Exploring the correlates of frailty among hospitalized older adults: A cross-sectional study in a Saudi teaching hospital.

Frailty is an important public health concern associated with aging. It increases the risk of adverse clinical outcomes, such as falls, late-life dependency, hospitalization, disability, and mortality. The objectives of this study were to estimate the prevalence of frailty and to identify factors associated with frailty among older adults (≥65 years) admitted to King Abdulaziz University Hospital, Jeddah, Saudi Arabia. This cross-sectional study was conducted at King Abdulaziz University Hospital. The data were collected during the months of January and February 2022 and included demographic characteristics, comorbidities, length of stay, and hospital mortality. Frailty status of participants was assessed using the Clinical Frailty Scale. A total of 147 patients (aged ≥ 65 years) were included in our study. The prevalence rates of frailty and non-frailty were 71.4% and 28.6%, respectively. Frail patients had higher comorbidity index (P = .003), polypharmacy (P = .003), heart failure (P = .001), and prolonged hospital stays (P = .007). The results of the multiple logistic regression revealed that the tall patients had a lower risk of frailty (odds ratio = 0.0089, 95% confidence interval: 0.0001-0.7588, P = .042) and patients with higher comorbidity indexes had higher risk of frailty (odds ratio = 1.4907, 95% confidence interval: 1.1449-1.9927, P = .004). In this study, more than two-thirds of the hospitalized older patients were classified as frail. High comorbidity index, heart failure, and polypharmacy were strong predictors of frailty. Patients with frailty were more likely to have a prolonged hospital stay than those without frailty. Therefore, early detection of frailty and proper intervention are essential for improving health outcomes in this vulnerable population.

Young-onset dementia following chronic abuse of amphetamine-type stimulants.

Young-onset dementia (YOD) is influenced by various risk factors, including substance abuse. In this report, we present the case of a 54-year-old man who developed YOD following prolonged abuse of amphetamine-type stimulants. The patient exhibited insidious cognitive decline over a three-year period before seeking medical attention. Neuroimaging revealed atrophy of the temporal lobe, suggesting a connection between amphetamine-induced neurotoxicity and the cognitive abnormalities observed in the patient condition. Our case highlights the importance of considering amphetamine-type stimulants as potential risk factors for YOD and emphasizes the need to recognize cognitive impairment resulting from substance abuse. Additionally, we look into relevant literature to provide further context and insights.

Comprehensive mapping of mutations in TDP-43 and α-Synuclein that affect stability and binding.

Abnormal aggregation and amyloid inclusions of TAR DNA-binding protein 43 (TDP-43) and α-Synuclein (α-Syn) are frequently co-observed in amyotrophic lateral sclerosis, Parkinson's disease, and Alzheimer's disease. Several reports showed TDP-43 C-terminal domain (CTD) and α-Syn interact with each other and the aggregates of these two proteins colocalized together in different cellular and animal models. Molecular dynamics simulation was conducted to elucidate the stability of the TDP-43 and Syn complex structure. The interfacial mutations in protein complexes changes the stability and binding affinity of the protein that may cause diseases. Here, we have utilized the computational saturation mutagenesis approach including structure-based stability and binding energy calculations to compute the systemic effects of missense mutations of TDP-43 CTD and α-Syn on protein stability and binding affinity. Most of the interfacial mutations of CTD and α-Syn were found to destabilize the protein and reduced the protein binding affinity. The results thus shed light on the functional consequences of missense mutations observed in TDP-43 associated proteinopathies and may provide the mechanisms of co-morbidities involving these two proteins.Communicated by Ramaswamy H. Sarma.

Toxic trespassers: Uncovering phthalates and organophosphate flame retardants in children's rooms and their health implications.

Organophosphate flame retardants (OPEs) and phthalates have garnered significant attention due to their widespread presence in indoor environments. Many recent investigations have reported extensive contamination of indoor dust, air, children's toys, and other environmental compartments with these chemicals. This research aimed to analyze OPEs and phthalates in air (PM10) and dust samples collected from the bedrooms of children (N = 30) residing in various households in Jeddah, Saudi Arabia. High mean levels (ng/g) of phthalates namely DEHP (1438600) and DnBP (159200) were found in indoor dust while TPhP (5620) was the major OPEs in indoor dust. Similarly, DEHP and DnBP were the predominant phthalates in PM10 samples, exhibiting mean levels of 560 and 680 ng/m3, respectively. However, TCPP was the main OPEs with average levels of 72 ng/m3 in PM10 samples. The majority of individual phthalates and OPEs were detected in 90-100 % of the dust samples, whereas in PM10 samples, their presence ranged from 25 % to 100 %. The concentrations of OPEs were notably greater than those of PBDEs and other BFRs previously reported in these samples, suggesting their broader use than alternative BFRs. The estimated long-term non-carcinogenic risk, hazardous index (HI) and daily exposure via dust for children was above threshold levels for DEHP. On the other hand, the cumulative risk of cancer was below the concerning levels. Further research is required to explore diverse groups of chemicals in indoor microenvironments particularly significant for children, such as kindergartens, primary schools, and their rooms at home.

Alzheimer's Behavioral and Psychiatric Burden in Saudi Arabia: Validation of the Saudi Version of the Neuropsychiatric Inventory.

BACKGROUND: The burden of behavioral and psychiatric symptoms in dementia (BPSD) has not been characterized in Saudi patients with Alzheimer disease (AD). Moreover, the Saudi version of the Neuropsychiatric Inventory (SNPI) has not been validated. OBJECTIVES: The purpose of this study was to validate the SNPI and describe frequency and determinants of BPSD in Saudi AD patients. METHODS: The SNPI and BEHAVE-AD instruments were administered to community-dwelling Saudi AD patients and their caregivers. RESULTS: The sample size was 192. The first 59 constituted the validation cohort. Cronbach alpha of the SNPI and BEHAVE-AD were 0.91 and 0.79, respectively. There were significant correlations between: (1) the total SNPI and BEHAVE-AD scores ( r =0.84, P <0.001); (2) analogous SNPI and BEHAVE-AD symptom subscores ( P <0.05); (3) SNPI and BEHAVE-AD caregiver distress ( F =22.6, P <0.001). Inter-rater reliability of the SNPI was excellent (kappa=0.74). Ninety percent of patients experienced 4 SNPI symptoms or more. Patients with stroke and prior psychiatric history were most likely to experience BPSDs. The most common symptom was apathy (82%). Caregiver distress was determined by the total NPI score and impulsiveness subscale score. CONCLUSIONS: The SNPI is valid and reliable for assessing BPSD in Saudi AD patients. Longitudinal studies of BPSDs in Saudi specialized dementia clinics are needed.

Systematic review and pooled analysis of randomized controlled trials in countries of the Gulf Cooperation Council (GCC): Methods and quality assessment.

OBJECTIVES: To describe variations in characteristics of randomized controlled trials conducted in the Gulf Cooperation Council (GCC) countries, and critically appraising the quality of design, conduct and analysis of the trials. METHODS: We carried out a systematically comprehensive electronic search of articles published between 1990 and 2018 and indexed in several databases: i) MEDLINE/PubMed, ii) EMBASE, iii) Cochrane Central Register of Controlled Trials (CENTRAL), iv) ClinicalTrials.gov, and v) World Health Organization International Clinical Trials Registry Platform. We summarized the overall risk of bias present in all analyzed studies using the Cochrane Collaboration risk of bias tool (CCRBT). RESULTS: A remarkable shift in numbers of publications from 2006 onwards was found. The largest number of publications were from Saudi Arabia and consisted of hospitals/clinics based studies. Lack of randomization was found in the majority of reports, and nearly three-fourth of the studies involved the use of intention-to-treat (ITT) principle. However, the proportion of adequately generated random sequence methods has increased yearly, and this increase accounted for a relatively large proportion over the latter half of the studied period (p<0.001), in contrast to the proportion of allocation concealment and blinding. Journal impact factor was significantly correlated with the quality of random sequence generation (r=0.145; p=0.014). CONCLUSION: The randomization methods have gained more attention over the last 3 decades. Secondly, Journal impact factor can serve as an indicator of randomization quality. To mitigate the large rate of overall high risk of bias in GCC studies, high-quality trials must be considered by ensuring adequate allocation concealment and blinding methods. PROSPERO No. ID: CRD42022310331.

Falls and correlations among community-dwelling older adults: A Cross-sectional study in Jeddah, Saudi Arabia.

Objectives: Falls are one of the major health issues faced by older adults, and they can result in physical harm, eventual loss of independence, and even death. Herein, we investigated the prevalence, alongside the main risk factors and resulting injuries, of falls among older adults. Methods: We employed a descriptive cross-sectional approach. Data were collected between February and July 2021 from 403 older adults aged 60 years or above via an online self-reported questionnaire. Basic activities of daily living (BADLs) and instrumental activities of daily living (IADLs) were also recorded. Results: The prevalence of falls among community-dwelling older adults was 47.4%. Among those who had experienced a fall, 36.2% incurred injuries, 25.3% had fractures, and 23.1% required walking aids. Age between 95-104 years, female sex, participants on anti-hypertensive medications, history of hip or knee replacement surgery, and presence of a caregiver, were significantly more likely to have had a previous history of falls (p < 0.05). Furthermore, having a previous history of stroke, osteoporosis, lower limb weakness, dizziness, using wheelchairs as walking aids, and living with the fear of stumbling or slipping were significantly associated with history of previous falls (p < 0.05). Conclusions: The prevalence of falls is high among community-dwelling older adults in Jeddah. Physicians should identify older adults with higher falling risk and provide them with appropriate interventions. Public health strategies could significantly reduce falls and fall-related injuries in older adults.

Predictors of Mortality in Home Health Care Service: Data from Saudi Arabia.

Objective: This study aimed to 1) report the prevalence of chronic conditions among Saudi people receiving long-term home health care (HHC) services, 2) identify the predictors of mortality among individuals receiving long-term HHC services, and 3) study the association between frailty and poor health outcomes among HHC users. Design: Retrospective cross-sectional descriptive study. Setting and Participants: A total of 555 participants were recruited from HHC services at King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia. We collected the data from electronic health records (EHR), patient charts, and caregiver interviews for 555 participants included in HHC program from the year 2019 to 2022. Methods: Only individuals fulfilling the HHC program's eligibility criteria were included to the study. A total of 555 participants were included in the analysis. We assessed the functional performance by the Katz activity of daily living and Bristol Activity of Daily Living Scale (BADLS). A trained health care provider assessed frailty using the Clinical Frailty Scale (CFS). We calculated the means and frequency to describe the prevalence of chronic conditions and variables of interest. A Chi-square test or independent-samples t-test was run to determine if there were differences between the alive and deceased individuals. A binary logistic regression model was performed to predict mortality of HHC service recipients. Results: The mean age for deceased individuals in HHC was 78.3 years. Over twenty percent of individuals receiving HHC services were readmitted to the hospital. We found that the strongest predictors for mortality were pressure ulcers with an odds ratio of 3.75 and p-value of <0.0001, and the Clinical Frailty Scale, which had an odds ratio of 1.69 and p-value of 0.002, using multivariate regression analysis. Conclusions and Implications: In conclusion, our study found that pressure ulcers and frailty are the strongest predictors of mortality for individuals receiving home health care services.

Smart Health System to Detect Dementia Disorders Using Virtual Reality.

Smart health technology includes physical sensors, intelligent sensors, and output advice to help monitor patients' health and adjust their behavior. Virtual reality (VR) plays an increasingly larger role to improve health outcomes, being used in a variety of medical specialties including robotic surgery, diagnosis of some difficult diseases, and virtual reality pain distraction for severe burn patients. Smart VR health technology acts as a decision support system in the diseases diagnostic test of patients as they perform real world tasks in virtual reality (e.g., navigation). In this study, a non-invasive, cognitive computerized test based on 3D virtual environments for detecting the main symptoms of dementia (memory loss, visuospatial defects, and spatial navigation) is proposed. In a recent study, the system was tested on 115 real patients of which thirty had a dementia, sixty-five were cognitively healthy, and twenty had a mild cognitive impairment (MCI). The performance of the VR system was compared with Mini-Cog test, where the latter is used to measure cognitive impaired patients in the traditional diagnosis system at the clinic. It was observed that visuospatial and memory recall scores in both clinical diagnosis and VR system of dementia patients were less than those of MCI patients, and the scores of MCI patients were less than those of the control group. Furthermore, there is a perfect agreement between the standard methods in functional evaluation and navigational ability in our system where P-value in weighted Kappa statistic= 100% and between Mini-Cog-clinical diagnosis vs. VR scores where P-value in weighted Kappa statistic= 93%.

Patient Health Questionnaire-9 scores do not accurately estimate depression prevalence: individual participant data meta-analysis.

OBJECTIVES: Depression symptom questionnaires are not for diagnostic classification. Patient Health Questionnaire-9 (PHQ-9) scores ≥10 are nonetheless often used to estimate depression prevalence. We compared PHQ-9 ≥10 prevalence to Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (SCID) major depression prevalence and assessed whether an alternative PHQ-9 cutoff could more accurately estimate prevalence. STUDY DESIGN AND SETTING: Individual participant data meta-analysis of datasets comparing PHQ-9 scores to SCID major depression status. RESULTS: A total of 9,242 participants (1,389 SCID major depression cases) from 44 primary studies were included. Pooled PHQ-9 ≥10 prevalence was 24.6% (95% confidence interval [CI]: 20.8%, 28.9%); pooled SCID major depression prevalence was 12.1% (95% CI: 9.6%, 15.2%); and pooled difference was 11.9% (95% CI: 9.3%, 14.6%). The mean study-level PHQ-9 ≥10 to SCID-based prevalence ratio was 2.5 times. PHQ-9 ≥14 and the PHQ-9 diagnostic algorithm provided prevalence closest to SCID major depression prevalence, but study-level prevalence differed from SCID-based prevalence by an average absolute difference of 4.8% for PHQ-9 ≥14 (95% prediction interval: -13.6%, 14.5%) and 5.6% for the PHQ-9 diagnostic algorithm (95% prediction interval: -16.4%, 15.0%). CONCLUSION: PHQ-9 ≥10 substantially overestimates depression prevalence. There is too much heterogeneity to correct statistically in individual studies.

Metabolic syndrome among adults with type 2 diabetes in a Saudi teaching hospital: A comparative prevalence study using WHO and ATP III definitions.

OBJECTIVE: Metabolic syndrome (MetS) has become a global health concern and is a reliable predictor of long-term adverse health outcomes. This study aimed to determine the prevalence of MetS and its components in a group of Saudi adults with type 2 diabetes using the World Health Organization (WHO) and Adult Treatment Panel (ATP) III definitions, and to examine agreement between both definitions. METHODS: This cross-sectional study included adults with type 2 diabetes who were followed up at the family medicine and endocrinology clinics of King Abdulaziz University Hospital (KAUH) from January to March 2018. An interview-administered questionnaire was designed to collect demographic data, anthropometric measurements, and medical history. We used the 1999 WHO and 2001 ATP III definitions for diagnosing MetS. RESULTS: The study included 155 diabetes patients. The overall prevalence of MetS components (three of more components) among patients was 80% according to the WHO criteria and 85.8% according to the ATP III criteria. The kappa statistics demonstrated good agreement between both definitions (κ = 0.751, p < 0.001). The sensitivity and specificity of diagnosing MetS using the WHO versus ATP III criteria were 92.5% and 95.5%, respectively. There was weak positive association between the number of MetS components and the number of diabetic complications. CONCLUSIONS: MetS was highly prevalent among Saudi adults with type 2 diabetes regardless of the diagnostic criteria. It is, therefore, imperative that clinicians identify MetS in this patient population and educate them on the importance of adherence to treatment and therapeutic lifestyle changes.

A low dose of risperidone resolved Charles Bonnet syndrome after an unsuccessful trial of quetiapine: a case report.

Charles Bonnet syndrome (CBS) is a diagnosis of exclusion. Typical affected patients have impaired visual acuity, vivid recurring visual hallucinations, and no cognitive impairment. Vision loss is most commonly due to macular degeneration, although many other causes exist. Here, we report a case of an 87-year-old woman with CBS and discuss the diagnosis and treatment.

Prevalence of malnutrition and associated factors among hospitalized elderly patients in King Abdulaziz University Hospital, Jeddah, Saudi Arabia.

BACKGROUND: Malnutrition is a nutritional disorder that adversely affects the body from a functional or clinical perspective. It is very often observed in the elderly population. This study aimed to estimate the prevalence of malnutrition among hospitalized elderly patients and its associated factors and outcomes in terms of length of stay and mortality in King Abdulaziz University Hospital, Jeddah, Saudi Arabia. METHODS: In a cross-sectional study, we evaluated the nutritional status of hospitalized elderly patients using the most recent version of the short form of Mini Nutritional Assessment (MNA-SF). RESULTS: A total of 248 hospitalized patients were included (70.0 ± 7.7 years; 60% female). According to the MNA-SF, a total of 76.6% patients were either malnourished or at risk of malnutrition. Malnourished patients had significantly lower levels of serum albumin (28.2 ± 7.7), hemoglobin (10.5 ± 1.8), and lymphocyte (1.7 ± 0.91). They had increased tendency to stay in the hospital for longer durations (IQR, 5-11 days; median = 7 days) and had a mortality rate of 6.9%. CONCLUSION: Malnutrition was highly prevalent among hospitalized elderly and was associated with increased length of stay and mortality.

Strategies to overcome barriers to implementing osteoporosis and fracture prevention guidelines in long-term care: a qualitative analysis of action plans suggested by front line staff in Ontario, Canada.

BACKGROUND: Osteoporosis is a major global health problem, especially among long-term care (LTC) facilities. Despite the availability of effective clinical guidelines to prevent osteoporosis and bone fractures, few LTC homes actually adhere to these practical recommendations. The purpose of this study was to identify barriers to the implementation of evidence-based practices for osteoporosis and fracture prevention in LTC facilities and elicit practical strategies to address these barriers. METHODS: We performed a qualitative analysis of action plans formulated by Professional Advisory Committee (PAC) teams at 12 LTC homes in the intervention arm of the Vitamin D and Osteoporosis Study (ViDOS) in Ontario, Canada. PAC teams were comprised of medical directors, administrators, directors of care, pharmacists, dietitians, and other staff. Thematic content analysis was performed to identify the key themes emerging from the action plans. RESULTS: LTC teams identified several barriers, including lack of educational information and resources prior to the ViDOS intervention, difficulty obtaining required patient information for fracture risk assessment, and inconsistent prescribing of vitamin D and calcium at the time of admission. The most frequently suggested recommendations was to establish and adhere to standard admission orders regarding vitamin D, calcium, and osteoporosis therapies, improve the use of electronic medical records for osteoporosis and fracture risk assessment, and require bone health as a topic at quarterly reviews and multidisciplinary conferences. CONCLUSIONS: This qualitative study identified several important barriers and practical recommendations for improving the implementation of osteoporosis and fracture prevention guidelines in LTC settings.

Knowledge of the residents at King Abdul-Aziz University Hospital (KAAUH) about palliative care.

BACKGROUND: Palliative care is a rapidly growing subspecialty that aims at improving the quality of life and relieving suffering associated with life threatening disease. Despite its rapid growth and huge demand, the knowledge of health care professionals on palliative care remains inadequate. OBJECTIVE: This study aims to determine the knowledge of residents at King Abdul-Aziz University Hospital (KAAUH) on palliative care. MATERIALS AND METHODS: Through a cross-sectional design, all residents in the hospital were invited to complete a two-part self-administered questionnaire in June 2010. The first part of the questionnaire included variables describing the socio-demographic characteristics and educational background, and the second part developed by palliative care education initiative at Dalhousie University in Canada in 2000 had 25 items on the knowledge of palliative care. RESULTS: Of the 80 residents 65 (81%) responded, the overwhelming majority of whom were Saudis (92.3%) with an equal representation of males and females. The mean age of the participants was 29.1 ± 2.4 years. Less than one-third (29.2%) indicated that they had previous didactic education on palliative care. The percentage of right answers on items reflecting knowledge on palliative care accounted for 29.9% ± 9.9%. No statistically significant difference was found in the level of knowledge among the residents according to their demographics or graduation and training characteristics. CONCLUSION: Resident physicians enrolled in postgraduate programs have suboptimal knowledge of basic palliative care. Substantial efforts should be made to incorporate a palliative care module into the theoretical and practical training of medical students and resident physicians.