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Objectives: An increasing number of elderly subjects with cancer were admitted to the palliative care unit and they have suffered both distressing symptoms and cognitive impairment. We aim to identify the prevalence of cognitive impairment among elderly cancer patients receiving in-patient palliative care and to examine any difference between patients with cognitive impairment on self-reported symptoms. Materials and Methods: Subjects’ age ≥65 admitted to a palliative care unit from 01 September 2015 to 31 August 2020 was included in the study. Exclusion criteria were those with an impaired conscious state, severe cognitive impairment, or language problems that were non-communicable. Variables collected included baseline demographics, cancer diagnosis, cancer stage, mobility state using the modified Barthel index (mBI), and performance status as measured by the palliative performance scale. Cognitive impairment was defined by abbreviated mental test ≤6. Self-reported symptoms scales were measured by the Chinese version of MD Anderson Symptom Inventory and EORTC QLQ C-30 (European Organisation for Research and Treatment of Cancer, Quality of Life Core Questionnaire 30). Results: Nine hundred and ninety-one subjects with 1174 admissions were retrieved. Eight hundred and seventy-three admission episodes were included in this study. Three hundred and eight (35%) have cognitive impairment. Cognitively impaired subjects were older, showed worse physical function and performance status, and more often residing in old age homes. Independent predictors of cognitive impairment were age (OR 1.09), mBI (OR 0.96), chair/bed bound state (OR 1.79), and presence of brain metastasis (OR 2.63). They reported lower scores in pain (P < 0.001), distress (P < 0.001), sleep disturbance (P < 0.001) and nausea and vomiting (P = 0.012) in the self-reported symptoms scale. Conclusion: Elderly cancer patients with cognitive impairment were older with poorer performance status. They have reported a lower level of pain, distress, and sleep disturbance. Clinicians should be alerted to this phenomenon to tackle the unmet concomitant symptoms.

Aim To investigate the prevalence and risk factors of delirium in an extended care unit, the persistence of delirium and 3-month outcome. Method Patients aged >65 years were recruited. Basic demographic data, medical comorbidity using the Charlson Comorbidity Index, pre-existing cognitive impairment using the informant questionnaire on cognitive decline in the elderly, place of residence and physical function as measured by the modified Barthel Index were recorded. Delirium was assessed by the Confusion Assessment Method and Direct Observation Scale. Delirium status, physical function and placement were reassessed on discharge, and at 1 month and 3 months after discharge. Results A total of 261 patients were recruited with a mean age of 81.9 years. Delirium was present in 89 participants (34.1%). Of these, 70 patients continued to be delirious on discharge. A total of 76 patients had persistent delirium at 1 month, and 49 remained to be delirious at 3 months. Pre-existing cognitive impairment (OR 9.12), use of psychoactive drugs (OR 3.61), presence of metabolic disturbances (OR 3.53), acute infection (OR 3.49) and old age home residents (OR 3.04) were associated with delirium on admission. A smaller number of delirium patients can return home on discharge, and they have poorer functional status on admission, at discharge, and at 1 month and 3 months after discharge. Unplanned hospital admission was significantly higher among the delirium group (42.9% vs 24.1%, P

Background/PurposeElderly patients who are cognitively impaired tend to have a decreased ability to communicate and report pain, which results in the under-detection and under-treatment of pain. This study aimed to describe the prevalence of pain in elderly patients with moderate to severe dementia who were residing in nursing homes and to determine the factors associated with pain.MethodsElderly patients older than 60 years of age with Mini-mental State Examination (MMSE) scores of

Aim: Dementia patients are found to have more sleep disturbances that can affect their quality of life and functional and cognitive abilities, and these disturbances are associated with greater risk of psychiatric symptoms. The aim of this study is to investigate the presence of sleep disturbances among a group of moderately patients with dementia and their effects on the development of depression, apathy, daytime sleepiness, apathy, and caregiver stress. Method: Baseline demographic data were collected in 105 participants with a mean age of 79 years. Sleep disturbance was measured by Sleep Disorder Inventory (SDI). The Epworth Sleep scale (ESS) was used to measure excessive daytime sleepiness, while the Cornell Depression score (CDS) was used to measure for the presence of depressive symptoms. The Starkstein Apathy scale was used for assessment of apathy on sleep and the Zarit Burden Interview (ZBI) was used to evaluate carer stress. We found that patients on hypnotics generally have a higher SDI (4.7 vs, 1.48, p ¼ 0.021) and higher CDS (9.3 vs. 4.9, p ¼ 0.033). There was no statistical significant difference in different cholinesterase inhibitors on SDI, ESS, CDS, apathy score, and carer stress. SDI was positively correlated with ESS, CDS, and ZBI, but not related to the MMSE score and apathy. Linear regression found that ESS, CDS, and ZBI were independently associated with SDI. Conclusion: Sleep problems in dementia patients are associated with carer stress, excessive daytime sleepiness, and depression using simple objective assessment instruments. This study helps to provide insights into sleep disturbances in dementia patients and highlights the importance of this frequently missed aspect in the care of dementia patients and their caregivers. Copyright 2012, Asia Pacific League of Clinical Gerontology & Geriatrics. Published by Elsevier Taiwan

Introduction: Post-stroke delirium is not uncommon, and is associated with poorer outcome, higher mortality, longer hospital stay and greater risk of post-stroke dementia. We aim to identify the incidence of post-stroke delirium, risk factors for its development and 1-year outcome. Method: Consecutive patients aged >50 years admitted to the acute stroke unit were recruited. Baseline demographic data, types of stroke, location of infarct, etiology of stroke, premorbid cognitive impairment, living arrangement, comorbidity, drug history and biochemical parameters were collected. Delirium was screened by the Confusion Assessment Method. Outcome data included length of stay, mortality, functional mobility, and placement on discharge 6 months and 12 months post-stroke. Results: A total of 314 patients with a mean age of 72.9 years were recruited. Of those patients, 86 (27.4%) had delirium. Age (OR 1.05), presence of acute urinary retention (OR 7.67), chest infection (OR 22), National Institutes of Health Stroke Scale (OR 1.13), total anterior circulation infarct (OR 18.8), posterior circulation infarct (OR 3.52) and pre-existing cognitive impairment (OR 2.51) were independent predictors of post-stroke delirium. Patients with delirium had more functional disability, a higher proportion went to a nursing home on discharge (62% vs 11.2%), at 6 months (60% vs 12.5%) and at 12 months (65% vs 13%), and there was higher inpatient mortality (18% vs 2.2%) and 1-year mortality (30% vs 7.4%). Hospital stay was also longer (45 vs 22 days). Conclusion: Delirium is a common complication post-stroke, with treatable risk factors. It results in higher functional impairment, nursing home placement and mortality. Comprehensive geriatric assessment of older stroke patients might help to reduce the occurrence of delirium. Geriatr Gerontol Int 2013; 13: 123–129.

Aim: Depression is frequently encountered in hospitalized elderly persons. Studies have found an independent association between depressive symptoms, mortality and functional decline. Only a few studies look specifically at other potential effects of depressive symptoms, such as subsequent hospital readmission or nursing home admission. In this study, we aim to investigate the association between the presence of depressive symptoms and nursing home placement, hospital admission and mortality in a group of geriatric outpatients receiving rehabilitation. Methods: All community dwelling elderly patients with no history of depression or cognitive impairment who were new attendances of a geriatric day hospital of a regional hospital in Hong Kong were recruited. Baseline demographic data, medical comorbidities, functional status and presence of depressive symptoms defined as a Geriatric Depression Scale score of more than 8 were recorded. Outcome variables were mortality, nursing home admission and unplanned hospital admission rate at 1 year. Results: Two hundred and nine subjects were included with a mean age of 77.4 years (standard deviation, 7.6). There was no statistically significant difference on mortality at 1 year and nursing home admission. However, depressed subjects were found to have increased risk of hospital admission (odds ratio = 2.67, 95% confidence interval = 1.31, 5.32) and have more episodes of unplanned hospital admission (odds ratio = 1.52, 95% confidence interval = 1.1, 2.12). Conclusion: Elderly patients with depressive symptoms are associated with increased risk of hospital admission and greater inpatient service utilization, independent of their functional status. These results emphasize the need to improve the management of depressive symptoms and heighten the recognition and treatment of depression in the elderly population. Geriatr Gerontol Int 2011; 11: 174–179.

To investigate the prevalence and risk factors of delirium in an extended care unit, the persistence of delirium and 3-month outcome.Patients aged 65 years were recruited. Basic demographic data, medical comorbidity using the Charlson Comorbidity Index, pre-existing cognitive impairment using the informant questionnaire on cognitive decline in the elderly, place of residence and physical function as measured by the modified Barthel Index were recorded. Delirium was assessed by the Confusion Assessment Method and Direct Observation Scale. Delirium status, physical function and placement were reassessed on discharge, and at 1 month and 3 months after discharge.A total of 261 patients were recruited with a mean age of 81.9 years. Delirium was present in 89 participants (34.1%). Of these, 70 patients continued to be delirious on discharge. A total of 76 patients had persistent delirium at 1 month, and 49 remained to be delirious at 3 months. Pre-existing cognitive impairment (OR 9.12), use of psychoactive drugs (OR 3.61), presence of metabolic disturbances (OR 3.53), acute infection (OR 3.49) and old age home residents (OR 3.04) were associated with delirium on admission. A smaller number of delirium patients can return home on discharge, and they have poorer functional status on admission, at discharge, and at 1 month and 3 months after discharge. Unplanned hospital admission was significantly higher among the delirium group (42.9% vs 24.1%, P 0.001).Delirium in post-acute convalescence units is highly prevalent and persistent. It is associated with poor functional recovery, higher nursing home placement and unplanned hospital admission. These findings reinforce the necessity to implement a program to prevent, early detect and treat delirium in elderly patients admitted to post-acute care units. Geriatr Gerontol Int 2016; 16: 586-592.

Objectives: To determine the clinical presentation, findings, and outcomes of older adults (> 60) with severe acute respiratory syndrome (SARS) and compare these with a control group of younger patients (≤60). Design: Retrospective cohort study. Setting: A community-based, acute hospital in Hong Kong. Participants: All adult inpatients with a clinical diagnosis of SARS. Measurements: Clinical presentations, investigations, treatment, and 30- and 150-day mortality. Results: There were 52 young and 25 older patients with a mean age±standard deviation of 39.5±11.7 and 72.1±7.2, respectively. Fever, chills, and diarrhea were more common in younger patients, whereas decrease in appetite and general condition occurred only in older patients. The prevalence of positive reverse-transcriptase polymerase chain reaction for SARS-associated coronavirus (SARS-CoV) in nasopharyngeal secretions and stool samples was similar in the two groups. The prevalence of positive serological tests for SARS-CoV was significantly lower in older patients (42% vs 92%, P

Post-stroke delirium is not uncommon, and is associated with poorer outcome, higher mortality, longer hospital stay and greater risk of post-stroke dementia. We aim to identify the incidence of post-stroke delirium, risk factors for its development and 1-year outcome.Consecutive patients aged50 years admitted to the acute stroke unit were recruited. Baseline demographic data, types of stroke, location of infarct, etiology of stroke, premorbid cognitive impairment, living arrangement, comorbidity, drug history and biochemical parameters were collected. Delirium was screened by the Confusion Assessment Method. Outcome data included length of stay, mortality, functional mobility, and placement on discharge 6 months and 12 months post-stroke.A total of 314 patients with a mean age of 72.9 years were recruited. Of those patients, 86 (27.4%) had delirium. Age (OR 1.05), presence of acute urinary retention (OR 7.67), chest infection (OR 22), National Institutes of Health Stroke Scale (OR 1.13), total anterior circulation infarct (OR 18.8), posterior circulation infarct (OR 3.52) and pre-existing cognitive impairment (OR 2.51) were independent predictors of post-stroke delirium. Patients with delirium had more functional disability, a higher proportion went to a nursing home on discharge (62% vs 11.2%), at 6 months (60% vs 12.5%) and at 12 months (65% vs 13%), and there was higher inpatient mortality (18% vs 2.2%) and 1-year mortality (30% vs 7.4%). Hospital stay was also longer (45 vs 22 days).Delirium is a common complication post-stroke, with treatable risk factors. It results in higher functional impairment, nursing home placement and mortality. Comprehensive geriatric assessment of older stroke patients might help to reduce the occurrence of delirium.

Aim: Urinary incontinence associated with dementia can result in medical comorbidities. We aimed to determine the prevalence of urinary incontinence and to identify the etiology and factors associated with urinary incontinence in dementia patients. Methods: Patients with an Mini-Mental State Examination (MMSE) score of more than 10, attending the memory clinic were recruited. Basic demographic data, types and duration of dementia, use of cholinesterase inhibitor and other drugs with anticholinergic effects, carer stress and presence of urinary incontinence in the previous 6 months were recorded. Urodynamic studies were carried out in those patients with urinary incontinence. Results: One hundred and forty-four subjects with a mean age of 78 years (standard deviation 6.8) were included. Forty-eight (33.3%) had urinary incontinence. There was no statistically significant difference between continent and incontinent groups regarding age, MMSE, duration of dementia, use of cholinesterase inhibitor and of drugs with anticholinergic effects. Presence of nocturia of more than twice per night (odds ratio [OR] 4, 95% confidence interval [CI] 1.7, 9.2), use of walking aids (OR 2.6, 95% CI 1.1, 5.9) and male sex (OR 1.36, 95% CI 1.1, 5.2) were independent predictors of urinary incontinence. Urodynamic studies showed that 21 subjects had detrusor overactivity, 13 had bladder outlet obstruction, two with low compliance bladder, two with small bladder capacity, four with detrusor hyperactivity and impaired contractility. Conclusion: Urinary incontinence commonly occurs in dementia subjects. Poor mobility and presence of nocturia increase the risk of urinary incontinence. Correction of the possible reversible factors may help to reduce the prevalence of urinary incontinence in patients with dementia and reduce carer stress.

Objectives: To determine the clinical presentation, findings, and outcomes of older adults (> 60) with severe acute respiratory syndrome (SARS) and compare these with a control group of younger patients (≤60). Design: Retrospective cohort study. Setting: A community‐based, acute hospital in Hong Kong. Participants: All adult inpatients with a clinical diagnosis of SARS. Measurements: Clinical presentations, investigations, treatment, and 30‐ and 150‐day mortality. Results: There were 52 young and 25 older patients with a mean age±standard deviation of 39.5±11.7 and 72.1±7.2, respectively. Fever, chills, and diarrhea were more common in younger patients, whereas decrease in appetite and general condition occurred only in older patients. The prevalence of positive reverse‐transcriptase polymerase chain reaction for SARS‐associated coronavirus (SARS‐CoV) in nasopharyngeal secretions and stool samples was similar in the two groups. The prevalence of positive serological tests for SARS‐CoV was significantly lower in older patients (42% vs 92%, P

Oral anticoagulants have an expanding role in cardiovascular and thrombotic disorders. Few data are available describing their safety among Chinese patients. We aim to evaluate the incidence of major and minor bleeding complications among Chinese patients receiving long term anti coagulants in community practice.A retrospective cohort study was undertaken in a regional hospital. All patients who were initiated on warfarin from January 1, 1998 to December 31, 1998 were enrolled. Out-patient medical charts were reviewed for demographic data, clinical characteristics and adequacy of anticoagulation. Major and minor bleeding complications were documented.A total of 131 patients were identified. The mean age was 67.8 (SD 11.9) years and 52.6% were women. The mean duration of follow-up was 2.2 years (SD 1.1). Major indications for warfarin were: non-valvular atrial fibrillation (60%), venous thrombosis (17%) and rheumatic heart disease (16%). The subjects spent 50% of their total time within target international normalized ratio range. The average annual rates for major and minor bleeding events were 1.8% (95% confidence interval 0.6 to 4.1%) and 18.5% (95% confidence interval 13.9 to 24.2%), respectively. The cumulative incidences of first major and minor bleeding events at 1, 2 and 3 years were 3%, 4%, 5% and 15%, 24% and 37%, respectively. Intensity of anticoagulation was the only predictive factor identified to be associated with bleeding complications.Among Chinese patients receiving long-term warfarin, major hemorrhage occurred at an acceptable range in clinical practice, while considerable minor bleeding was observed. Utilization of oral anticoagulants in Chinese patients appears safe and should be advocated in situations with appropriate indications.