Characteristics of human immunodeficiency virus infections among the elderly in Taiwan: A nationwide study

AbstractBackgroundInformation regarding human immunodeficiency virus (HIV) infections and acquired immunodeficiency syndrome (AIDS) in the elderly of Taiwan is limited. This study looked into the aforementioned issues.MethodsData from the National HIV/AIDS Registry, relating to individuals diagnosed in 2007, were analyzed.ResultsAmong 1,975 HIV-infected individuals diagnosed in 2007, the elderly group (age ≧50 years) consisted of 153 subjects and the younger (control) group (age 15–39 years) consisted of 1,458 individuals. Some markers, such as primarily males/local Taiwanese, being unemployed, one third of subjects infected by means of intravenous drug use, and primarily diagnosed in hospitals, were similar between the two groups. The elderly group had more married, divorced, and separated individuals, and widows/widowers than the younger group. The causes of death differed insignificantly between the two groups. The younger group had more variety than the elderly group in distribution of occupations. Fewer prison-diagnosed HIV, high ratio of individuals developing AIDS, heterosexuals, high mortality, and unsupported marital status were significant markers of elderly HIV-infected subjects.ConclusionIn Taiwan, elderly HIV infections have reflected the aforementioned characteristics. Some specific issues concerning elderly HIV infections, such as heterosexual predominance, high mortality and fewer men who have sex with men, are similar with reports from other countries. These characteristics can guide possible directions of social and health care interventions

The utilization of hospice care among patients with motor neuron diseases: The experience in Taiwan from 2005 to 2010

AbstractBackgroundThe nature and extent of how patients with motor neuron diseases (MNDs) utilize hospice care in Taiwan remains unclear. This study aims to investigate the use of hospice care in Taiwan by patients with MND, and those factors that affect the extent, the cost, and the quality of their hospice treatment and care.MethodsWe analyzed data from hospice care inpatient claims of MNDs, using the National Health Insurance Research Database of Taiwan during 2005–2010.ResultsThirty patients and 58 related discharges were enrolled into our study, which consisted of 13 males and 17 females, with a mean age 58.3 years. Of that total, 27 of them (90%) had amyotrophic lateral sclerosis, and four (13.3%) had comorbid cancers; 17 died during hospice care. Acute low respiratory conditions (31.0%) accounted for the most common acute comorbidity. Noninvasive ventilation care was performed in only 13 (22.4%) of the discharges. In contrast to nasogastric intubation (40 discharges, 69.0%), no gastrostomy/jejunostomy was noted. These procedures bore no relationship to results observed in the discharges. Family physicians provided most inpatient hospice services (74.1%). Respiratory problems were the major causes of death (70.6% of decedents). The mean inpatient costs of hospice care were noticeably reduced from previously established nationwide mean costs.ConclusionHospice care can save costs for patients with terminal MNDs, and family physicians play a valuable role in caring for these patients. However, respiratory and feeding problems are prevalent, yet there are proven benefits when noninvasive ventilation care and gastrostomy/jejunostomy are promoted

Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome: A case report

AbstractRemitting seronegative symmetrical synovitis with pitting edema (RS3PE) is a rare form of paraneoplastic tenosynovitis, which is more prone to occur in elderly males. A 78-year-old male had a past history of gastric cancer 23 years ago and underwent subtotal gastrectomy then. He led a fair life after the surgery. However, fever, edema in four extremities, gait disturbance, and liver function impairment bothered him for 5 months, which caused significant physical functional decline. Despite of extensive laboratory and imaging examinations, no definite diagnosis and treatment were provided. He was referred to Kyoto University hospital and RS3PE was diagnosed. After the diagnosis of RS3PE syndrome was made, systemic steroid was given and fever, edema and liver function impairment improved dramatically within 7 days. The patient was well managed by oral prednisolone 30mg per day after discharge. RS3PE should be considered when an elderly man with aforementioned presentations in order to prevent significant functional decline in daily living

Nondiabetic older adults with untreated hypertension in Taiwan: Treatment implication in elderly hypertension

AbstractBackgroundHypertension is common and often left undiagnosed in the elderly. The main purpose of this study was to evaluate the clinical characteristics of nondiabetic hypertensive older adults.MethodsCommunity-living older adults in Taipei City participating in annual health examinations were invited for study. Subjects with diabetes mellitus, whether treated or newly diagnosed, were excluded for further analysis. All participants were classified into three groups: normotension, untreated hypertension (UH), and treated hypertension (TH).ResultsIn total, 3244 subjects (mean age: 73.4±5.4 years, 56.2% males) were enrolled. The prevalence of hypertension, chronic kidney disease (CKD), and left ventricular hypertrophy (LVH) was 52.9% (36.1% TH and 16.8% UH), 20.9%, and 6.2%, respectively. Compared with the normotension group, UH subjects were older (73.8±5.5 years vs. 72.9±5.6 years, p=0.003); having higher body mass index (24.2±3.4kg/m2 vs. 23.6±3.4kg/m2, p=0.001), fasting glucose (101.7±9.1mg/dL vs. 100.5±9.0mg/dL, p=0.007), total cholesterol (TC) (205.0±37.8mg/dL vs. 196.5±36.4mg/dL, p<0.001), triglyceride (TG) (134.5±84.9mg/dL vs. 119.4±77.0mg/dL, p<0.001); and higher prevalence of overt proteinuria (19.3% vs. 13.5%, p=0.001), CKD (21.1% vs. 16.6%, p=0.025), and LVH (8.1% vs. 3.8%, p<0.001). However, the prevalence of overt proteinuria (19.3% vs. 21.1%, p=0.378) and LVH (8.1% vs. 8.5%, p=0.79) between UH and TH groups was similar. Adjusted for age, TC, TG, fasting plasma glucose, and the incidence of LVH, both UH [odds ratio (OR)=1.30, 95% confidence interval (CI)=1.01–1.66, p=0.040] and TH (OR=1.69, 95% CI=1.39–2.05, p<0.001) were significant risk factor for CKD. In addition, independent risk factors for CKD included age (OR=1.07, 95% CI=1.05–1.09, p<0.001), body mass index (OR=1.07, 95% CI=1.04–1.10, p<0.001), TC (OR=1.003, 95% CI=1.001–1.005, p=0.021), TG (OR=1.002, 95% CI=1.001–1.003, p<0.001), and hypertension (TH or UH) (OR=1.44, 95% CI=1.20–1.72, p<0.001).ConclusionIn conclusion, risk of CKD existing along with blood pressure rises among nondiabetic older hypertensive adults, and hypertension (TH or UH) carries a significant risk of CKD after adjustment of other cardiovascular risk factors. Renal protection should be highlighted in the antihypertensive treatment strategy in older hypertensive patients

The utilization of hospice care among patients with motor neuron diseases: The experience in Taiwan from 2005 to 2010

Abstract Background: The nature and extent of how patients with motor neuron diseases (MNDs) utilize hospice care in Taiwan remains unclear. This study aims to investigate the use of hospice care in Taiwan by patients with MND, and those factors that affect the extent, the cost, and the quality of their hospice treatment and care. Methods: We analyzed data from hospice care inpatient claims of MNDs, using the National Health Insurance Research Database of Taiwan during 2005e2010. Results: Thirty patients and 58 related discharges were enrolled into our study, which consisted of 13 males and 17 females, with a mean age 58.3 years. Of that total, 27 of them (90%) had amyotrophic lateral sclerosis, and four (13.3%) had comorbid cancers; 17 died during hospice care. Acute low respiratory conditions (31.0%) accounted for the most common acute comorbidity. Noninvasive ventilation care was performed in only 13 (22.4%) of the discharges. In contrast to nasogastric intubation (40 discharges, 69.0%), no gastrostomy/jejunostomy was noted. These procedures bore no relationship to results observed in the discharges. Family physicians provided most inpatient hospice services (74.1%). Respiratory problems were the major causes of death (70.6% of decedents). The mean inpatient costs of hospice care were noticeably reduced from previously established nationwide mean costs. Conclusion: Hospice care can save costs for patients with terminal MNDs, and family physicians play a valuable role in caring for these patients. However, respiratory and feeding problems are prevalent, yet there are proven benefits when noninvasive ventilation care and gastrostomy/ jejunostomy are promoted

Prescriptions of Chinese Herbal Medicines for Insomnia in Taiwan during 2002

Chinese herbal medicine (CHM) has been commonly used for treating insomnia in Asian countries for centuries. The aim of this study was to conduct a large-scale pharmaco-epidemiologic study and evaluate the frequency and patterns of CHM use in treating insomnia. We obtained the traditional Chinese medicine (TCM) outpatient claims from the National Health Insurance in Taiwan for the year 2002. Patients with insomnia were identified from the diagnostic code of International Classification of Disease among claimed visiting files. Corresponding prescription files were analyzed, and an association rule was applied to evaluate the co-prescription of CHM. Results showed that there were 16 134 subjects who visited TCM clinics for insomnia in Taiwan during 2002 and received a total of 29 801 CHM prescriptions. Subjects between 40 and 49 years of age comprised the largest number of those treated (25.3%). In addition, female subjects used CHMs for insomnia more frequently than male subjects (female : male = 1.94 : 1). There was an average of 4.8 items prescribed in the form of either an individual Chinese herb or formula in a single CHM prescription for insomnia. Shou-wu-teng (Polygonum multiflorum) was the most commonly prescribed single Chinese herb, while Suan-zao-ren-tang was the most commonly prescribed Chinese herbal formula. According to the association rule, the most commonly prescribed CHM drug combination was Suan-zao-ren-tang plus Long-dan-xie-gan-tang, while the most commonly prescribed triple drug combination was Suan-zao-ren-tang, Albizia julibrissin, and P. multiflorum. Nevertheless, further clinical trials are needed to evaluate the efficacy and safety of these CHMs for treating insomnia

Depression is the Strongest Independent Risk Factor for Poor Social Engagement Among Chinese Elderly Veteran Assisted-living Residents

BackgroundSocial engagement prolongs the lifespan and preserves cognition in the elderly. However, most studies concerning social engagement have been conducted in Western countries; few have been performed in the Chinese population. This study attempted to identify the risk factors for poor social engagement among elderly veterans in Taiwan.MethodsA total of 597 male veterans were enrolled, with a mean age of 80.8 ± 5.0 years. This cross-sectional study employed the Resident Assessment Instrument (RAI) Minimum Data Set (MDS), the Geriatric Depression Scale–Short Form (GDS-SF), and the Mini-Mental State Examination (MMSE). Multivariate logistic regression analysis was done to investigate significant independent risk factors for poor social engagement, which were identified using the MDS Index of Social Engagement (ISE).ResultsMean ISE score was 1.5 ± 1.3 (range, 0–5); 52% of subjects had poor levels of social engagement (ISE < 2; 312/597). Regression analyses suggested that depression (OR, 6.6; 95% CI, 2.7–16.1; p < 0.001), illiteracy (OR, 2.2; 95% CI, 1.3–3.8; p = 0.003), the presence of unsettled relationships (OR, 3.6; 95% CI, 1.5–8.7; p = 0.004), and cognitive impairment (OR, 2.0; 95% CI, 1.1–3.9; p = 0.03) were significant independent risk factors for poor social engagement, after controlling for age, marital status, level of daily living activity and degree of sensory impairment.ConclusionPoor social engagement is common among Chinese assisted-living veteran home residents. Depression is the greatest risk factor of poor social engagement in this population

Cataract surgery utilization after acute stroke: A nationwide cohort study

AbstractBackgroundCataract is a common and correctable ophthalmological condition that is associated with a poor quality of life and shortened life expectancy in older people. However, little is known regarding the use of cataract surgery in stroke patients after the incident event.MethodsA national cohort of 5462 patients who had experienced an acute stroke event without severe physical disability between 2000 and 2003, and 26,434 randomly selected age- and sex-matched controls were obtained from a random population-based sample of the National Health Insurance database in Taiwan. Multivariate Cox proportional hazard regression analysis was used to assess the association between stroke events and cataract surgery.ResultsAfter a 5-year follow-up, 482 stroke patients (8.8%) and 1897 controls (7.2%) had received cataract surgery after the index dates of their stroke. The incidence of subsequent cataract surgery following acute stroke was 27% higher than that in the comparison group (crude hazard ratio 1.27; p < 0.001). Adjusted for age, sex, co-morbid medical diseases, use of systemic steroids, exposure to radiation during computed tomography, and socioeconomic status, the incidence of cataract surgery in the stroke patients was 30% higher than that in the comparison group (adjusted hazard ratio 1.30; p < 0.001).ConclusionA 30% increase in the use of cataract surgery was noted among the survivors of acute stroke with mild-to-moderate disabilities, which may result from the increased need for better vision after stroke