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To evaluate the association of cognitive impairment, depressive mood and sarcopenia among older men living in the veterans retirement community in southern TaiwanThis cross-sectional study recruited 353 men aged 65 years and older. In addition to demographic characteristics, all participants were measured for gait speed, handgrip strength and muscle mass by using bioelectrical impedance analysis (BIA). The diagnosis of sarcopenia was made according to the European Working Group on Sarcopenia in Older People criteria. Slow walking speed was defined as ≤ 0.8 meter/second. Low muscle strength was defined as the handgrip strength less than 22.5 kg which was adjusted according to Taiwanese norms. A height-adjusted muscle mass of 8.87 kg/m2 from a previous Taiwanese study was defined as low muscle mass. Cognitive function was evaluated by the Mini-Mental State Examination (MMSE), and the Geriatric Depression Scale-15 (GDS-15) was used for screening of depressive symptoms.Among the 353 participants (mean age 82.7 ± 5.3 years), 30.9% (109/353) were classified as sarcopenic. Multivariate logistic regression showed that sarcopenia was independently associated with cognitive impairment (adjusted OR 3.03, 95% CI 1.63-5.65, P0.001) and depressive symptoms (adjusted OR 2.25, 95% CI 1.03-4.89, P = 0.04).Sarcopenia was significantly associated with cognitive impairment and depressive symptoms among otherwise healthy older men living in the veterans retirement community. Further outcome study is required to explore the interrelationship of cognition, depressive symptoms and sarcopenia in older adults.

Although patients admitted to post-acute care (PAC) units are usually clinically stable, unexpected medical conditions requiring acute ward readmissions still occur and can jeopardize the clinical effectiveness of PAC services. The main purpose of the present study was to evaluate predictive factors for clinical instability of patients in PAC units to improve the quality of PAC services.This was a nationwide multicenter cohort study that recruited patients from five PAC units in Taiwan between July 2007 and June 2009. All patients received the comprehensive geriatric assessment (CGA) within 72 h of PAC unit admissions. Conditions requiring acute ward re-admissions from PAC units were defined as clinical instability. Causes of clinical instability for all patients and data of CGA were collected for analysis.Of 918 enrolled participants, 119 (12.9%) experienced acute ward readmissions, including 106 (89.1%) admissions related to medical conditions and 13 (10.9%) for surgical causes. Common conditions included diseases of the respiratory system (n = 32, 26.9%), genitourinary system (n = 24, 20.2%) and digestive system (n = 14, 11.8%). Surgical conditions, mainly fractures and dislocation of upper limbs, were significantly more likely to occur later (P = 0.05) in the PAC unit admissions than medical conditions. Compared with the non-readmission group, the readmission group was leaner (mean body mass index 21.1 ± 2.8 vs 22.0 ± 3.8 kg/m(2) , P = 0.007), having poorer functional status (mean Barthel Index 41.0 ± 19.4 vs 45.4 ± 20.3, P = 0.02; mean IADL: 1.3 ± 1.6 vs 1.7 ± 1.8, P = 0.016), poorer cognitive function (mean Mini-Mental State Examination: 16.8 ± 6.4 vs 18.3 ± 6.4, P = 0.022), poorer ambulation (mean Timed UpGo test 32.7 ± 18.7 vs 26.6 ± 11.7 s, P = 0.039) and poorer nutritional status (mean Mini-Nutrition Assessment 13.3 ± 5.7 vs 15.4 ± 5.8, P 0.001), but similar in depression status (mean Geriatric Depression Score 3.7 ± 3.3 vs 3.4 ± 2.8, P = 0.247). In multivariate logistical regression model, lower Mini-Mental State Examination score was the only independent predictor for clinical instability (odds ratio 3.8, 95% confidence interval 1.348-10.870, P = 0.012).Approximately 13% of PAC patients might experience acute ward readmissions, and nearly 90% of them are caused by medical conditions. Poor cognitive function is a significant predictive factor for clinical instability in PAC, which deserves more clinical attention for all PAC patients.

Background Activation of inflammatory pathway with elevation of inflammatory biomarkers such as Interleukin 6 (IL-6) has been considered a pathophysiological feature of frailty. In recent years, the association between Intercellular adhesive molecule -1 (ICAM-1) and vascular inflammatory was established. Provocation of inflammatory cascades from ICAM-1 is potential IL-6 related, although the association between the inflammatory process and frailty is little to known. The study was intended to evaluate the relationship between serum ICAM-1, IL-6 and frailty. Materials and Methods Data was derived from a representative national sampling cohort in Taiwan. The cross-sectional study included nine-hundred-forty-six community-dwelling people aged 53 and older. Frailty was defined as having three or more components (including, muscle shrinkage, slowness, weakness, exhaustion, and low activity) Serum IL-6 and ICAM-1 levels were measured using standard enzyme–linked immunosorbent assays. Results Soluble ICAM-1 (sICAM-1) levels were stepwise increased in non-frail, pre-frail and frail elderly people (the median levels were 255 vs. 265 vs. 285 ng/ml, respectively p

Elderly people with dementia are at increased risk of falls and intervention trials to prevent falls have failed to demonstrate clinical effectiveness in this population. This study evaluates the role of urinary incontinence as a fall risk factor in older patients with dementia, with the aim of developing relevant intervention strategies.Elderly patients with dementia visiting our center were recruited. All subjects underwent a Comprehensive Geriatric Assessment (CGA), and patients were divided into two groups (fall and non-fall) according to their history of falls in the past year. Components of the CGA, including physical function, mental function, depressive symptoms, incontinence, and nutritional status, were evaluated according to fall history.Overall, 159 patients with dementia (mean age 77.3 ± 9.0 years, 59.1% male) participated. Fifty-four patients (34.0%) had experienced falls in the past year. Among all subjects, 50.3% were diagnosed with mild dementia, 37.7% with moderate dementia, and 12.0% with severe dementia according to an established Clinical Dementia Rating scale. Subjects in the fall group displayed poorer physical function, balance, depressive mood, nutritional status, urinary incontinence, and had an increased prevalence of polypharmacy. However, multivariate analysis revealed urinary incontinence as the only independent risk factor for falls (OR = 4.9 ± 2.2, 95% CI: 2.0-12.0, P0.001).Urinary incontinence is a previously unidentified risk factor for falls among elderly dementia patients. An interventional study with the focus of urinary incontinence could improve the effectiveness of fall prevention among these patients.

Taiwan is one of the fastest aging countries in the world. As such, the government has developed various strategies to promote an age-friendly health-care system. Health services are supported by National Health Insurance (NHI), which insures over 97% of citizens and over 99% of health-care institutes. The current health-care system has difficulties in caring for older patients with multiple comorbidities, complex care needs, functional impairments, and post-acute care needs. Taipei, an international metropolis with a well-preserved tradition of filial piety in Chinese societies, has developed various strategies to overcome the aforementioned barriers to an age-friendly health-care system. These include an emphasis on general medical care and a holistic approach in all specialties, development of a geriatrics specialty training program, development of post-acute services, and strengthening of linkages between health and social care services. Despite achievements thus far, challenges still include creating a more extensive integration between medical specialties, promotion of an interdisciplinary care model across specialties and health-care settings, and integration of health and social care services. The experiences of Taipei in developing an age-friendly health-care service system may be a culturally appropriate model for other Chinese and Asian communities.

Objective: To compare the effectiveness of the Minimum Data Set-based Depression Rating Scale (MDS-DRS) and Geriatric Depression Scale (GDS) in screening depression among older institutionalized Chinese men living in Taiwan. Method: MDS Nursing Home 2.1 Chinese version, Mini-Mental State Examination (MMSE), and short form Geriatric Depression Scale (GDS-15) were used among elderly residents in Banciao Veterans Home. Screening results of MDS-DRS and GDS-15, and relationship between 16 MDS Mood and Anxiety symptoms and depression were evaluated. Results: The prevalence of depression defined by MDS-DRS and GDS were 0.2% and 8.7%, respectively. Multiple logistic regression disclosed that E1a (OR: 12.9, 95% CI: 2.8-58.8, p = 0.001), E1k (OR: 15.6, 95% CI: 5.6-43.5, p < 0.001), and E1l (OR: 22.2, 95% CI: 6.1-83.3, p < 0.001) were all independent associative factors for GDS-defined depression but only explained 51.9% of all depressive subjects. Conclusions: The effectiveness of MDS-DRS is limited, and a new MDS-based depression screening instrument is needed.

Introduction: Delirium, the acute deterioration of cognitive function and attention, is the most frequent mental disorder in elderly. Its correct diagnosis and adequate management are of crucial importance for the patient’s health and functional outcome. The aim was to highlight potential intervention points to offset the risk of incurring a hip fracture and delirium its attendant disability. Methods: We conducted a retrospective chart review study carried out in our Orthogeriatric Unit. A total of 542 consecutive hip fracture, we selected those with delirium during the admission. Underwent comprehensive geriatric assessment that evaluates co morbidities, medication use, ability to perform basic activities of daily living and instrumental activities of daily living, place of residence and family support. Results: We found 163 patients with delirium and hip fracture; the mean age of our cohort was 87.23±9.6 years (76–98 years). 46 (28%) patients were male. The mean duration of the hospital stay was 13.62±9.6 days (range 2–41 days). 42.3% of the patients with pre-existing neurological conditions. In 44 patients, we were able to identify possible precipitating cause of an acute confusional state. Anemia and hyponatremia were frequent factors associated with delirium. Surgical treatment was performed 90.18%. Conclusions: • Delirium is a very prevalent condition in patients with hip fracture. • Delirium may increase the complications after hip fracture. • Patients, in whom a cause was found out, had better prognosis in terms of lesser mortality and the duration of hospital stay. P468 Interrelationship of delirium and cognitive impairment on adverse functional outcomes of older patients receiving orthopedic surgery: a prospective cohort study M.Y. Chou, C.K. Liang, C.L. Chu, Y.T. Lin, T. Lu, C.J. Hsu, L.K. Chen Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Taipei Veterans General Hospital, Taipei, Taiwan

Being older as a risk factor for vomiting in those undergoing spinal anesthesia [Journal of Clinical Gerontology & Geriatrics 3 (2012) 68–72] Wei-Hung Lien, MD , Ming-Yueh Chou, MD, Chih-Kuang Liang, MD , Kang Liu, MD , Yu-Mei Chou, MD, MS a,* Department of Anesthesiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan Department of Family Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan Geriatric Medicine Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan National Yang-Ming University, School of Medicine, Taipei, Taiwan

PurposeTo explore the effect of older age (≥ 65 years) as a risk factor for nausea and vomiting in the context of spinal anesthesia by assessing patient-, surgery- and anesthesia-related variables.MethodsThis is an observation study using a survey instrument in a tertiary general hospital. Patients scheduled to undergo surgery with spinal anesthesia were surveyed by questionnaire and record review to prospectively and consecutively study all patients consenting to spinal anesthesia for surgery during the intraoperative and 24-hour postoperative periods. Risk factors were examined via univariate and multivariate analysis.ResultsOf the 903 patients (69.7% were men) scheduled to undergo surgery with spinal anesthesia, 421 of them (46.6%) were older than 65 years of age. During the intraoperative and postoperative 24-hour observation period, 87 patients (28.1%) experienced nausea and 55 (17.7%) vomited. The incidence of nausea did not differ between elderly (≥ 65 years) and nonelderly patients. However, being elderly was a risk factor for vomiting (24.7% vs. 15.6%, p

Summary Background Hip fractures in the elderly are significant with mortality. Most of the deaths occur during the early period after the operation. Hence, defining the risk factors may assist in preventive measures. The aim of this study is to determine the risk factors for mortality in elders with fracture hip in one year after hospitalization. Methods This study included 195 elderly and ambulatory patients before fracture who receiving surgery for hip fracture at a medical center of Southern Taiwan for non-pathologic hip fractures from August 2011 to December 2013. Patients were treated with hip arthroplasty or open reduction internal fixation (ORIF). Participants' demographic, medical characteristics and functional status were collected at this study. Patients were followed for one year after surgery or until death. Results In total, 39 patients died during the one-year period. Patient survival was 91.4% at one month, and 79.9% at one year. The predictors of one-year mortality that remained in the final Cox's proportional hazard regression model were COPD (chronic obstructive pulmonary disease) (HR: 6.5), diabetes (HR: 4.0), solid tumors with metastasis (HR: 6.5) and Type of operation (HR: 3.3). Additionally, COPD was a strong predictor of death in this cohort. Conclusion This study showed that THR, COPD, diabetes, and solid tumors with metastasis were associated with an increase in one-year mortality in aged with fracture hip.

Background Although the clinical effectiveness of community hospital-based postacute care (PAC) services has been shown, little was known regarding the impact of depression on the clinical outcomes of older patients receiving PAC services in Taiwan. Methods From January 2009 to August 2010, patients aged 65 years and older referred from tertiary medical centers or acute wards of community hospitals to PAC units were invited for study. All patients received the 4-week Comprehensive Geriatric Assessment-based intervention program in the PAC units. The functional assessment was composed of Geriatric Depression Scale–Short Form (GDS), Mini-Mental Status Examination, Barthel Index, Instrumental Activities of Daily Living, and Braden Score. Results Among the 401 participants (mean age, 82.0 years; 95.5% males), 66 (16.5%) patients were depressed at PAC unit admission. Depressed patients had significantly lower Barthel Index (38.1 ± 2.4 vs. 47.6 ± 1.2, p = 0.002) and Braden Score (17.7 ± 0.3 vs. 18.8 ± 0.2, p = 0.004) than nondepressed patients. Improvement was noted on all measures of functional outcome among patients receiving PAC services. Furthermore, GDS was significantly improved in depressed patients (from 6.4 ± 0.2 to 2.8 ± 0.2 in depressed patients vs. from 1.6 ± 0.1 to 0.9 ± 0.1 in nondepressed patients, p Conclusion Depression was common when patients were newly admitted to PAC services, which was highly associated with poorer physical function. Improvement in physical function and depressive symptoms among all patients after PAC service was found, and the presence of depressive symptoms at PAC admission did not predict any adverse outcome of PAC services.

Background Herpes zoster (HZ) is a prevalent viral disease that inflicts substantial morbidity and associated healthcare and socioeconomic burdens. Current treatments are not fully effective, especially among the most vulnerable patients. Although widely recommended, vaccination against HZ is not routine; barriers in Asia-Pacific include long-standing neglect of adult immunisation and sparse local data. To address knowledge gaps, raise awareness, and disseminate best practice, we reviewed recent data and guidelines on HZ from the Asia-Pacific region. Methods We searched PubMed, Scopus, and World Health Organization databases for articles about HZ published from 1994 to 2014 by authors from Australia, China, Hong Kong, India, Indonesia, Japan, Korea, Malaysia, New Zealand, the Philippines, Singapore, Taiwan, Thailand, and Vietnam. We selected articles about epidemiology, burden, complications, comorbidities, management, prevention, and recommendations/guidelines. Internet searches retrieved additional HZ immunisation guidelines. Results From 4007 retrieved articles, we screened-out 1501 duplicates and excluded 1264 extraneous articles, leaving 1242 unique articles. We found guidelines on adult immunisation from Australia, India, Indonesia, Malaysia, New Zealand, the Philippines, South Korea, and Thailand. HZ epidemiology in Asia-Pacific is similar to elsewhere; incidence rises with age and peaks at around 70 years – lifetime risk is approximately one-third. Average incidence of 3–10/1000 person-years is rising at around 5% per year. The principal risk factors are immunosenescence and immunosuppression. HZ almost always causes pain, and post-herpetic neuralgia is its most common complication. Half or more of hospitalised HZ patients have post-herpetic neuralgia, secondary infections, or inflammatory sequelae that are occasionally fatal. These disease burdens severely diminish patients’ quality of life and incur heavy healthcare utilisation. Conclusions Several countries have abundant data on HZ, but others, especially in South-East Asia, very few. However, Asia-Pacific countries generally lack data on HZ vaccine safety, efficacy and cost-effectiveness. Physicians treating HZ and its complications in Asia-Pacific face familiar challenges but, with a vast aged population, Asia bears a unique and growing burden of disease. Given the strong rationale for prevention, most adult immunisation guidelines include HZ vaccine, yet it remains underused. We urge all stakeholders to give higher priority to adult immunisation in general and HZ in particular. Electronic supplementary material The online version of this article (doi:10.1186/s12879-017-2198-y) contains supplementary material, which is available to authorized users.

Falls are common among elderly patients who present at the emergency department (ED). When elderly patients suffer from an acute illness or the exacerbation of a chronic condition, they are frail, and, consequently, their balance may be affected. However, falls are not yet reported as the initial presentation of acute appendicitis. This is a case report of such. A 70-year-old gentleman called for emergency medical services help due to a fall. He presented at the ED with abrasion and contusion to his forehead and bilateral knees. He was taken to the traumatic division of the ED. However, some hours later, he developed fever and right lower abdominal pain. Acute appendicitis was diagnosed and appendectomy was performed. He had a smooth recovery without complications. Because surgical intervention is the only definitive treatment for acute appendicitis, emergency physicians should be aware of this rare presentation.