Prevalence of behavioural and psychological symptoms of dementia in cognitively impaired elderly residents of long-term care facilities in East Asia: a cross-sectional study.

OBJECTIVE: The aim of this study was to compare the prevalence of behavioural and psychological symptoms of dementia (BPSD) in cognitively impaired elderly residents of long-term care facilities in East Asia and to explore the factors associated with these patterns. METHODS: This was a cross-sectional survey of BPSD in cognitively impaired elderly residents of long-term care facilities in Japan, South Korea, China, Taiwan, and Thailand. The Mini-Mental State Examination, Clinical Dementia Rating (CDR), and Neuropsychiatric Inventory, Nursing Home version (NPI-NH), were used to assess cognitive status, dementia severity, and BPSD, respectively. NPI-NH subscale severity scores were multiplied by frequency scores to obtain the subscale scores and aggregated into two groups based on score (clinically insignificant = 1- 3; clinically significant ≥4). RESULTS: Data from 662 people were analyzed. Median age, median Mini-Mental State Examination scores, and median CDR scores differed significantly among the seven study sites. The prevalence of BPSD varied from 64% in Taiwan to 100% in dementia care units in Japan, and the median total NPI-NH scores ranged from 2 in Taiwan to 14 in dementia care units in Japan. After stratification of the sample by dementia severity and clinical significance of NPI-NH scores, differences in the prevalence of clinically significant BPSD were mostly observed among facilities dedicated to dementia patients in the CDR 1 group. In the CDR 3 group, the prevalence of some clinically significant BPSD, such as apathy, was high even among study sites with low median total NPI-NH scores. CONCLUSIONS: Our findings may suggest referral and selection biases in the study sites. Future prospective studies are needed to address the impact of environmental and care factors on the occurrence of BPSD in Asian countries.

Variations and factors associated with psychotropic use in cognitively impaired elderly residing in long-term care facilities in East Asia: a cross-sectional study.

BACKGROUND: The aim of this cross-sectional study was to compare patterns of psychotropic prescription drug use among cognitively impaired residents in long-term care facilities in East Asia and to explore factors associated with these patterns. METHODS: This study included elderly participants with cognitive impairments residing in long-term care facilities with and without dementia care units in Japan, South Korea, China, Taiwan, and Thailand. The Mini-Mental State Examination, the Clinical Dementia Rating, and the Neuropsychiatric Inventory, Nursing Home version were used to assess cognitive status, examine dementia severity, and evaluate behavioural psychological symptoms of dementia, respectively. The rate of psychotropic drug use and the relationship between the number of psychotropic drugs and clinical factors were examined. RESULTS: In total, 662 people were analyzed. Facilities with dementia care units had a higher rate of anti-dementia drug use than regular elderly care sites. Among the three dementia care sites, a Japanese hospital and a Korean site had a high rate of antipsychotic use and use of other types of psychotropics, whereas these drugs were used at a low rate in a Chinese nursing home. Patterns of psychotropic drug use may be partially associated with local regulations and facility type. Poly-pharmacy was identified as a common problem at all study sites. CONCLUSIONS: Our findings will be beneficial for health-care professionals and policymakers when developing practice guidelines and strategies to regulate overuse of psychotropics and poly-pharmacy. Prospective studies are needed to examine patterns of psychotropic prescriptions and to promote evidence-based practice.

Body mass index and multimorbidity risk: A systematic review and dose-response meta-analysis.

OBJECTIVE: To verify the dose-response relationship between body mass index (BMI) and multimorbidity risk. METHODS: PubMed, CINAHL, and Embase were systematically studied until January 25, 2023. Original articles on BMI and multimorbidity risk were included. Random effects model and dose-response meta-analysis were used to estimate the pooled odds ratio (OR) with 95 % confidence interval (CI). Subgroup analysis was performed to explore potential heterogeneity. RESULTS: A total of 43 studies involving 969,130 patients (94,978 with multimorbidity) were involved in the meta-analysis. In the longitudinal studies, the pooled results showed that, compared to being a normal BMI, being overweight was much similar with 1.32 times possibility of getting multimorbidity; in persons with obesity the risk was 1.93 times higher; and the risk decreased 0.80 times among underweight persons. Additionally, obesity was 1.75 times as likely to be multimorbidity than those non-obese persons. In the cross-sectional studies, the pooled results demonstrated that persons with overweight and obesity had a 1.38-fold and 2.38-fold risk for multimorbidity, respectively; and the risk decreased 0.90 times among underweight persons compared to those with normal BMI. Besides, obese people are 1.89 times more likely to have multimorbidity than non-obese people. Dose response analysis found the linear connection between BMI and multimorbidity risk (Pnon-linearity=0.762), that for each 1 kg/m2 and 5 kg/m2 increase in BMI, the multimorbidity risk increased by 6 % and 35 %, respectively. CONCLUSIONS: Multimorbidity increased linearly with an increase in BMI. Clinicians should pay attention to persons with abnormal weight, to help them achieve normal BMI.

Multimedia computer-assisted instruction for carers on exercise for older people: development and testing.

AIM: This paper is a report of a study conducted to develop a multimedia computer-assisted instruction for informal carers and test its content validity, user difficulty and user satisfaction. BACKGROUND: Healthy ageing is an increasingly important public health target globally. Changes in technology offer the opportunity for e-health promotion as a means of educating populations and healthcare staff to meet public health targets. METHODS: Computer-assisted instruction was developed and tested systematically in four phases during 2008, and these are outlined. Phase 1 consisted of topic and content identification using a literature review. Phase 2 comprised refinement of the content using an academic panel of experts. Phase 3 was the production of computer-assisted instruction comprising problem clarification, algorithm designing with reference to a cognitive theory of multimedia learning and program coding. Phase 4 consisted of testing for content validity, and writing a computer-assisted instruction manual and testing it for user difficulty and satisfaction. RESULTS: The data from each phase informed the development and refinement of the computer-assisted instruction. Content validity was confirmed and 'test' users reported few difficulties in its use and high satisfaction. CONCLUSION: This e-health promotion initiative is an example of how computer-assisted instruction may be developed to teach carers of older people.

Osteoporosis preventive behavior in Thai older adults: feasibility and acceptability.

The authors used a one-group pre-test-post-test design to examine the feasibility and acceptability of an osteoporosis prevention program and the effects of the program on knowledge, health beliefs, self-efficacy; and osteoporosis preventive behaviors in older adults. Participants included 48 older adults who attended a health center in Thailand. Results revealed that the program was feasible and acceptable. A significant improvement in osteoporosis knowledge, health beliefs, self-efficacy, and osteoporosis preventive behaviors occurred. Findings suggest that the program helps older adults incorporate new knowledge and skills into their daily lives and helps them maintain bone health.

Family support and self-care behavior of Chinese chronic obstructive pulmonary disease patients.

A descriptive correlation study was conducted at the outpatient pulmonary clinic of a large medical center to describe family support and self-care behavior and to ascertain the relationship of these two variables among Chinese chronic obstructive pulmonary disease (COPD) patients. A total of 98 COPD patients completed the questionnaires providing demographic data and information about perceived family support and self-care behavior. Results showed that most subjects perceived that they had received a high level of family support, and the majority of the subjects perceived that they had initiated an adequate amount of self-care behavior. A slightly statistically significant positive relationship between family support and self-care behavior was ascertained.