Risk factors and clinical aspects of delirium in elderly hospitalized patients in Iran.

BACKGROUND: Recognition of the risk factors of delirium has been clearly advantageous in preventing and managing it as it occurs. AIMS: The main aims of this study were to investigate the occurrence of delirium and identify the associated risk factors in a sample of hospitalized elderly in Southwestern Iran. METHODS: A cross-sectional, hospital-based study was performed on a total of 200 elderly patients, admitted to a general hospital for various health reasons. Data were gathered over a 3-month period of time in 2010. Abbreviated Mental Test score (AMTs) used for delirium detection in post-admission days 1, 3, and 5, followed by clinical diagnostic confirmation according to the DSM-IV-TR criteria for delirium. Information regarding physical, cognitive, emotional, and functional states of the participants was collected, too. RESULTS: Delirium developed in 22 % of the participants. The demographic characteristics of the patients with delirium indicated that they were typically single, older men who lived alone and had a lower level of education and poorer functional status. Among other variables, the following were significantly associated with delirium: hemoglobin ≤12 (P < 0.001); Blood urea nitrogen/creatinine ratio ≥1/20 (P < 0.005); and positive C-reactive protein (P = 0.022); depressive symptoms (P < 0.001), and previous cognitive decline (P < 0.001). Patients with more than six different categories of medications were at high risk for delirium as well. CONCLUSIONS: Delirium is a serious and common problem in people over 60 years of age who are admitted to hospitals. Understanding risk factors and clinical aspects of delirium in elderly hospitalized patients will provide us with a better delirium management strategy.

Sexual functioning among the elderly population in Tehran, Iran.

This study aims to demonstrate the sexual functioning of elderly Iranian retirees who reside in Tehran, Iran. The participants' sexual interests are also reviewed in association with their physical and mental health status. The authors recruited 390 elders (199 men, 191 women) by convenient sampling from 4 retirement organizations in Tehran from April 2007 to October 2008. Tools for evaluation included use of a demographic questionnaire, modified Brief Index of Sexual Functioning for Women, Brief Sexual Function Inventory for Men, and the General Health Questionnaire. Sexual activity was "important/very important" in 56.6% and 17.0% of men and women, respectively (p < .005), but their satisfaction from sexual life was similar. Sexual desire and activities were more common among men than among women (p < .05). Impotency and ejaculatory problems were 40% and 33%, respectively, among the male study participants. This study indicated that having a sexual partner was the most important variable for sexual activities. This study provides a profile of sexual behaviors among elderly people in Iran and shows that although sexual decline and dysfunction are seen in both genders, both groups express satisfaction with their sexual affairs when they have a partner available.

Farsi version of the Neuropsychiatric Inventory: validity and reliability study among Iranian elderly with dementia.

BACKGROUND: This study aimed to validate the Farsi version of Neuropsychiatric Inventory (F-NPI), with the aim of promoting clinical assessment and local research on evaluation of neuropsychiatric symptom profiles of individuals with dementia in Iran. METHODS: In this cross-sectional, psychometric study, 100 patients with dementia in the age range of 60­90 years participated. Two trained psychiatrists interviewed the study subjects. Positive and Negative Symptoms Scale (PANSS) and Geriatric Depression Scale (GDS) were used to determine the concurrent validity. Testretest,inter-rater reliability and internal consistency were calculated. Discrimination validity was determined,using a matched control group consisting of 49 participants without dementia. Cronbach's α and Pearson' scorrelation coefficients were used to analyze the data. RESULTS: The internal consistency (Cronbach's α = 0.9) was excellent. The inter-rater reliability varied between 0.6 and 0.98 for frequency, severity and total scale of the F-NPI, and test-retest reliability was between 0.4 and 0.96. Concurrent validity varied between 0.3 and 0.9 (P < 0.05). The most prevalent symptom was "apathy" and the least prevalent was "euphoria". CONCLUSION: The Farsi version of NPI has satisfactory psychometric indexes and is applicable for clinical and study works in Iranian community.

Sleep patterns, sleep disturbances and sleepiness in retired Iranian elders.

OBJECTIVES: Complaints of sleep disturbance increase with age and many studies have reported on the relationship of sleep problems to the greater use of health services, physical and mental morbidity, functional decline, and all causes of mortality. This study aimed to examine sleep patterns and sleep disturbances in Iranian elders and correlate their sleep quality to their health status. METHODS: Four hundred men and women, aged 60 years or older, were interviewed by trained interviewers regarding their physical and mental health status. The Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale (ESS), and a General Health Questionnaire (GHQ) were then administered to each participant. The data gathered were analyzed using chi(2)-test, t-test, and one-way analysis of variance and logistic regression. RESULTS: The results indicated that the majority of participants (82.6%) suffered from poor sleep quality and approximately one-third (29.2%) experienced sleepiness during the daytime. Difficulty falling asleep (p < or = 0.001) and maintaining sleep (p < or = 0.01) and the feeling of being too hot at night (p < or = 0.005) were significantly more prevalent in women, but men suffered more from leg twitching (p < or = 0.01). Being female (OR = 2.52), and having GHQ scores of more than 11 (OR = 4.14) increased the risk of poor sleep quality considerably. CONCLUSION: Promoting sleep hygiene education of elders in primary health care services are recommended.

Relationship between subjective memory complaints, objective memory performance, and depression among older adults.

A growing number of studies have investigated the relationship between the elderly subjective memory complaint and their actual memory performance. If memory complaints can be used as indicators of actual memory deficits, these complaints could be an invaluable test for early detection and management of dementia disorders. This study examined the relationships between the elderly subjective memory complaint and their objective memory performance while taking into account several factors such as health and depression. The individuals with subjective memory deficits scored higher on the depression scale in comparison to the individuals without subjective memory problems. However, the alert elderly subjective complaints should be taken seriously while evaluating for dementia.

Reliability, validity and factor structure of the GHQ-28 used among elderly Iranians.

BACKGROUND: The object of this study was to develop an Iranian version of the General Health Questionnaire-28 (GHQ-28) for use with elderly subjects. METHODS: The GHQ-28 Farsi version was evaluated for face validity among 204 elderly subjects aged 59 years or older, chosen randomly from residents of Tehran. The Composite International Diagnostic Interview (CIDI) was used to establish a gold standard diagnosis of mental disorders. RESULTS: The GHQ-28 was an internally consistent measure. Cronbach's alpha, split-half coefficients and test-retest reliability were 0.9, 0.89 and 0.58 respectively. Four factors were extracted using factor analysis: "depression," "psychosocial activity," "anxiety," and "somatic." Using receiver operating curve (ROC) analysis, the optimum cutoff score for the GHQ-28 in this group was 19/20 (sensitivity 0.83, specificity 0.76). Using a loading of 0.6 or greater, a short form of the instrument (GHQ-15) (alpha=0.9) was derived and correlated well with the longer form of the scale (r=0.97). Using ROC analysis, the optimum cutoff score was 10/11 (sensitivity 0.83, specificity 0.69). CONCLUSIONS: The short and long forms of the GHQ-28 are suitable screening instruments for elderly Iranian residents, particularly those living in urban areas.

Reliability, validity and factor structure of the GDS-15 in Iranian elderly.

OBJECTIVES: Depressive disorders are a public health problem even in developing countries. Access to valid and reliable screening instruments is needed for conducting community surveys. The main objective of this study is to provide the Iranian version of the Geriatric Depression Scale-15 (GDS). METHODS: The GDS-15 Farsi version was developed by translation and back translation. Two hundred and four subjects aged 59 years or older, who were chosen randomly from residents of the Ekbatan district of Tehran, the capital city of Iran, completed the GDS-15. The Composite International Diagnostic Interview (CIDI) was used to establish a gold standard diagnosis of major depressive disorders. RESULTS: The GDS was found to be an internally consistent measure. Alpha, split-half coefficients and test-retest reliability were 0.9, 0.89 and 0.58 respectively. Two factors were extracted by using factor analysis and the principle component analysis (varimax rotation): 'depression' and 'psychosocial activity'. The Depression factor (omitting items 2, 9, 10, 13), which could be considered as a short form of the scale (alpha = 0.92), has significant correlation with the main scale (r = 0.58). Using receiver operating curve (ROC) analysis, the optimum cutoff score for GDS-15 is 7/8, yielding a sensitivity of 0.9 and a specificity of 0.84. The optimum cutoff score for GDS-11 is 6, yielding a sensitivity of 0.9 and a specificity of 0.83. CONCLUSION: The long and short forms of the GDS have excellent properties as screening instruments for major depression in older dwellers in Iran, particularly in urban areas, as presented in our findings.