Bone health among older adults in Taiwan.

BACKGROUND AND PURPOSE: There has been much discussion about the risk factors for osteoporosis, but studies involving elderly population in Taiwan are minimal. We aimed to describe variables related to osteoporosis among community dwelling older people in Taiwan. METHODS: This is a cross-sectional study. The 671 participants were randomly selected from 3680 examinees of the annual Senior Citizens Health Examination in year 2010. Participants were interviewed with a detailed questionnaire, and 91 of them were invited for dual-energy X-ray absorptiometry (DXA). Predictor variables included age, gender and clinical risk factors for osteoporosis. The main outcome was osteoporosis confirmed by DXA. RESULTS: The mean age of the participants was 75.7±6.4years old. Overall, the most prevalent variables for osteoporosis were height loss in adulthood (41.0%), lack of dairy products or calcium supplements (32.0%) and insufficient physical activity (10.4%). In multivariate models, we found that underweight (OR=9.80) and lack of dairy products/calcium supplements (OR=3.68) were the main variables for osteoporosis. In the subgroup analysis involving only women, underweight (OR=14.60) was the main variable. DISCUSSION: Among community-dwelling older people in Taiwan, osteoporosis was mainly associated with underweight and lack of dairy products or calcium supplements. CONCLUSION: We suggest using the key questions of underweight and dietary pattern in clinical settings to identify high risk people who are candidates for further BMD exam.

Sarcopenia Screened With SARC-F Questionnaire Is Associated With Quality of Life and 4-Year Mortality.

OBJECTIVES: There is no gold standard in diagnosing sarcopenia. We aimed to assess the validity of screening sarcopenia using SARC-F (sluggishness, assistance in walking, rise from a chair, climb stairs, falls). DESIGN: Prospective cohort study. SETTING: Community hospital in Taiwan. PARTICIPANTS: Community-dwelling senior citizens. MEASUREMENTS: Participants were interviewed with a structured questionnaire annually. The questionnaire items were recoded into the 5 items of SARC-F (sluggishness, assistance in walking, rise from a chair, climb stairs, falls). In the baseline year, a subgroup was tested for grip strength and body composition. Healthcare utilization and mortality were based on self-report and hospital records. Our main outcome was 4-year mortality. Secondary outcomes included hospitalization, emergency care use, and quality of life (QOL) measured using the CASP-12 scale (control, autonomy, self-realization, pleasure (control, autonomy, self-realization, pressure). RESULTS: There were 670 participants. The mean age was 76.1 (standard deviation 6.36). One-half were men (n = 340, 50.7%). The prevalence of sarcopenia was 6.1% (n = 41). SARC-F scores were inversely associated with grip strength (P = .001) and skeletal muscle composition (P = .045). Participants with sarcopenia were mostly women (P = .005) and older (P < .001). In univariate analysis, sarcopenia was associated with 1- to 4-year mortalities (P = .033, .001, .001, <.001, respectively), overall hospitalization (P = .004), overall emergency care use (P = .017), and QOL (P < .001). In multivariate model, sarcopenia [odds ratio (OR) 7.35, 95% confidence interval (CI) 2.67-20.18], age (OR 1.19, 95% CI 1.09-1.29 for each year), and taking vitamin D supplements (OR 0.29, 95% CI 0.11-0.74) were factors associated with mortality. CONCLUSIONS: Sarcopenia screened using SARC-F was associated with subsequent QOL, overall hospitalization, overall emergency care use, and 4-year mortality. SARC-F can serve as a quick screening tool of sarcopenia.

Factors influencing health related quality of life in cancer patients with bone metastases.

OBJECTIVE: Health related quality of life (HRQOL) is a multidimensional concept that is especially important for cancer patients with bone metastases, as maintaining and improving HRQOL is often the main focus of treatment. This study aims to determine factors that may influence HRQOL, which may in turn influence treatment and care of patients. METHODS: Patients (n=396) completed the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ) Bone Metastases module (BM22) at baseline. The EORTC QLQ-BM22 consists of four scales: painful site (PS), pain characteristics (PC), functional interference (FI), and psychosocial aspect (PA) scales. EORTC QLQ-BM22 data, together with sociodemographic and medical factors were analyzed by univariate analysis of variance (ANOVA). Items of significance were determined through backward selection, which were then put through multivariate analysis to determine further significance. RESULTS: Through ANOVA analysis, KPS>80 and breast primary histology were predictive of better HRQOL in the PS scale, while KPS>80, female gender, and breast primary histology were predictive of better HRQOL in the PC and FI scales. KPS>80 and prostate primary histology were predictive of better HRQOL in the PA scale. KPS>80 and primary cancer site were confirmed as significant predictive factors in multivariate analysis. RECOMMENDATIONS: This study identified baseline factors of gender, performance status, and primary histology as determinants of HRQOL in patients with bone metastases. Further study focusing on current treatment (chemotherapy, bisphosphonates, and radiotherapy) and spiritual well-being may identify additional factors affecting HRQOL. Understanding the influence of these factors will allow health care professionals to provide more effective palliative care.

Development and validation of an instrument for the measurement of health-related quality of life based on view of traditional chinese medicine perspective.

OBJECTIVES: The objectives of this study were to develop and validate an instrument for the measurement of health-related quality of life (HRQoL) based on view of Traditional Chinese Medicine (TCM). DESIGN: Six domains of questions, five questions for each domain were developed about general health, and health of five major viscera according to TCM theory to measure the HRQoL. SETTINGS: 149 patients participated in this study and all of them were interviewed in the TCM clinic of a medical center. INTERVENTIONS: When interviewing, these patients' health conditions of the five viscera were rated by a TCM physician without knowledge of the patient's answers. A telephone interview was conducted one week later as a retest. MAIN OUTCOME MEASURES: Test-retest reliability (intraclass correlation coefficient, ICC), internal consistency (Cronbach's alpha coefficient), and the ability to differentiate the health conditions in each domain of the patients were assessed. RESULTS: The test-retest reliability coefficients of the six domains ranged from 0.46 for spleen to 0.69 for liver-male and kidney. The internal consistency coefficients of the six domains varied from 0.38 for spleen to 0.72 for heart. All scales except that of liver for females could significantly classify different health conditions (evidence of abnormality) assessed by TCM physicians. Ten factors were identified through factor analysis. Some items were found to be correlated with more than one domain. Most domains in the questionnaire had fair test-retest reliability and fair to good internal consistency, and could differentiate patients' health conditions. The low internal consistency of the spleen scale and the inter-related scale structures needs further evaluation.