Siriraj Medical Journal

Validation of Self-application-based Malnutrition and Limited Mobility Screening Tools Compared with Standard Diagnostic Tools in Older Adults

2025-01-02T13:57:57+07:00

Objective: To validate application screening tools against face-to-face standard tools (the Mini Nutritional Assessment (MNA) and Short Physical Performance Battery test (SPPB)) in older adults.

Materials and Methods: A mobile or tablet application was developed based on user interfaces and experiences. Outpatients aged 60 years and over were tested with this tool. We used 2 questions from the WHO-ICOPE algorithm and 3 questions from the STEADI algorithm to screen for at-risk malnutrition and limited mobility, respectively. The MNA and SPPB were used to detect malnutrition and limited mobility, respectively, to test their validity.

Results: The study involved 187 participants, 16% of whom were diagnosed with at-risk malnutrition by the MNA and 18.7% of whom had limited mobility according to the SPPB. The sensitivity and specificity of the malnutrition application tool were 66.6% and 96.1%, respectively. When BMI < 18.5 was combined in the application, the sensitivity and specificity were 90% and 91%, respectively. For limited mobility, the sensitivity and specificity of the application were 94.2% and 76.3%, respectively. The majority of participants rated the application for easy understanding as «excellent» (65%) and rated their confidence in their ability to use the application by themselves as “excellent” (70%).

Conclusion: The application is an age-friendly, time-saving tool that can be used when face-to-face screening is vdifficult with good validity.

Prevalence of Geriatric Syndromes and Satisfaction of Service in Older People Receiving Annual Health Screening at the Check-up Clinic, Siriraj Hospital

2025-01-02T13:57:53+07:00

Objective: To assess the prevalence of geriatric syndromes (GSs) and evaluate service satisfaction among older patients attending a comprehensive geriatric check-up clinic (CGCC) at Siriraj Hospital.

Materials and Methods: A cross-sectional study was conducted at the CGCC from December 2021 to November 2022. Participants aged 60 years and older were screened using a two-step approach; short screening by a standard questionnaire followed by an in-depth assessment. GSs were identified through standardized tools, and patient satisfaction was assessed using a structured questionnaire.

Results: Of 159 participants, 67.9% were women, with a mean age of 66.6 ± 6 years. In step 1, 43.7% showed cognitive impairment, 29.1% had a risk of falls, and 76% reported oral health issues. Step 2 confirmed cognitive impairment in 40.6%, malnutrition risk in 93.3%, and sarcopenia in 78%. The mean satisfaction score was 33.3 ± 2.5 out of 35 points. Total service time averaged 104.2 ± 36.9 minutes.

Conclusion: In a health check-up clinic where GSs are often under-recognized, GSs, particularly cognitive impairment, fall risk, and oral health issues, are prevalent. Despite extended service times, patient satisfaction remained high, highlighting the importance of comprehensive screening in geriatric care.

Reliability and Validity of the Thai Version of the PAINAD Scale: An Extended Application of Pain Assessment in the Moderately Severe Stage of Dementia

2025-01-02T13:58:00+07:00

Objective: To evaluate the reliability and validity of the Thai version of the PAINAD (PAINAD-Th) scale for assessing pain in people with dementia (PwD).

Materials and methods: A cross-cultural translation of the PAINAD scale involving forward and back-translation to and from Thai was conducted, and then the content validity index (CVI) of semantic equivalence was evaluated. The PAINAD-Th was tested on 120 videos of PwD. Each participant was recorded in two videos: one during an activity and the other at rest. Subsequently, two trained nurses independently observed the videos and rated the PAINAD-Th to assess inter-rater reliability. The rating process was repeated in one week to investigate the test-retest reliability. The concurrent validity was assessed against the Visual Analogue Scale rated by the expert committee.

Results: The CVI of PAINAD-Th was 1.00 for forward translation and 0.93 for back translation. The PAINAD-Th showed strong correlations with the reference standard (rs=0.854–0.943, p-value <0.001). The inter-rater agreement for the total scores was 0.937 and 0.955, and the test-retest reliabilities were 0.914 to 0.964 for the activity stage and 0.880 for the resting stage, respectively. The concurrent validity index did not vary significantly across different stages of dementia; the findings remained consistent in the delirium subgroup analysis.

Conclusions: The PAINAD-Th is a valuable tool for evaluating pain in PwD, not only in severe dementia but also in moderately severe stage, regardless of concurrent delirium. It also demonstrated good-to-excellent concurrent validity, inter-rater reliability, and test-retest reliability.

Clinical Effectiveness Evaluation and Cost-effectiveness Analysis of Comprehensive Geriatric Assessment and Multidisciplinary Team for Ambulatory Older Patients: A Cohort Study

2025-01-02T13:58:02+07:00

Objective: The comprehensive geriatric assessment (CGA) and multidisciplinary team (MDT) services are essential components of clinics that promote holistic care for older patients. However, their clinical and cost-effectiveness have not been fully established.

Materials and Methods: This study was a 1-year cohort, two-arm observational study conducted in ambulatory older patients at the Geriatric and Internal Medicine OPD. The primary endpoint was clinical effectiveness: activity of daily living (ADL), Thai mental status examination (TMSE), Mini-nutritional assessment (MNA), extra-visit, hospitalization, length of stay, fall rate, and death rate. The secondary endpoint was a cost-utility analysis using a decision-tree and Markov model. Outcomes included the incremental cost-effectiveness ratio (ICER), and quality of life, assessed by the European Quality of Life Five Dimensions Five Levels (EQ-5D-5L). Sensitivity analysis was conducted through probabilistic methods.

Results: Older adults who received the CGA and MDT service in the geriatric OPD showed improved nutritional status, with the MNA-SF score increasing from 9.3 (± 3.3) to 10.9 (± 2.9) (p=0.01). There were no significant differences between groups in terms of extra-visits, hospitalizations, length of stay, fall rate, or death rate. After one year, the ICER for the CGA and MDT group was US$-3,073 per quality-adjusted life year (QALY) gained to usual care, indicating cost savings at a threshold of $4, 564.9 US dollar per QALY gained.

Conclusion: The CGA and MDT service in a geriatric clinic is clinically effective compared to usual care over a one-year follow-up, as demonstrated by the improvement in nutritional status. Additionally, the CGA and MDT is a cost-saving intervention.

Impact of Frailty on Healthcare Utilization in Older Patients Admitted to Medical Wards: A Study from a Large Medical School in a Middle-income Setting

2025-01-02T13:58:05+07:00

Objective: The study aimed to evaluate healthcare utilization and mortality in patients stratified by frailty status and explore the factors associated with a prolonged length of hospital stay (LOS).

Materials and Methods: This retrospective cohort study included medical inpatients aged ≥60 years old. They were classified into robust, prefrail, and frail groups using the FRAIL Scale. The primary outcome was LOS, while the secondary outcomes were hospital costs, in-hospital mortality, and factors associated with a prolonged LOS. Multivariate analysis was used to explore the factors that influenced the prolonged LOS, and the results were expressed using an adjusted odds ratio (AOR).

Results: Of the 603 enrolled participants, 269 (44.6%) were classified as frail, 256 (42.5%) as prefrail, and 78 (12.9%) as robust. The frail group had longer hospital stays than the robust group (8 days [1,58] vs. 6 days [1,36]; p=0.003). Healthcare costs in the frail and prefrail groups were higher than in the robust group (1264.6 USD [128.9, 30216.0], 1051.7 USD [154.3, 37615.7], and 937.7 USD [174.8, 18539.8], respectively; p=0.001). Frail and prefrail patients were also more likely to die in hospital than the robust ones (7.1% vs. 0.0%, p=0.010; 6.3% vs. 0.0%, p =0.028, respectively). The multivariate analysis also revealed that frailty was associated with a prolonged LOS [AOR of 2.21(95%CI, 1.07–4.56); p=0.031].

Conclusion: Frailty leads to increased healthcare utilization by patients and higher mortality. Identifying frail older patients with an aim to provide appropriate care might reduce the negative outcomes associated with frailty.