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• The definition for slowness and weakness were adjusted to the current criteria produced in 2019. • The data about frail population was analyzed in the revised manuscript, as well as the prevalence about the each index of Fried criteria. • The method for multivariate regression analysis was described in detail. • For the relationship about cognitive function, frailty and PF and mortality, more discussion was shown. Both frailty and prefrailty (PF) are related to mortality. However, there is no consensus about the PF subtypes for prediction of the mortality risk. We aimed to compare the 5-year mortality of functionally independent geriatric outpatients with nonfrailty, different PF subtypes and frailty. This was a single-center, retrospective cohort study. Community-dwelling older adults who visited the geriatric outpatient clinic in a healthcare institution in Taiwan were enrolled. PF1 was defined based on exhaustion and/or body weight loss whereas PF2 was defined by one or two of the following criteria: weakness, slowness, and low physical activity. Frailty was defined by three or more above criteria. Demographics and results of comprehensive geriatric assessment were compared and Kaplan–Meier survival analysis was used to determine the 5-year survival among the nonfrail, PF1, PF2 and frail groups. Of the 982 participants, the proportion of PF and frailty was high (PF 45.7% and frailty 24.5%). The cumulative 5-year survival rate of the nonfrail group, PF1, PF2 subgroups and frail group was 98.6%, 95.8%, 89.1% and 81.3% respectively. Age, male sex, PF2 subtype and frailty were significantly associated with 5-year mortality [hazard ratio (95% confidence interval) 1.05 (1.01–1.08), 1.96 (1.08–3.57), 5.18 (1.57–17.09), and 6.87 (2.05–23.04), respectively]. The proportion of PF and frailty was high in old outpatient population with functional independence. PF2 subtypes and frailty could influence the 5-year mortality risk in these participants. Identifying PF2 participants earlier and instituting prompt intervention may be beneficial in older patients. [ABSTRACT FROM AUTHOR]

Abstract: Disability is associated with increased long-term care use among the elderly, but its association with utilization of acute care is not well understood. The aim of this study is to investigate the association between functional disability and acute medical care utilization among the elderly. This nationwide, population-based cohort study was based on data from the 2005 National Health Interview Survey (NHIS), linking to the 2004–2007 National Health Insurance (NHI) claims data. A total of 1521 elderly subjects aged 65 years or above were observed from the year 2004 to 2006; this sample was considered to be a national representative sample. The utilization of acute medical care (including outpatient services, emergency services, and inpatient services) and medical expenditure were measured. Functional disability was measured by determining limitations on activities of daily living (ADLs), instrumental activities of daily living (IADLs), and mobility. After adjusting for age, comorbidity, and sociodemographic characteristics, functional disability that affected IADLs or mobility was a significant factor contributing to the increased use of care. A clear proportional relationship existed between disability and utilization, and this pattern persisted across different types of acute care services. Disability affecting IADLs or mobility, rather than ADLs, was a more sensitive predictor of acute medical care utilization. Compared to elderly persons with no limitations, the medical expenditure of those with moderate-to-severe limitations was 2–3 times higher for outpatient, emergency, and inpatient services. In conclusion, functional disability among the elderly is a significant factor contributing to the increased use of acute care services. [Copyright &y& Elsevier]

Abstract: Elderly patients who are hospitalized with acute illnesses frequently have adverse outcomes. To maintain functional independence, the geriatric evaluation and management unit (GEMU) was established to provide the opportunity for functional recovery (FR). This study''s aim was to investigate potential prognostic factors for functional improvement in a GEMU of Taichung Veterans General Hospital, Taiwan. A total of 117 elderly patients (age, 80.0±6.3 years, 84.6% males) were enrolled. A comprehensive geriatric assessment and functional status evaluation, including the functional reach test (FRT) and the timed up-and-go (TUG) test, were performed. FR was defined by a greater than 10% improvement in the Barthel Index (BI) before GEMU discharge. Lower BI (44.7±25.2 vs. 68.7±34.5, p < 0.001), lower instrumental activities of daily living (IADL) scores (1.8±1.5 vs. 3.5±2.6, p < 0.001), impaired FRT (83.3% vs. 63.5%, p = 0.028), and impaired TUG test (94.4% vs. 74.6%, p = 0.008) were predictive factors for functional improvement. On multivariate logistic regression, an impaired TUG test (Odds ratio = OR = 6.18, 95% confidence interval = 95% C.I. = 1.69–22.6, p = 0.006) was an independent variable associated with FR. The results indicate that elderly hospitalized patients, even with poor physical function, could benefit from geriatric integrated care delivered by a GEMU. [Copyright &y& Elsevier]

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: As Taiwan has become the fastest aging country in the world, developing elderly-friendly health care services is of great importance. Compared with traditional health-care service models, healthcare needs of older people may differ extensively. It has been reported that geriatric evaluation and management (GEM), helps to differentiate the atypical presentations of frail older patients, to discover hidden health-social problems, and to promote long-term clinical outcome. The main purpose of this study was to explore the demographic characteristics of older patients visiting outpatient GEM service and its impact to health-care utilization in a tertiary medical center in Taiwan. From January to October of 2008, 1054 patients visited the outpatient GEM service, and comprehensive geriatric assessment was performed for 140 patients (62.9% males with the mean age was 81.0±6.6 years), and 34.8% of them were college graduates. Overall, the prevalence of functional impairment was 11.4%, depressive symptoms 20.7%, cognitive impairment 32.1%, and abnormal timed up-and-go test 32.1%. During the 12-month follow-up, items of mean oral medications were significantly reduced (3.2±2.7 vs. 3.8±2.8, p <0.001) and the health-related quality of life was significantly improved (64.6±8.0 vs. 61.6±4.0, p <0.001). In conclusion, patients visiting outpatient GEM services in Taiwan are old and well-educated, and they possessed various functional impairments. The outpatient GEM services significantly reduced the items of oral medications and improved quality of life. The possible better compliance of this cohort due to high educational status may overestimate the clinical effectiveness of outpatient GEM services. Further investigations are needed to clarify the long-term benefits of outpatient GEM services. [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]