Insulin resistance as one of indicators for metabolic syndrome and its associated factors in Indonesian elderly.

AIM: to obtain factors that are associated with insulin resistance in Indonesian elderly. METHODS: a cross sectional study was conducted at the Geriatric Outpatient Clinic of Cipto Mangunkusumo Hopital in 172 elderly patients. Data on subject characteristics (age and sex), body mass index, total body fat, peripheral subcutaneous fat, trunk subcutaneous fat, waist circumference, carbohydrate and fiber intake, physical activity, and 25(OH)D concentration were collected. Sample size was calculated in accordance with the formula of sample size on hypothesis testing for difference of two proportions and hypothesis testing for difference of mean of two independent groups. Significance level of 95% and power of 80% were used. Chi-square analysis and independent t-test were performed. Logistic regression analysis was conducted to recognize the most affecting variables for insulin resistance. P<0.05 was considered as the significance level. RESULTS: we found that the prevalence of insulin resistance among elderly in our study was 25%. Bivariate analysis showed that there was a significant association of age and body mass index with insulin resistance in elderly. There were also significant differences of mean on fat mass, fat mass (%), waist circumference, peripheral subcutaneous fat, trunk subcutaneous fat, which were significantly higher in insulin-resistance group compared to the non-insulin resistance group. Results of multivariate analysis demonstrated that only several factors were correlated to insulin resistance in elderly, that were peripheral subcutaneous fat (OR 1.09; 95% CI 1.05-1.15) and trunk subcutaneous fat (OR 0.93; 95% CI 0.87-0.99). CONCLUSION: peripheral subcutaneous fat and trunk subcutaneous fat are associated with insulin resistance in elderly.

Incidence and predictors for delirium in hospitalized elderly patients: a retrospective cohort study.

AIM: to determine the incidence and predictors for delirium and to develop a prediction model for delirium in hospitalized elderly patient in Indonesia. METHODS: a retrospective cohort study was conducted in elderly patients (aged 60 years and older) who were hospitalized in Internal Medicine Ward and Acute Geriatric Ward Cipto Mangunkusumo Hospital from January 2008 until December 2010. Patients were not delirious on admission. Twelve predefined predictors for development of delirium during hospitalization were identified on admission. Independent predictors for delirium were identified by Cox's proportional hazard regression analysis and each independent predictor was quantified to develop delirium prediction model. The calibration performance of the model was tested by Hosmer-Lameshow test and its discrimination ability was determined by calculating area under the receiver operating characteristic curve (AUC). RESULTS: subjects consist of 457 patients, predominantly male (52.5%) and were in 60-69 age group (55.8%), with mean age of 69.6 (SD 7.09) years old. Delirium developed in 86 patients (cumulative incidence 18.8%, incidence density 0.021 per person-days) during first fourteen-days of hospitalization. Three independent predictors for delirium were identified, including: infection (without sepsis, adjusted HR1.83 (95% CI 0.82-4.10); with sepsis, adjusted HR 4.86, 95% CI 2.14-11.04), cognitive impairment (adjusted HR 3.12; 95%CI 1.89-5.13) and decrease of functional status (adjusted HR 1.74; 95% CI 1.07-2.82). Predictive model was performed using the final model of multivariate analysis and stratified into three levels: low- (rate of delirium 4.4%), intermediate- (32.8%), and high-risk (54.7%) groups.The Hosmer-Lemeshow test revealed good precision (p-value 0,066) and the AUC showed good discrimination ability (0.82, 95% CI 0.78-0.88). CONCLUSION: incidence of delirium is 18.8% in hospitalized elderly patients, with incidence density of 0.021 per person days. Infections, cognitive impairment, and decrease of functional status on admission are independent predictors for the development of delirium during hospitalization.