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Abstract: Older people tend to have multiple comorbid conditions and subsequent polypharmacy, which place them at higher risk of adverse drug events, drug–drug and drug–disease interactions and IP. IP includes several patterns, such as inappropriate dose or duration, prescribing drugs having significant drug–disease or drug–drug interactions, and the omission of potentially beneficial medications. The main purpose was to evaluate the prevalence of IP among medical inpatients in a medical center, so to evaluate the associative factors of IP in Taiwan. From January to December of 2009, all patients aged 65 years and older who were discharged from the medical wards of Taipei Veterans General Hospital were randomly sampled for study (the sampling rate around 1.0%). The IP was evaluated by the STOPP and START criteria. Each medical record was carefully reviewed by physicians who had been trained. Overall, 520 records of elderly medical ward inpatients (mean age=79.2±6.7 years, 73.8% males) were included for study. In total, 3455 items of medication were prescribed for these 520 patients (mean=6.6±3.2 items). According to STOPP criteria, 36.2% of the study subjects had at least one potentially inappropriate medication (PIM). The most common PIMs were: (1) medications that may adversely affect those who are prone to falls, e.g., benzodiazepines, neuroleptics and first generation antihistamines (14.2%). (2) Ca-channel blockers with chronic constipation (12.3%). (3) Use of neuroleptic agents (5.6%). (4) Long-term, long-acting benzodiazepines (2.5%). (5) Prolonged use of first generation antihistamines (2.1%). Besides, 218 patients (41.9%) had at least one potentially prescribing omission (PPO). Common PPOs included: (1) statin therapy in diabetes mellitus if coexisting major cardiovascular risk factors present (19.0%). (2) Antiplatelet therapy in diabetes mellitus with co-existing major cardiovascular risk factors (12.5%). (3) Metformin with type 2 diabetes with or without metabolic syndrome (in the absence of renal impairment) (8.7%). (4) Angiotensin converting enzyme inhibitor or angiotensin II receptor blockers with chronic heart failure (7.3%). (5) Aspirin or clopidogrel with a documented history of atherosclerotic coronary, cerebral or peripheral vascular disease in patients with sinus rhythm (7.1%). Logistic regression showed that older age and number of medications were significant risk factors for PIMs. In conclusion, the prevalence of PIMs among elderly medical inpatients in a medical center in Taiwan was 36.2% and PPOs was 41.9%. Further study is needed to clarify the underlying causes of potentially IP to promote better quality of prescribing for older patients. [Copyright &y& Elsevier]

Abstract: The incidence of ischemic stroke increases with age, and it has a great impact on patients'' functional independence. The aim of this study was to analyze the clinical features, laboratory findings, and stroke subtypes in different age subgroups and identify the predictive factors for functional independence 6 months after stroke. A total of 533 patients with first-ever ischemic stroke were enrolled in this study. They were divided into two subgroups: more than 80 years old (n = 108) and less than 80 years old (n = 425). Patients aged 80 years or over had higher frequencies of heart disease and atrial fibrillation, and lower frequencies of dyslipidemia, alcohol drinking, and a family history of ischemic stroke. Significantly lower body mass index, serum albumin levels, and lipid profiles, including total cholesterol, low-density lipoprotein, and triglyceride levels, but higher severity of initial neurologic deficit, and higher rates of mortality and complications during hospitalization were noted in patients aged over 80 years. The multivariate logistic regression analysis showed that higher serum total cholesterol level, less severity of neurologic deficit at admission, and absence of a history of diabetes mellitus were predictive of functional independence 6 months after stroke. [Copyright &y& Elsevier]

Abstract: Circulating levels of inflammatory and prothrombotic factors are elevated in the metabolic syndrome (MS) and linked with the occurrence of cardiovascular events. The aim of our study was to investigate the relationship between inflammatory and prothrombotic markers and the MS in elderly institutionalized residents. A total of 326 non-diabetic residents of Chuang-Hua Veterans Care Home (age: 79.9±4.1 years; 100% males) were enrolled. MS was diagnosed according to the AHA/NHLBI Scientific Statement criteria. Body fat percentage was measured by bioelectrical impedance analysis. Insulin resistance was calculated by homeostasis model assessment for insulin resistance (HOMA-IR). Inflammatory markers, including tumor necrosis factor-a (TNF-α), high sensitivity C-reactive protein (hsCRP), and plasminogen activator inhibitor-1 (PAI-1), were determined using ELISA. Elderly residents with the MS had higher systolic and diastolic blood pressures (both p < 0.001) and higher HOMA-IR (p < 0.001), hsCRP (p = 0.008), and PAI-1 levels (p < 0.001) than those without the MS. On multivariate logistic regression analysis, PAI-1 was an independent risk factor for the MS. Of the MS components, elderly residents with higher waist circumferences and higher levels of plasma fasting glucose, and triglyceride (TG), and lower levels of high density lipoprotein (HDL) had higher PAI-1 levels than those without the above components. [Copyright &y& Elsevier]