Thai medical students' attitudes regarding what constitutes a "good death": a multi-center study.

BACKGROUND: Few studies exist regarding the perception of medical students toward older adults' wishes during their end-of-life period. Better understanding of students' perceptions regarding this topic could help improve palliative education. The purposes of this study were to examine the perceptions of medical students regarding what constitutes a "good death" and to demonstrate the factors associated with the necessary care decisions in older patients. METHODS: This is a cross-sectional study. A questionnaire was developed and given to all of the medical students at two medical schools in Thailand (Siriraj and Srinagarind Hospital) from September 2017 to February 2018. They were asked to response to the questions by imagining how older people would think, and their preferences regarding care at the end-of-life period. The anonymous questionnaires were collected and analyzed. RESULTS: A total of 1029 out of 2990 surveys were returned (34.4%). A minority of the sixth-year medical students rated themselves as being knowledgeable about palliative care (11.3%). According to the survey, desire to have spiritual needs met and have their loved ones present were the most important conditions that contributed to a "good death". Factors associated with reluctance to receive prolonged treatment were female sex (adjusted odds ratio (AOR 1.39), being in the clinical years of training (AOR 1.92), self-rated good health (AOR 1.45), and prior experience of watching someone dying (AOR 1.61). Enrollment in Srinagarind medical school (AOR 2.05), being a clinical student (AOR1.91), and being dissatisfied with life (AOR 1.78) were independent factors related to preference for home death. CONCLUSIONS: Most medical students signified understanding of concepts of geriatric palliative care but felt that they had insufficient knowledge in this area. Multiple factors related to decision regarding the care that was required were identified. Medical schools should consider this information to improve geriatric palliative medical education in undergraduate training.

Perspectives regarding what constitutes a "good death" among Thai nurses: A cross-sectional study.

Palliative care is a crucial component in improving peoples' end-of-life period. It is important to understand the wishes of people at the end of life and the perceptions of their healthcare providers regarding these wishes. As nurses play a key role in patient care, in this study we set out to determine nurses' perceptions regarding what constitutes a "good death", comparing what they thought their older patients would prefer to their own preferences for their own end-of-life care. Questionnaires asking about various options of end-of-life care were distributed to nurses, and they were asked how they thought older people would respond to each of the questions and what their own preferences would be if they were terminally ill. In total, 656 participants were enrolled and they rated relief from suffering as the most important component, both for themselves and for those in their care. More than 80% of nurses agreed with all of the statements on the questionnaire. However, some of the nurses' preferences for their own end of life differed from those they expected their patients to value.

Comparison of Thai older patients' wishes and nurses' perceptions regarding end-of-life care.

BACKGROUND: Achieving a "good death" is a major goal of palliative care. Nurses play a key role in the end-of-life care of older patients. Understanding the perceptions of both older patients and nurses in this area could help improve care during this period. OBJECTIVES: To examine and compare the preferences and perceptions of older patients and nurses with regard to what they feel constitutes a "good death." RESEARCH DESIGN: A cross-sectional study. PARTICIPANTS AND RESEARCH CONTEXT: This study employed a self-report questionnaire that asked about various options for end-of-life care. It was distributed to older patients who attended the outpatient clinic of internal medicine and nurses who worked at two medical schools in Thailand from September 2017 to February 2018. Patients were asked to respond to the questions as if they were terminally ill, and nurses were asked to imagine how older patients would answer the questions. ETHICAL CONSIDERATION: Approval from Institutional Review Board was obtained. FINDINGS: A total of 608 patients and 665 nurses responded to the survey. Nurses agreed with concepts of palliative care, but they rated themselves as having poor knowledge. The patient respondents felt that it was most important that they receive the full truth about their illnesses (29.2%). The nurses thought the most important issue was relief of uncomfortable symptoms (25.2%). On seven out of the 13 questions, nurses overestimated the importance of the relevant issue to patients and underestimated the importance on one question (p < 0.05). DISCUSSION: Both nurses and older patients signified concepts of palliative care, but nurses felt that they lacked adequate knowledge. Nurses estimated that patients would have positive attitudes toward autonomy and the closure of life affairs to a significantly greater degree than the patient respondents. CONCLUSIONS: We recommend that palliative care education be improved and that steps be taken to allow for more effective nurse-patient communication with regard to the patients' end-of-life wishes.

CAN NECK CIRCUMFERENCE PREDICT METABOLIC SYNDROME? AN EXPERIENCE FROM A UNIVERSITY COMMUNITY.

OBJECTIVE: Neck circumference (NC) is associated with cardiovascular risk factors. The data for the measurement of the NC to predict metabolic syndrome (MetS) are limited. The objectives of this study were to determine the capability of the NC to detect MetS and to identify the optimal cutoff points of the NC among Thais. METHODS: Participants who were aged ≥50 years who attended the Healthy Ageing Khon Kaen University Campus Project between March 2012 and April 2015 were recruited to this cohort study specific for atherosclerotic-related diseases. Baseline characteristics, anthropometric measures including NC, and metabolic profiles were collected. MetS was identified using the criteria of the National Cholesterol Educational Program Adult Treatment Panel III (NCEP ATP III) and International Diabetes Foundation (IDF). RESULTS: There were 201 males and 386 females recruited for this study. The areas under the receiver operating characteristic (ROC) curves (AUCs) of NC based on the IDF criteria for females and males were 0.79 (95% confidence interval [CI] 0.75, 0.84) and 0.84 (95% CI 0.79, 0.9), respectively. For the NCEP ATP III criteria, the AUCs were 0.77 (95% CI 0.72, 0.82) in females and 0.71 (95% CI 0.64, 0.78) in males. An NC of 39 cm using IDF criteria for makes was determined as the optimal cutoff point to identify subjects with MetS. An NC of 33 cm for females was the best cutoff point for determining which subjects had MetS using both criteria. CONCLUSION: NC measurement and the use of established cutoff points is useful for predicting MetS in older Thai people.

Prevalence of insomnia and related impact.

Background Sleep problem is a common geriatric condition that can result in various outcomes, both physical and mental, that reduce quality of life. The studies regarding the prevalence and impact of insomnia on daily activities in Thailand in pre-elderly and elderly adults are few. Objectives The primary objective of this study was to determine the prevalence of insomnia among pre-elderly and elderly populations and the secondary objective was to study the impact of insomnia on their daily lives. Methods This study included the participants from the urban middle class in the pre-retirement age of 50 years or older adults who worked for Khon Kaen University (KKU), Khon Kaen, Thailand, and their elderly relatives. Information on baseline characteristics, sleep problems, and outcomes were collected. Descriptive analytical statistics were used to analyze baseline data. Multivariate analysis was used to analyze associated factors of the impact of insomnia. Results A total of 491 participants were recruited. The prevalence of insomnia was 60%. The significant consequences related to insomnia were feeling unrefreshed (adjusted odds ratio (AOD) 2.22, 95% confidence interval (CI) 1.44-3.04), daytime sleepiness (AOD 2.04, 95% CI 1.29-3.22), need for a sedative drug (AOD 4.23, 95% CI 2.09-8.55), depression (AOD 4.74, 95% CI 1.73-13), and impaired attention (AOD 2.29, 95% CI 1.52-3.45). Conclusions Insomnia was found in the majority of pre-elderly and elderly participants and resulted in several poor outcomes. Early detection of insomnia may prevent some inevitable outcomes.

Nurses' Perspectives and Understanding of Sarcopenia in a Tertiary Care Hospital.

Background: Sarcopenia is prevalent in older adults. It is essential for nurses to sustain updated information regarding the knowledge of sarcopenia, particularly in relation to approaches to diagnosing and addressing sarcopenia. However, there are limited studies examining the attitudes and awareness of nurses in relation to this condition. Objective: To assess the attitude and knowledge of nurses regarding sarcopenia and correlation between positive attitude and scores on knowledge. Materials and Methods: An electronic survey was carried out among the nurses of the Faculty of Medicine, Khon Kaen University, Thailand, during November 2022 and January 2024. This survey encompassed questionnaires aimed at evaluating the nurses' perspectives and understanding of sarcopenia. The participants were invited to complete the survey, and they were returned to the researchers for analysis. Results: A total of 231 nurses were recruited (response rate 46.2%). Only 58.4% of them were familiar with "sarcopenia," while only 16% had confidence in diagnosing it. For general knowledge, they achieved a total score of 19/30 (63.3%). They demonstrated proficiency in "etiology" (75%), while their performance was fair in "management and prevention" (62.5%) and low in "terminology & importance" (50%) and "diagnosis" (50%). The correlation between positive attitude and knowledge on sarcopenia was 0.22 (p < 0.05). Conclusion: Nurses exhibited a reduced awareness regarding "sarcopenia." Their comprehension about terminology, diagnosis, prevention, and management of this condition was limited. There was a weak correlation between positive attitude and knowledge. The findings emphasize the essentiality of augmenting the educational programs to enhance the recognition of sarcopenia among nurses.

Prevalence and factors influencing slow gait speed among geriatric patients at outpatient clinic of a tertiary care hospital.

BACKGROUND: Slow gait speed (GS) is a marker of functional decline and overall poor health status and could be considered as possible sarcopenia. Early detection with modified treatable causes is likely to lessen adverse health outcomes in older adults. AIMS: The aim of this study is to determine the prevalence of slow GS and related factors of older adults in an outpatient setting of a tertiary care hospital. METHODS: A cross-sectional study of older adults at an outpatient clinic of Internal Medicine Department of a tertiary care hospital was conducted during April 2020 and December 2021. Demographic data were collected including Montreal Cognitive Assessment (MoCA) for cognitive assessment and Pittsburgh Sleep Quality Index (PSQI) for sleep quality assessment. A 4-m walk test < 1 m/s was defined as slow GS. RESULTS: A total of 198 participants were available for analysis. The prevalence of slow GS was 75.8% (66.2% in men and 81.5% in women). The multivariate analysis showed that age, the presence of cerebrovascular disease (CVA), and MoCA scores were associated with slow GS with adjusted odds ratios of 1.1, 8.8, and 0.9, respectively. CONCLUSIONS: Slow gait speed was frequent among older patients in an outpatient setting indicating of a high prevalence of patients with poor physical performance and impending frailty. Increasing age, presence of CVA, and cognitive decline were associated with slow GS. Interventions concentrating on the amendable factors might help to reduce unfavorable health consequences.

Frailty as a Predictor of Hospitalization and Low Quality of Life in Geriatric Patients at an Internal Medicine Outpatient Clinic: A Cross-Sectional Study.

Frailty is an aging-associated state that increases patients' vulnerability to disease, and can lead to various adverse outcomes. It is classified as either physical frailty alone or physical frailty in combination with cognitive impairment (cognitive frailty). There are currently limited data available regarding the prevalence and adverse outcomes of frailty in Thailand. This was a cross-sectional study aimed at determining the prevalence of physical and cognitive frailty and their effects on hospitalization and quality of life. Participants were older patients who attended an internal medicine outpatient clinic. Frailty was diagnosed using the Thai Frailty Index. The Thai version of the MoCA was used to evaluate cognitive status. Univariate and multivariate analyses were performed to compare adverse outcomes in terms of poor quality of life and history of admission to hospital between patients with frailty and non-frail patients, and among patients with physical frailty, cognitive frailty, cognitive impairment, and robust (non-frail and non-cognitively impaired) patients. We enrolled 198 participants. The prevalence of physical and cognitive frailty was 28.78% and 20.70%, respectively. When compared with non-frail patients, frailty was associated with hospitalization (adjusted OR 3.01, p = 0.002) but was not significantly related to quality of life (adjusted OR = 1.98, p = 0.09). However, physical and cognitive frailty were associated with fair quality of life when compared with normal patients (adjusted OR = 4.34, p = 0.04 and adjusted OR = 4.28, p = 0.03, respectively). The prevalence of frailty-particularly cognitive frailty-was high. Frailty was associated with adverse outcomes in terms of hospitalization and quality of life.

The Prevalence of Low Handgrip Strength and Its Predictors among Outpatient Older Adults in a Tertiary Care Setting: A Cross-Sectional Study.

BACKGROUND: Low muscle strength is linked to several adverse health outcomes. However, there are limited data regarding its prevalence and associated factors in Thai older adults. This study aimed to fill that gap. METHODS: This cross-sectional study was conducted with patients aged ≥ 60 years at the outpatient clinic of the internal medicine department of a tertiary care hospital from April 2020 to December 2021. Patient characteristics were collected, and a handgrip dynamometer was used to measure handgrip strength (HGS). Low HGS was defined according to the 2019 recommendations of the Asian Working Group for Sarcopenia. RESULTS: In total, 198 patients were recruited. The prevalence of low HGS was 51%. Median HGS was 17.8 kg and 27.7 kg in women and men, respectively. Every age per year increase, greater number of medications of any type, and lower Montreal Cognitive Assessment (MoCA) score were independent factors associated with low HGS, with adjusted odds ratios of 1.1, 1.2, and 0.9, respectively. CONCLUSIONS: Low HGS was prevalent among older patients in this setting, indicating a high degree of possible sarcopenia. As there were some modifiable factors associated with low HGS, routine measurement, medication review, and cognitive evaluation are recommended for early diagnosis and management.

The Mini-Cog, Clock Drawing Test, and Three-Item Recall Test: Rapid Cognitive Screening Tools with Comparable Performance in Detecting Mild NCD in Older Patients.

BACKGROUND: Early mild neurocognitive disorder (mild NCD) detection can allow for appropriate planning and delay disease progression. There have been few studies examining validated mild NCD detection tools. One such tool that may be of use is the Mini-Cog, which consists of the clock drawing test (CDT) and three-item recall. METHODS: This study aimed to compare the diagnostic properties of the Mini-Cog, the CDT alone, and the three-item recall test alone in mild NCD detection according to DSM-5 criteria. The participants were older patients attending the medicine outpatient clinic. Area under receiver operating characteristic (ROC) curve (AUC) analysis was used to compare the tools' accuracy. RESULTS: A total of 150 patients were enrolled, 42 of whom were diagnosed as having mild NCD. The AUCs of ROC curves of the three-item recall, CDT, Mini-Cog1, and Mini-Cog2 were 0.71, 0.67, 0.73, and 0.71, respectively (p = 0.36). The sensitivity of the tools was 85.7%, 66.7%, 57.4%, and 69% respectively. The tests performed similarly in participants with ≤6 years of education (p = 0.27) and those with >6 years of education (p = 0.49). CONCLUSIONS: All tools exhibited similar acceptable performance in detecting mild NCD and were not affected by education. These convenient tools might be suitable for use in clinical practice.

Performance of the Rowland Universal Dementia Assessment Scale in Screening Mild Cognitive Impairment at an Outpatient Setting.

INTRODUCTION: Mild cognitive impairment (MCI) is defined as the symptomatic pre-dementia phase on the continuum of cognitive decline. Early recognition and application of potential interventions could prevent or delay the progression to dementia. The Rowland Universal Dementia Assessment Scale (RUDAS) shows good performance in the screening of dementia but has limited data regarding its diagnostic properties in the screening of MCI. The objectives of this study were to assess the psychometric properties of the Thai version of the RUDAS (RUDAS-Thai) in the screening of MCI, identify associated factors for the RUDAS performance, and determine the optimal cutoff point in detecting MCI. METHODS: This was a cross-sectional study conducted from January 2020 to March 2021. Older patients at the outpatient clinic of an internal medicine department at a tertiary care hospital in Thailand were examined. Baseline data were collected, and the RUDAS-Thai was administered to each patient. Afterward, a geriatrician assessed each patient for MCI. RESULTS: A total of 150 patients were included, of whom 42 cases (28%) had MCI. The overall performance of the test using an area under the receiver operating characteristic curve (AUC) was 0.82 (95% confidence interval 0.75-0.89). At the optimal cutoff point of 25/30, the AUC was 0.76 with sensitivity and specificity of 76.2 and 75%, respectively. The educational level affected the test performance according to regression analysis. For patients with years of education ≤6 and >6, the optimal cutoff points were 25/30 and 26/30, respectively. CONCLUSION: The RUDAS-Thai performed well in differentiating patients with MCI from normal cognition; however, it was affected by educational level. A score of 25/30 or lower for persons with ≤6 years of education or 26/30 or lower for persons with higher than 6 years of education is the optimal cutoff point for indication of developing MCI.

Can RUDAS Be an Alternate Test for Detecting Mild Cognitive Impairment in Older Adults, Thailand?

The Montreal Cognitive Assessment (MoCA) is the commonly used cognitive test for detecting mild cognitive impairment (MCI) in Thailand. Nevertheless, cultural biases and educational levels influence its performance. The Rowland Universal Dementia Assessment Scale (RUDAS) seems to lower the limitation of the MoCA. This study aimed to compare the performance of the RUDAS and the MoCA for the diagnosis of MCI and demonstrate the correlation between them. A cross-sectional study of 150 older participants from the outpatient setting of the Internal Medicine Department, Srinagarind Hospital, Thailand was recruited during January 2020 and March 2021. The diagnostic properties in detecting MCI of the RUDAS and the MoCA were compared. MCI was diagnosed in 42 cases (28%). The AUC for both RUDAS (0.82, 95% CI 0.75-0.89) and MoCA (0.80, 95% CI 0.72-0.88) were similar. A score of 25/30 provided the best cut-off point for the RUDAS (sensitivity 76.2%, specificity 75%) and a score of 19/30 for the MoCA had sensitivity and specificity of 76.2% and 71.3%. The Spearman's correlation coefficient between both tests was 0.6. In conclusion, the RUDAS-Thai could be an option for MCI screening. It was correlated moderately to the MoCA.

Comparison of the Perspective of a "Good Death" in Older Adults and Physicians in Training at University Hospitals.

Background: It is important to enhance physicians' understanding of patients' wishes at the end of life (EOL) for improving palliative care system. Method: This was a cross-sectional study aimed to examine and compare the preferences and perceptions of elderly patients and physicians regarding what they feel constitutes a good death. Participants were asked about their preferences, and physicians were also asked the care they would recommend for patients. The participants' results were compared, as were the physicians' preferences regarding their own care and that regarding patients' EOL care. Results: A higher proportion of patients than physicians wished to be conscious toward the last hour of life and to pass away at home. The higher proportion of physicians agreed with most of the statements on the questionnaire when asked about their EOL care than when asked about that of patients, particularly not prolonging suffering. Conclusion: There were some differences between patients' and physicians' preferences regarding EOL care. Better communication between them may help to close this gap.

A comparison of preferences of elderly patients for end-of-life period and their relatives' perceptions in Thailand.

BACKGROUND: Goal of palliative care is to experience a good death. Understanding the perceptions of elderly patients and their relatives about this issue should provide healthcare professionals with practical guidance in order to achieve this goal. OBJECTIVES: To determine and compare the perceptions of elderly patients and relatives regarding wishes during their end-of-life(EOL) period. METHODS: This was a cross-sectional study conducted at Siriraj and Srinagarind Hospital in Thailand from September 2017 to February 2018. A questionnaire was given to elderly patients and the relatives of them. The patients were asked to respond to the questions as though they were terminally-ill patients, and relatives were asked to imagine how elderly people would respond to the questions. RESULTS: We recruited 608 elderly patients and 607 relatives. The most important issue in both groups was"receiving the full truth about their illnesses". The perceptions of the patients and relatives differed significantly in 8/13 areas covered in the questionnaire. Independent factors associated with preference for home death were elderly from Khon Kaen (adjusted odds ratio (AOR) 2.6;95%CI 1.7,4.1), previous self-employed/general work compared to individuals who did not work (AOR 0.5;95%CI 0.3,0.9), low educational level (AOR 2.3;95%CI 1.3,4.0), low income (AOR 1.7;95%CI 1.1,2.5), greater family size (AOR 1.7;95%CI 1.1,2.6) and dissatisfaction in life (AOR 2.5;95%CI 1.1,5.4). CONCLUSION: Receiving the full truth about their illnesses was the most important issue for participants in both groups. The major differences between the two groups had to do with autonomy. Factors influencing place of death were location of patients, previous occupation, educational level, family income, family size and dissatisfaction in life.

Perception of a "good death" in Thai patients with cancer and their relatives.

BACKGROUND: Understanding the perceptions regarding what constitutes a "good death" among cancer patients and their families could help healthcare teams to ensure proper palliative and supportive care. OBJECTIVES: To demonstrate and compare the wishes cancer patients and the perceptions of their relatives regarding end-of-life care, and to identify factors associated with patients' preferences regarding place of death. METHODS: A sample of cancer patients and their relatives who attended the Srinagarind Hospital (Thailand) oncology clinic or day chemotherapy from September 2017 to August 2018 were enrolled. Questionnaires were given to the participants, in which the patients were asked to respond based on their own end-of-life preferences, and relatives were asked to imagine how the patients would respond to the questions. RESULTS: One hundred eighty pairs of patients and relatives were recruited. Respondents in both groups placed importance on place of death, relationship with family, physical and psychological comfort, and relationship with the medical staff. Both groups generally agreed with the statements on the questionnaire (10/13 statements). Relatives underestimated the preferences of the patients in 3 areas: "not being a burden to others," "preparation for death," and "physical and psychological comfort." Being married (adjusted odds ratio (AOD) 6.4, 95%confidence interval (CI) 1.1,36.5), having had more than 6 years of education (AOD 6.5, 95%CI 1.8,23.7), having lung cancer compared to colon cancer (AOD 12, 95%CI 1.2,118.7), duration after cancer diagnosis (AOD 0.9, 95%CI 0.93,0.99), previous hospital admission (AOD 5.7, 95%CI 1.5,21.2), and life satisfaction (AOD 17.6, 95%CI 2.9,104.9) were factors associated with preference for home death. CONCLUSION: Thai cancer patients and their relatives indicated similar preferences with regard to what constitutes a good death and patients' wishes for their end-of-life period. However, the patients' relatives underestimated the importance patients placed on statements in three domains. Factors that influenced a preference for a home death were identified.