Group II. Conclusion: Clinicians must be vigilant for the development of cognitive impairment and cognitive decline when an elderly patient is admitted to the hospital, as early detection and optimum management provides better clinical and cognitive outcome.
Nutritional status and food environment of the elderly population residing in tea gardens of a block of Darjeeling District, West Bengal, India
(The Indian Academy of Geriatrics, 2023-01) Sullar, Kunal Singh; Dasgupta, Pallabi; Ishore, Kaushik
Objectives: In India, poverty, illiteracy, and difficult terrains make the tea garden elderly population more vulnerable to malnutrition. The food environment shows the interface through which consumers interact with their food system. Hence, the present study was done to assess the nutrition status and identify the sociodemographic and food environmental factors affecting the nutritional status of the elderly population residing in tea gardens of Naxalbari block, Darjeeling district, West Bengal, India. Materials and Methods: A community-based cross‑sectional study was conducted in all tea gardens of Naxalbari block, Darjeeling, from March 2022 to September 2022, among older people aged 60 years and above selected by simple random sampling. Using the predesigned, pretested questionnaire, the Mini Nutritional Assessment tool for nutritional assessment and the elderly population’s perceived food environment was determined based on five points Likert’s scale. Perceived food environment clusters were identified using a two‑stage cluster analysis. Binary logistic regression was used to determine predictors of nutritional status. Results: Out of the 294 study participants, the majority of 190 (64.6%) of the older people were at the risk of malnutrition, 18 (6.1%) malnourished, and 86 (29.3%) had normal nutritional status. Binary logistics regression showed older people who were illiterate (adjusted odds ratio [AOR] 14.864; 95% confidence interval [CI]; 4.311–51.457) and not working (AOR 3.775; 95% CI; 1.753–8.128) had significantly higher odds of being undernourished. Older people who perceived a favorable food environment (AOR 0.408; 95% CI; 0.214–0.775) had significantly lesser odds of being undernourished. Conclusion: Tea garden older population is at higher risk of malnutrition. Illiteracy, working status, and perceived favorable food environment plays important role in altering the nutritional status of the elderly. Prior interventions such as awareness regarding food nutrition and developing elderly friendly food environment are needed.
Prognostic value of serum albumin and C-reactive protein levels in the elderly for assessing morbidity and mortality in a tertiary care center
(The Indian Academy of Geriatrics, 2023-01) John, Sanjo, K; Padmaja, N; Rao, I V. Ramachandra; Priya, Subalin; John, Centina Rose; James, Tittu Thomas
Introduction: There is an increased population of elderly globally due to advancement of technology in health care. Elderly individuals are susceptible to various diseases, owing to deficits in nutrition or healthy lifestyle. Serum albumin and C‑reactive protein (CRP) are found to be sensitive to nutritional status as well as inflammation. This study is an attempt to analyze the prognostic value of CRP and serum albumin and analyze its usefulness as a prognostic marker in assessing morbidity and mortality in elderly patients. Methodology: One hundred patients above the age of 65 years and were admitted to the emergency care facilities of our tertiary care center were recruited for the study. Serum albumin and CRP estimation was done on the day of admission along with Charlson Comorbidity Index (CCI), and was follow-up till discharge. Statistical analysis was performed to evaluate relationship between the serum values and CCI scores. Results: It was observed that 83.3% (10/12) of deaths occurred in those with low serum albumin levels, and 91.6% (11/12) with high CRP levels. The hazard ratio shows a 6% increased probability of death with one unit increase in CRP, whereas a one unit increase in serum albumin value decrease the probability of death. Conclusion: The present study concludes that low serum albumin and high CRP levels at the time of admission in the elderly population are associated with high CCI scores, longer hospital stay, and increased risk of mortality, demanding their estimation in the elderly in emergency and acute care facilities.
Anemia in elderly patients ≥65 years of age: a hospital-based cross-sectional study
(The Indian Academy of Geriatrics, 2023-01) Kadhiravan, E; Devi, Agalya; Mohan, Reenaa; Sindhuri, R; Abdula, Shiek; Devi, D, S. Karthika
Introduction: Anemia in elderly patients of any degree contributes significantly to morbidity and mortality and has a significant effect on the quality of life. Despite of high prevalence, very few studies have examined the effect of anemia in elderly patients in India. Hence, this study is undertaken to know the prevalence and clinicopathological pattern of anemia in elderly patients. Objectives: 1. To estimate the prevalence of anemia in the elderly aged 65 years and above. 2. To determine the severity, clinicohematological patterns, and causes of anemia in the elderly aged 65 years and above. Materials and Methods: A hospital-based descriptive cross-sectional study was done. The study was conducted for 1 year; during this period, elderly patients aged 65 years and above admitted for other medical conditions were recruited in the study using consecutive sampling technique until the desired sample size of 236 was achieved and they were evaluated for anemia. Among them with hemoglobin cutoff value <13 g% for men, <12 g% for women were further evaluated to known the cause of anemia and its clinicohematological pattern. Ethical committee approval was obtained. Data were analyzed using SPSS Software version 23.0. Results: The mean age of the participants was 73.9 ± 7.4 (standard deviation [SD]) years. Majority, 53.8%, of the participants were males. Among the 236 elderly patients, recruited in the study 65.3% were anemic and among them 44.2 had mild anemia and 37% had moderate anemia. Mean hemoglobin value of the participants was 10.7 ± 2.83 SD and it ranged from 3 to 16.3 g/dl. There was no significant difference in the hematological parameters between male and female elderly patients in the study. The main cause of anemia was found to be due to chronic diseases followed by iron‑deficiency anemia. Conclusion: This study concludes that anemia was highly prevalent among elderly patients and most of them had identifiable and treatable etiology. Hence, all elderly patients with anemia should be evaluated properly for underlying etiology and treated accordingly to reduce the mortality and morbidity in elderly patients with multiple comorbidities.
Geriatric intertrochanteric fractures – A challenge to manage
(The Indian Academy of Geriatrics, 2023-01) Madhuchandra, P; Pawankumar, K M; Manish, K; Raju, K P
Background: Intertrochanteric fractures are among the frequently seen fractures in the elderly population. Treating these fractures is very challenging considering the fact that the quality of bone is poor and highly osteoporotic. The high failure rates with dynamic hip screw (DHS) especially in unstable fractures lead to the development of intramedullary devices such as proximal femoral nail (PFN) which has got multiple advantages over DHS. Materials and Methods: This prospective study included 30 patients above the age group of 60 years with unstable intertrochanteric fractures conducted in a tertiary institute between February 2021 and June 2022. Results were analyzed clinically and radiologically using the Modified Harris hip score. Results: Patients’ age group was 61–85 years with a mean age of 69 years, comprising 63% female and 37% male. The average Harris hip score was 83.76 at 24 weeks’ follow-up with 33.33% excellent, 56.66% good, 3.33% fair, and 6.67% poor. Postoperative complications included revision surgery in two patients, superficial infection in one patient, Z effect in one patient, peri-implant fracture in one patient. Conclusion: Treatment with PFN for unstable intertrochanteric fracture has the advantages of closed reduction, less tissue damage, early rehabilitation, and return to work. Osteosynthesis with short PFN resulted in good-to-excellent functional and radiological outcomes.
Annular pigmented actinic keratosis mimicking lentigo maligna melanoma in a 75-year-old female: An unusual presentation
(The Indian Academy of Geriatrics, 2023-01) Pathave, Hari
Pigmented actinic keratosis (PAK) is an uncommon variant of actinic keratosis that can mimic different pigmented lesions, which may be benign or malignant. The diagnosis of PAK is often challenging because of overlapping features with lentigo maligna melanoma (LMM). Clinically, lesions of both conditions almost look similar; the diagnoses must be established histologically and with the help of immunostaining whenever needed. The distinction between a large PAK and LMM is important because their prognosis and management differ. We present a 75-year-old female with annular brown-to-black-colored maculo-plaque on forehead having clinical suspicious of melanocytic malignancy; which was diagnosed with a PAK on biopsy with help of histopathology and confirmed with Melan A/MART‑1 immunostaining.
Angiolymphoid hyperplasia with eosinophilia: A report of a rare entity in an elderly male
(The Indian Academy of Geriatrics, 2023-01) Aggarwal, Anushruti; Gupta, Sharang; Chopra, Dimple; Arora, Raina
Angiolymphoid hyperplasia with eosinophilia (ALHE) is an uncommon benign proliferation of blood vessels of uncertain etiology. It primarily affects the head‑and‑neck region. Histologically, it is characterized by the prominent proliferation of plump endothelial cells, and accompanying eosinophilic and lymphocytic infiltration. Herein, we report the case of ALHE in a 65‑year‑old male.
Factors predicting mortality in elderly patients hospitalized for congestive heart failure
(The Indian Academy of Geriatrics, 2023-01) Sharda, Meenaxi; Vijay, Ankit; Gandhi, Nikhil; Aggarwal, Meghna
Background: Heart failure (HF) is a complex clinical syndrome that results from any structural or functional impairment of ventricular filling or ejection of blood. There are range of factors that predict the mortality, morbidity, and outcome in congestive HF (CHF) patients. Objectives: The objective was to study the clinico‑epidemiological characteristics and predictors of inhospital mortality of elderly patients ≥60 years hospitalized for HF. Subjects and Methods: A complete medical history of enrolled patients and physical examination inclusive of etiology, New York Heart Association (NYHA) grade, heart rate (HR), and systolic blood pressure (SBP) were noted. Complete blood count, blood urea, serum creatinine, serum sodium, serum potassium, 12-lead electrocardiogram, X-ray of the chest, and echo were obtained in all patients. Outcomes were analyzed till the study endpoints. Results: Compared to normal comparators, a higher mortality was observed in patients with age >75 years (33.3%), HR >100 beats per min (27.14%), SBP <80 mmHg (60%), NYHA IV HF (37.1%), hemoglobin (Hb) <12 mg/dl (31.25%), blood urea ≥40 mg/dl (26.39%), serum creatinine >1.30 mg/dl (29.17%), serum sodium <135 meq/L (26.69%), and ejection fraction (EF) <50% (26.39%). Conclusion: Increasing age, prior history of CHF on admission, higher NYHA grade on admission, higher HR, lower SBP, lower EF, low Hb, higher blood urea, serum creatinine, and low serum sodium levels are statistically significant predictors of inhospital mortality of elderly CHF patients
Thymoma: A rare presentation as recurrent pericardial effusion
(The Indian Academy of Geriatrics, 2023-01) Jha, Dipesh; Tendulkar, Prakash; Dhar, Minakshi; Shah, Bishal Pratap; Bisht, Khusbhoo
Recurrent pericardial effusion is always complicated for the primary care physician to diagnose, and it often goes undiagnosed. Thymoma is rare cancer, but it is the most common tumor in the anterior mediastinum. It can present in a variety of ways; it can be asymptomatic for an extended period of time and only rarely as pericardial effusion. A 68‑year‑old male presented to us with two episodes of pericardial effusion in the previous 2 years and was later diagnosed with thymoma.
Repigmentation of gray hair: A case report with a brief review of literature
(The Indian Academy of Geriatrics, 2023-01) Jerath, Vinod Parkash; Nischal, Richa; Jerath, Aditya
A case of gray hair nearly 99% was seen to be converted to more than 99% of the pigmented hair, after using full sleeves shirts for 2 years, with 1‑year follow‑up, with the same results, and on screening the literature, we find it first such case in the world literature of almost complete repigmentation of both the forearms after using full sleeves shirts for 2 years and a follow-up of 1 year.
Characteristics of centenarian studies and variables related to longevity: A narrative review
(The Indian Academy of Geriatrics, 2023-01) Teo, Shyh Poh
Studying centenarians requires a “positive biology” approach, where rather than focusing on disease, the research aims to understand the causes of positive phenotypes and explain biological mechanisms of health and longevity. This review outlines the characteristics of the key centenarian studies. Variables that may relate to the longevity of these oldest old are also described, including cardiovascular health, cognitive function, physical ability, mental and cognitive health, personality, and the social circumstances of the centenarian.
Strengths, weaknesses, opportunities, and threats analysis of the national program for health care of the elderly
(The Indian Academy of Geriatrics, 2023-01) Joshi, Nitin Kumar; Joshi, Vibha; Bajaj, Komal
Background: The National Program for the HealthCare of the Elderly (NPHCE) was adopted by the Ministry of Health and Family Welfare in 2010 to provide promotional, preventive, curative, and rehabilitative health-care services for the fast-growing older population in India. As literature about the assessment of NPHCE is lacking, the present study was conducted to perform a strengths, weaknesses, opportunities, and threats (SWOT) analysis of the program. Methods: The SWOT of the NPHCE program is analyzed using available literature and relevant documents. Results: Although this program embraces strategies to provide specialized training and services at primary health center, community health center, and district levels, including dedicated bedded wards, equipment, consumables, and pharmaceuticals but home-based care for the elderly, and the role of caregivers is overlooked in this program. NPHCE program can utilize the framework and take support of various ongoing healthy aging initiatives of international agencies to augment the health-care strategies for the elderly in India. Integrating schemes developed by the government for the upliftment of the elderly and the inclusion of traditional medicine systems in the program can serve as an opportunity for meeting unmet needs and improving the quality of life and well-being of the elderly. However, the growing elderly population, rise in nuclear families, and dual disease burden are significant threats to the program’s implementation. Conclusion: This program can be more effective in providing comprehensive health care to the elderly if more emphasis is given to community participation, home‑based care, and integrating digital health technologies and other existing welfare schemes.
Frailty as a predictor of outcome in heart failure in the elderly: An observational study at a tertiary care center
(The Indian Academy of Geriatrics, 2023-01) Kumar, Pratap; Dhar, Minakshi; Kumar, Barun; Jain, Vikram
Introduction: Heart failure is the leading contributor to global morbidity and mortality. Frailty is an emerging prognostic factor in heart failure. There is little data on the prognostic role of frailty in patients admitted for acute heart failure as most studies have been done on stable heart failure patients. Methodology: The study included elderly (age ≥60 years) patients admitted with acute heart failure at a tertiary care center in India. Patients with dementia, cognitive impairment, and documented terminal illness were excluded. The sample size was 85 patients. Frailty assessment was done using short performance physical battery (SPPB) and Fried phenotype scales and follow‑up data was collected at 3 months postdischarge telephonically. The primary objective of the study was to determine the proportion of frailty in elderly in‑hospital heart failure patients. The secondary objectives were to see the agreement between the frailty assessment tools used (SPPB and Fried phenotype). Results: Eighty seven patients were included in the study. The majority were male (n = 45) and had heart failure with reduced ejection fraction (n = 56). Coronary artery disease (CAD) (n = 60) was the most common cause of heart failure. Eighty-two patients had at least one comorbidity. The proportion of frailty as per the SPPB was 43.67%, and as per the Fried phenotype was 68.9%. A total of 4 deaths and 15 re-admissions occurred during the follow-up period of 3 months. The majority belonged to the frail category as per both the frailty scales (P < 0.001 for SPPB, P = 0.087 for Fried phenotype). Fleiss’s kappa coefficient for agreement between the scales was 0.373 (SE = 0.106, P < 0.001), which signifies that there was a fair agreement between the two scales. The Spearman Rank correlation coefficient was −0.691 (P < 0.01) between the two scales. Hence, the SPPB score inversely correlated with the Fried phenotype. Conclusion: Frailty is largely prevalent in elderly heart failure patients. It can be used to predict poor outcomes in these patients. Clinicians should identify these high-risk patients at the time of discharge from their facility and consider interventions (tailored rehabilitation programs) to minimize the adverse outcomes.
A comparative study on quality of life of elderly among those living with families and in old age homes in a District in South India
(The Indian Academy of Geriatrics, 2022-10) Vignesh, Nawin, Jai; George, Neethu; Hemadharshini, S
Introduction: The elderly population in India is steadily increasing and it is expected to triple in 2050 as of the census 2011. Drastic improvements in health care made betterment in physical health but their subjective well?being remains unaccounted. Therefore, the present study aims to assess the quality of life (QoL) among elderly and to compare the differences in QoL among elderly population residing in homes and in old age homes. Methodology: An analytical cross?sectional study among elderly above the age of 60 years residing with families and other 40 elderly population residing in old age homes. A questionnaire-based interview was conducted using a standard semistructured World Health Organization-BREF QoL questionnaire. Results: In the study, most of the participants 45 (56.3%) were male and 35 (43.8%) belonged to the age group of 70–79 years with a mean (standard deviation) age of 73.96 (7.44) years. The study found that there is nil significant difference in QoL among elderly living in old age homes and in family setups. The domain scores of psychological, social, and environmental domains showed a slight nonsignificant increase in elderly among old age homes. Conclusion: The study showed nil significant difference in QoL score in all domains for the elderly. The concept of QoL needs to be looked into with more preference to psychological, social, and environmental domains.
Quality of life among malnourished elderly population in rural Puducherry, South India
(The Indian Academy of Geriatrics, 2022-10) Sivapushani, Aruljothi; Mathiyalagen, Prakash; Dhasaram, Premnath; Sivadamien, Thirunavukarasu
Context: Health of the elderly will be an important issue in defining the health status of a population in coming years. There is a paucity of information with regard to quality of life (QOL) among malnourished elderly. Aims: To assess the QOL among malnourished elderly in a rural field practice areas of tertiary care hospital, Puducherry, and to find the sociodemographic factors associated with QOL among malnourished elderly population. Settings and Design: A community?based cross?sectional study in the rural field areas of Government Medical College of Puducherry. Subjects and Methods: After obtaining ethical approval, the study was conducted among 225 malnourished elderly (>60 years) from April to June 2019 using multistage random sampling technique. Sociodemographic data were obtained using a semistructured questionnaire. Malnutrition was screened using Mini Nutritional Assessment Short Form and QOL was assessed using World Health Organization QOL?BREF questionnaire. Results: The mean and standard deviation of the study participants’ age was 69.89 + 6.3 years. 57.8% of them were female, 81.3% were unemployed, and 73.3% were dependent on their old age pension for their livelihood. QOL of malnourished elderly was poor in all the domains when compared to those without malnourished and this is found to be statistically significant. In binomial logistic regression analysis, the presence of comorbidity (adjusted odds ratio [AOR]: 2.4 and 95% confidence interval: 1.3–4.4), unemployed (AOR: 4.8; 1.4–15.9), and living without family (AOR: 0.2; 0.06–0.7) revealed the statistically significant association with low QOL score among malnourished elderly. Conclusions: The mean score of QOL among malnourished elderly was below average in all four domains in which psychosocial domain was badly affected.
Factors affecting hypertension among rural geriatric population in Odisha: Findings from AHSETS study
(The Indian Academy of Geriatrics, 2022-10) Biswal, Ramesh Kumar; Kumar, Subudhi, B Swagat; Sethi, Somanath; Kshatri, Jaya Singh; Bhoi, Trilochan
Background: Worldwide, around 1.28 billion adults, aged 30–79 years have hypertension (HTN) and most (two?thirds) of them living in low? and middle?income countries like India. While only less than half of adults (42%) with HTN are diagnosed and treated. This study is an effort to estimate the prevalence and determine the determinants of HTN among the rural elderly population in Tigira block, Cuttack district of Odisha. Methodology: This cross?sectional study was carried out among 725 rural elderly (>60 years) people using probability proportionate to sample (PPS) sampling in the year 2019–2020. Previous medical history of HTN diagnosed by medical professional was taken as positive for HTN. Bivariate analysis was performed using the Chi?square test. The binary logistic regression model was used to find out the predictors of HTN. Results: This cross?sectional study found an HTN prevalence of 34.75% (n = 252) among rural older adults. Factors found to be significantly associated with HTN were female gender (adjusted odds ratio [AOR] = 1.73, confidence interval [CI] = 1.129–2.666), elderly aged ?80 years (AOR = 1.98, CI = 1.170–3.379), not working elderly (AOR = 2.14, CI = 1.178–3.89), lower?middle socioeconomic status (SES) (AOR = 1.61, CI = 1.093–2.372), overweight elderly (AOR = 2.01, CI = 1.309–3.098) and diabetics (AOR = 4.56, CI = 2.704–7.718), respectively. Conclusion: HTN prevalence was found to be high in the rural area, and the factors such as female gender, elderly aged ?80 years, not working elderly, lower?middle SES, overweight elderly, and diabetes were found to be the determinants of HTN in the rural elderly population of Odisha.
Caregiving for elderly population: A mixed-method study conducted in the urban population of Tamil Nadu
(The Indian Academy of Geriatrics, 2022-10) Premanandh, K; Rajalakshmi, M; Mohan, Reenaa
Background: Caregiving for elderly individuals is an emerging health issue that affects the quality of life of caregivers. The objective of this study was to explore the difficulties faced by caregivers in providing care to the elderly population. Methodology: This study was conducted using an explanatory mixed?method study design, in which a quantitative component (cross?sectional study) was followed by a qualitative component (in-depth interview). A total of 101 caregivers of the elderly population (with moderate disability level and above) were screened for personal stress using a perceived stress scale. Following quantitative data collection, an in?depth interview was conducted among caregivers selected by purposive sampling using an interview guide to explore the issues faced by caregivers. Results: A total of 384 individuals aged 60 years and above were screened for the level of disability. A total of 101 caregivers who were providing supportive care to elderly people with moderate and severe levels of disability were screened for stress using a perceived stress scale. Around 54% of the caregivers reported high perceived stress and 28% of the caregivers reported moderate stress. In?depth interviews using purposive sampling identified the following themes for caregivers of elderly individuals: frustration about providing continuous care, dealing with personal health problems, feeling anger, and isolation and financial stress. Conclusions: The need for caregiving for the older population is increasing. A significant amount of stress has been reported among caregivers. Frustration about providing continuous care, dealing with personal health problems, and feeling isolation and financial stress were the common challenges reported by the caregivers.
Patterns and outcomes of empirical antimicrobial use in elderly outpatients: A pilot observational study from North India
(The Indian Academy of Geriatrics, 2022-10) Ojha, Bisweswar; Singh, Amit; Chakrabarti, Sankha Shubhra; Kaur, Upinder
Introduction: Despite the rampant use of antimicrobials in health?care settings, the safety and clinical outcome data of antimicrobials are scarce in the elderly population. The main aim of this study is to assess the prescription pattern, therapeutic gains, and adverse reactions resulting out of antimicrobial use in elderly outpatients. Subjects and Methods: This was a prospective observational study conducted for 7 months from June 2019 to December 2019 in elderly patients visiting the geriatric outpatient department of a tertiary hospital of North India. Primary outcomes included clinical improvement as well as the incidence and type of adverse drug reactions (ADRs) observed with antimicrobial use. Results: Of 110 participants recruited, 107 were assessed for clinical outcomes. The common indications of antimicrobial use were lower respiratory tract infection (48.6%), urinary tract infection (18.7%), and worm infestations (14%). Macrolides (57%) and beta?lactams (43%) were the commonly prescribed individual antimicrobials. Outcome?wise, clinical improvement was seen in 91.3%, 88.5%, and 14.3% of patients receiving beta?lactams, macrolides, and antiprotozoals, respectively. ADRs occurred in 17.7% of participants and gastrointestinal disturbance was the commonly reported ADR. Beta?lactams and macrolides were responsible for the majority of ADRs, in 19.6% and 13.1% of participants, respectively. No association of antimicrobial?associated clinical responses or ADRs was observed with demographics and underlying comorbidities. Conclusions: Elderly patients with respiratory tract infections showed improvement with empirical extended-spectrum beta-lactams and azithromycin therapy. The response was suboptimal to empirically selected antiprotozoal therapy. Elderly patients are at increased risk of ADRs. Close to one out of every five elderly prescribed beta?lactams may develop ADR to the antimicrobial agent. Larger clinical studies are required to predict the risk factors of ADRs and poor responsiveness to antimicrobials.

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