An investigation of the use of the Kinect system as a measure of dynamic balance and forward reach in the elderly.

OBJECTIVE: To investigate the reliability and correlations of Kinect-derived valuables of forward reach distance and velocity with the traditional functional reach distance, scores on posturography, and other measures of physical fitness. DESIGN: Observational study. SETTING: Community hospital. SUBJECTS: Individuals >65 years who attended a geriatric health examination were enrolled. MAIN MEASURES: The Kinect system was used to record the reach distance and velocity of the forward reach test. Center of pressure displacement was measured by posturography. Physical fitness performance was assessed using the 2-Minute Step Test, the 30-Second Chair Stand Test, the Sit-and-Reach Test, grip strength, and walking speed. RESULTS: A total of 442 individuals were enrolled (mean age: 73.3 ± 5.2 years). Forward reach tracking using the Kinect system showed good repeatability and correlated with traditional functional reach ( r = 0.719, P < 0.001); the reaching velocity correlated with scores on posturography ( r = -0.257, P = 0.047). Reach distances were significantly decreased in the older group (≥75 years) than in the younger group (<75 years) ( P < 0.001). CONCLUSION: The Kinect system provides a simple, reliable, and age-sensitive assessment of balance in older adults. The valuables correlate with the traditional functional reach, scores on posturography, and physical fitness performance. It provides alternative representation of both static and dynamic balance function.

Potentially inappropriate medications in geriatric outpatients with polypharmacy: application of six sets of published explicit criteria.

AIM: Our aim was to compare the practicability of six different potentially inappropriate medication (PIM) criteria in geriatric outpatients with polypharmacy. METHODS: We analysed baseline data from the Medication Safety Review Clinic in Taiwanese Elders (MSRC-Taiwan) study. The prevalence and correlates of PIMs were determined on the basis of criteria developed in the USA, Canada, France, Norway, Ireland and Thailand. The percentage of PIMs considered as drug-related problems and the problem-solving rate are reported. RESULTS: In the 193 participants, the prevalence of PIM varied from 24 to 73%. Application of the criteria revealed that a high number of chronic medications was a common risk factor for having at least one PIM. Of the 1713 medications reviewed, 5.6-14.8% were considered PIMs. Only 30-40% of the identified PIMs were reported as drug-related problems by the MSRC team experts. Criteria with a higher number of statements and a higher percentage of local market/institution drug availability tended to detect more PIMs. CONCLUSIONS: The prevalence of PIM varied significantly when different criteria were applied. Caution should be exercised in applying PIM criteria developed in other regions when medication availability in the local market is limited.

Drug-related problems (DRPs) identified from geriatric medication safety review clinics.

Drug-related problems (DRPs) were identified from baseline data of 193 Medication Safety Review Clinic (MSRC) patients. MSRCs enroll older adults (≥ 65 years) with either (1) prescriptions of ≥ 8 chronic medications (drugs prescribed for ≥ 28 days) or (2) a visit to ≥ 3 different physicians at the two participating hospitals in Taipei, Taiwan from August to October 2007. The Pharmaceutical Care Network Europe (PCNE) Classification Version 5.01 was used to report DRPs. Mean age was 76.2 ± 6.2 years and 53% of participants were male. Participants had, on average, 9.0 ± 2.6 chronic conditions and took 8.9 ± 3.1 chronic medications and 1.7 ± 1.8 dietary supplements. Eighty-seven percent had at least one DRP. Being older, having orthostatic hypotension and taking more chronic medications were associated with higher likelihood of having at least one DRP. For the 1713 medications and 331 diet supplements reviewed, 427 DRPs were found, 490 causes (1.1 ± 0.4 per problem) identified and 1067 interventions proposed (2.5 ± 0.6 per problem). The most common DRP category was "drug not taken/administered" (35%), and the most common offending drug category was cardiovascular agents (33%). Prevalence of DRPs was high among geriatric outpatients prescribed multiple medications. Careful medication review is needed in routine clinical practice to improve prescription quality.

Medication adherence among geriatric outpatients prescribed multiple medications.

BACKGROUND: Poor medication adherence (PMA) is associated with higher risks of morbidity, hospitalization, and mortality. Polypharmacy is not only a determinant of PMA but is also associated with many adverse health outcomes. OBJECTIVE: We aimed to determine the prevalence and correlates of PMA in an older population with polypharmacy. METHODS: Baseline data from 193 older adults from the Medication Safety Review Clinic Taiwan Study were analyzed. Patients were either prescribed ≥8 long-term medications or visited ≥3 different physicians between August and October 2007. PMA was defined as taking either <80% or >120% of prescribed amounts of a medication. Patients were classified as no (0%), low level (>0 but <25%), and high level (≥25%) PMA depending on what percentage of entire medication regimen taken reached PMA. RESULTS: Mean (SD) age was 76 (6) years, and mean number of medications was 9 (3), with a mean medication class number of 4 (1). Of the 1713 medications reviewed, 19% had PMA. However, at patient level, 34%, 32%, and 34% of patients were classified as no, low level, and high level PMA, respectively. Correlates varied by levels of PMA. Compared with patients without PMA, higher medication class number and use of alimentary tract, psychotropic, and hematologic agents were associated with both low and high level PMA. History of dizziness was associated with low level PMA, and higher Mini Mental Status Examination score was associated with high level PMA. CONCLUSIONS: To enhance medication adherence in older adults prescribed multiple medications, medication class numbers and certain high-risk medication classes should be taken into account. Physicians should also routinely assess systemic (eg, cognition) or drug-specific characteristics (eg, side effects).

Associations between body mass index and serum levels of C-reactive protein.

BACKGROUND: Obesity leads to increased risk of cardiovascular disease and glucose intolerance, which are phenomena of chronic inflammation. This study was performed to determine whether a higher body mass index (BMI) and central obesity are associated with low-grade inflammation. METHODS: An analysis of 8 453 adults aged > or =20 years was performed. Every subject completed a household interview and a questionnaire regarding personal health, and their BMI and serum C-reactive protein (CRP) level were measured. The BMI data were divided into quintiles, using multiple linear regression to estimate the relationship between CRP level and BMI quintiles. An extended-model approach was used for covariate adjustment. The association between central obesity and CRP level was examined by this method as well. RESULTS: After controlling for demographics, chronic diseases, health behaviours and levels of folate and vitamin B12, the beta coefficient (which represents the change of natural-log-transformed levels of CRP for each kg/m2 increase in BMI) was 0.078 (p < 0.001). The CRP levels also increased across increasing quintiles of BMI (p for trend <0.001). The beta coefficient, representing the change of natural-log-transformed levels of CRP comparing subjects with central obesity to those without, was 0.876 (p < 0.001). CONCLUSION: Higher BMIs as well as central obesity are independently associated with higher levels of CRP.