A survey of opinions regarding wishes toward the end-of-life among Thai elderly.

BACKGROUND: Knowledge of wishes toward the end-of-life is crucial for carrying out high quality palliative care. However, advance directive is not commonly available among Thais, particularly for non-cancerous older patients. OBJECTIVE: The present study aimed to explore Thai older person's wishes toward cares needed at the end-of-life. MATERIAL AND METHOD: A convenience sample of 100 older patients, who attended geriatric clinic at a university hospital in Thailand, was recruited. A 3-page questionnaire developed to suit Thai culture was utilized to elicit opinions concerning circumstances around end-of-life period. RESULTS: All participants were Buddhists with mean age of 75.9 (8.2). Toward the end-of-life, the majority wanted to know the truth about their illnesses and to be free from uncomfortable symptoms. Seventy-five percent did not want "prolong-life" treatments when chance of surviving is slim. Age less than 70 and having education of no more than 6 years were factors associated with being unwilling to prolong suffering with OR of 9.88 (1.20-81.57, p = 0.03) and 3.15 (1.11-8.95, p = 0.03), respectively. Interestingly, fifty-six percent of elderly did not want to die at home. Age less than 70 was the only factor significantly associated with being unwilling to die at home with OR of 2.80 (95% CI = 1.05-7.47, p = 0.04). CONCLUSION: The present study illustrated older persons' opinions in relation to cares at the end-of-life from a Thai perspective, which showed some similarities and differences when compared to western countries. These opinions should be crucial for carrying out optimal and qualitative end-of-life care for older people when advanced care planning is not in place for the individual.

Short-term clinical outcomes in delirious older patients: a study at general medical wards in a university hospital in Thailand.

AIM: Delirium, a common disorder in hospitalized older patients, frequently results in unfavorable consequences. Previous studies in different settings have provided conflicting results regarding clinical outcomes and mortality. We aimed to study three clinical outcomes--length of stay (LOS), in-hospital mortality and 3-month mortality--among delirious Thai older patients. METHODS: A prospective observational study was carried out in a university hospital in Thailand. All patients aged older than 70 years admitted to general medical wards were included. Delirium assessments were undertaken within the first 24 h of admission and serially until discharge. Subsequent assessments were carried out at 3 months after discharge. Delirium was diagnosed based on the Diagnostic and Statistical Manual of Mental Disorders fourth edition criteria. Factors associated with mortality were determined by using logistic regression models. RESULTS: LOS was significantly longer in the delirium group (10 and 8 days, P = 0.001). Furthermore, the delirium group had higher in-hospital and 3-month mortality (P < 0.001). Factors significantly associated with in-hospital mortality in multivariate analysis were age more than 80 years (AOR 2.74, 95% CI 1.05-7.15), malignancy (AOR 3.11, 95% CI 1.16-8.33), severe illness (AOR 3.75, 95% CI 1.38-10.20) and delirium (AOR 7.34, 95% CI 1.51-35.69). Delirium remained a strong predictor for 3-month mortality in multivariate analysis with AOR of 3.33 (95% CI 1.45-7.62) CONCLUSIONS: Delirium was associated with prolonged hospital-stay and was the strongest predictor for mortality among older hospitalized patients. It requires serious attention from physicians, healthcare administrators and policy makers to implement an appropriate management plan for this high-burden issue.

Risk factors for falls in the Thai elderly in an urban community.

BACKGROUND: Instability or falls in the elderly are a health condition meeting all criteria for prevention i.e. high frequency, evidence of preventability and a high burden of morbidity. The consequences of a fall affect not only the elderly per se such as fractures and various kinds of physical and mental impairment, but also the family and the society as a whole in terms of the financial expenditure involved. The need for a comprehensive study to identify the risk factors for falls among the Thai elderly is, therefore, crucial for further management. OBJECTIVE: To identify the significant risk factors for falls among the Thai elderly for further prevention and management. METHOD: A cross-sectional study in the urban community around Siriraj Hospital, Bangkok. 1,043 community-dwelling people aged > or = 60 years were recruited. A structured questionnaire, including mental test and physical examinations as well as various laboratory tests, were used to identify the risk factors for falls between faller and control groups. RESULTS: The overall prevalence of falls among elderly Thais in an urban area was 19.8 per cent during a period of 6 months. However, the prevalence was 24.1 per cent in women but only 12.1 per cent in men. Older people who were likely to fall also had a lower bone mass which predisposed them to future fractures. The independent risk factors for falls after multiple logistic regression analysis were: female gender, hypertension, deafness, poor memory, poor self-perceived health status, poor performance in the instrumental activities of daily living, kyphoscoliosis, use of spectacles, rapid pulse rate after a 5 minute rest, higher serum transferrin and poor nutrition in terms of low lean body mass and reduced serum albumin level. CONCLUSIONS: Special sense, activity of daily living, nutritional status, kyphoscoliosis, hypertension and cognitive ability were six important factors determining the likelihood of fall among the elderly in an urban area.