AIM: Based on this document, a Southeast Asia Working Group (SEAWG) wished to see how the new ESCEO algorithm developed in 2019 was perceived by Southeast Asian experts and how it was integrated into their clinical practice.
METHODS: A SEAWG was set up between members of the international ESCEO task force and a group of Southeast Asian experts.
RESULTS: Non-pharmacological management should always be combined with pharmacological management. In step 1, symptomatic slow-acting drugs for osteoarthritis are the main background therapy, for which high-quality evidence is available only for the formulations of patented crystalline glucosamine sulfate and chondroitin sulfate. In step 2, oral NSAIDs are a useful option, considering the cardiovascular/renal/gastrointestinal profiles of the individual patient. Intra-articular hyaluronic acid and corticosteroids are a possible alternative to oral NSAIDs, but limited evidence is available. If steps 1 and 2 do not give adequate relief of symptoms, tramadol can be used, but its safety is debated. In general, the indications of the ESCEO algorithm are important in Southeast Asian countries, but the reimbursement criteria of local health systems are an important aspect for adherence to the ESCEO algorithm.
CONCLUSION: This guidance provides evidence-based and easy-to-follow advice on how to establish a treatment algorithm in knee OA, for practical implementation in clinical practice in Southeast Asian countries.
AIMS: This study aimed to determine common combinations of medications used among women aged 77-96 years and to describe characteristics associated with these combinations.
METHODS: A cohort study of older women enroled in the Australian Longitudinal Study on Women's Health over a 15-year period was used to determine combinations of medications using latent class analysis. Multinomial logistic regression was used to determine characteristics associated with these combinations.
RESULTS: The highest medication users during the study were for the cardiovascular (2003: 80.28%; 2017: 85.63%) and nervous (2003: 66.03%; 2017: 75.41%) systems. A 3-class latent model described medication use combinations: class 1: 'Cardiovascular & neurology anatomical group' (27.25%) included participants using medications of the cardiovascular and nervous systems in their later years; class 2: 'Multiple anatomical group' (16.49%) and class 3: 'Antiinfectives & multiple anatomical group' (56.27%). When compared to the reference class (class 1), the risk of participants being in class 3 was slightly higher than being in class 2 if they had > 4 general practitioner visits (RRR 2.37; 95% CI 2.08, 2.71), Department of Veterans Affairs' coverage (RRR 1.59; 95% CI 1.36, 1.86), ≥ 4 chronic diseases (RRR 3.16; 95% CI 2.56, 3.90) and were frail (RRR 1.47; 95% CI 1.27, 1.69).
CONCLUSION: Identification of combinations of medication use may provide opportunities to develop multimorbidity guidelines and target medication reviews, and may help reduce medication load for older individuals.
AIMS: This study determined the use of potentially inappropriate medications according to frailty status using the Beers Criteria 2019, identified medications that should be flagged as potentially inappropriate and harmful depending on individual health factors, and determined the association between frailty and PIMs, adjusted for characteristics associated with PIMs.
METHODS: This prospective longitudinal study included 9355 participants aged 77-82 years at baseline (2003). Frailty was measured using the FRAIL (fatigue, resistance, ambulation, illness and loss of weight) scale. Generalised estimating equations using log-binomial regressions determined the association between frailty and risk of using PIMs.
RESULTS: Among participants who were frail and non-frail at baseline, the majority used ≥ 3 PIMs (74.2% and 58.5%, respectively). At 2017, the proportion using ≥ 3 PIMs remained constant in the frail group (72.0%) but increased in the non-frail group (66.0%). Commonly prescribed medications that may be potentially inappropriate in both groups included benzodiazepines, proton-pump inhibitors and non-steroidal anti-inflammatory drugs, and risperidone was an additional contributor in the non-frail group. When adjusted for other characteristics, frail women had a 2% higher risk of using PIMs (RR 1.02; 95% CI 1.01, 1.03).
CONCLUSION: Given that the majority of frail women were using medications that may have been potentially inappropriate, it is important to consider both frailty and PIMs as indicators of health outcomes, and to review the need for PIMs for women aged 77-96 years who are frail.
AIMS: A community-based longitudinal study was performed to determine the incidence and to identify possible predictors of multimorbidity among multiethnic older adults population in Malaysia.
METHODS: Comprehensive interview-based questionnaires were administered among 729 participants aged 60 years and above. Data were analyzed from the baseline data of older adults participating in the Towards Useful Aging (TUA) study (2014-2016) who were not affected by multimorbidity (349 without any chronic diseases and 380 with one disease). Multimorbidity was considered present in an individual reporting two or more chronic diseases.
RESULTS: After 1½ years of follow-up, 18.8% of participants who were initially free of any diseases and 40.9% of those with one disease at baseline, developed multimorbidity. The incidence rates were 13.7 per 100 person-years and 34.2 per 100 person-years, respectively. Female gender, smoking, and irregular preparing of food (lifestyle) were predictors for incidence of multimorbidity, especially in those without any disease, while Body Mass Index (BMI) 22-27 kg/m2 and inadequate daily intake of iron were identified as predictors of multimorbidity among participants who already have one disease.
CONCLUSIONS: The incidence rates of multimorbidity among Malaysian older adults were between the ranges of 14-34 per 100 person-years at a 1½-year follow-up. Gender, smoking, BMI 22-27 kg/m2, inadequate daily intake of iron and lack of engagement in leisure or lifestyle physical activities were possible predictors in the development of multimorbidity. There is a need to formulate effective preventive management strategies to decelerate multimorbidity among older adults.
OBJECTIVE: This study aimed to assess the impact of different TC styles on motor function in older adults with functional impairments.
METHOD: We searched five databases-PubMed, Scopus, Chinese National Knowledge Infrastructure (CNKI), Web of Science, and Wiley Online Library-including studies published up to September 2024. The selection of literature adhered to PRISMA guidelines, with quality assessment independently carried out by two researchers.
RESULTS: Fourteen studies met the inclusion criteria for this review. The analysis revealed that TC interventions for functionally impaired older adults primarily employed Yang-style, Sun-style, Chen-style, and simplified-style TC. The populations studied included individuals with mild cognitive impairment (MCI), nonspecific low back pain (NS-LBP), preclinical disabilities, chronic diseases, poor balance, osteoarthritis (OA), Parkinson's disease (PD), sarcopenia, and those at risk of falls. The findings indicated that motor function in functionally impaired older adults were closely linked to balance, gait, mobility, strength, and fall rates. Among the various TC styles, Yang-style was the most frequently utilised intervention.
CONCLUSION: This review examined four types of TC interventions and found strong evidence supporting the effectiveness of Yang-style TC in improving motor function in older adults with functional impairments. Additionally, five assessment methods-Single-Leg Stance (SL), Six-Minute Walk Test (6MWT), Timed Up and Go Test (TUGT), Chair Stand Test (CST), and Fall Efficacy Scale (FES)-were identified as suitable for evaluating this population. Based on the findings, it is recommended that individuals with functional impairments engage in Yang-style 24-movement TC, with an intervention duration of 12 weeks, practicing two to five times a week for 60 min each session.
AIM: To determine the influence of psychosocial factors and health-seeking behaviour on the risk of falling among individuals with type 2 diabetes.
METHODS: This prospective study included community-dwelling adults aged ≥55 years selected through stratified random sampling from three neighbouring parliamentary constituencies. Data was collected at baseline in 2013-2015 with computer-assisted home-based interviews and follow-up in 2019 via telephone interviews.
RESULTS: Data on diabetes status and falls were available for 908 participants at baseline and follow-up. Diabetes was present in 42.2% of included participants at follow-up, of whom 22.8% at baseline and 25.3% at 5-year follow-up had at least one fall within the last 12 months. Diabetics had a higher risk of falls at baseline (OR: 1.484; 95% CI: 1.060-2.077) and follow-up (OR: 1.424; 95% Cl: 1.038-1.954) than non-diabetics. It was found that female gender, arthritis, alcohol and presence of depression anxiety or stress were associated with increased risk of falls in diabetics. The presence of any depression, anxiety or stress remained significantly associated with falls in diabetics (OR: 1.947; 95% Cl: 1.115-3.402) after adjustments for age, gender, ethnicity, and education but this relationship was attenuated after additional adjustment for arthritis (OR: 1.763; 95% CI: 0.996-3.122).
CONCLUSION: Our findings suggest that psychological issues are significantly associated with increased risk of falls at five-year follow-up in individuals aged 55 years and over with diabetes. These findings highlight the potential importance of psychosocial support among diabetics to reduce the risk of falls, improve patient outcomes and quality of life.