Chi-Hua Yen

Leisure activity, mobility limitation and stress as modifiable risk factors for depressive symptoms in the elderly: results of a national longitudinal study.

Few national longitudinal studies have investigated the modifiable risk factors for depression in the elderly. This study investigated the risk factors and health-related behaviors associated with depressive symptoms using a national survey of Taiwanese elderly with a 4-year follow-up period. In this prospective cohort study, 1481 non-demented population-based elderly were interviewed at baseline in 2003 and at follow-up in 2007. The independent variables included demographics, chronic medical diseases and health-related behaviors assessed at baseline. The dependent variable was depressive symptoms assessed at follow-up. Reduced rank regression was applied to characterize independent factors related to depressive symptoms. The prevalence of depressive symptoms at follow-up was 21.1%. The results of multivariate analyses revealed three independent risk factors for depressive symptoms: fewer leisure activities (odds ratio, OR=0.56, 95% confidence interval, CI=0.38-0.83, p=0.0034), more mobility limitations (OR=1.93, 95% CI=1.30-2.86, p=0.0011) and higher stress levels (OR=2.43, 95% CI=1.68-3.50, p<0.0001). The leisure activities least associated with depression were reading newspapers/books and doing outdoor building projects; the two mobility limitations most associated with depression were difficulty in lifting things and in climbing stairs. The two stresses most associated with depression were perceived health stress and financial stress. These results indicated that interventions to prevent or reduce depression in older adults should include practical strategies aimed at these modifiable risk factors.

Severity of disease as main predictor for mortality in patients with pyogenic liver abscess

BACKGROUND The purpose of this study was to explore the relationship between severity of illness at admission and mortality of patients with pyogenic liver abscess (PLA). METHODS Medical records from 298 PLA patients > or =18 years old were reviewed. Severity of illness at admission was evaluated with the Acute Physiology and Chronic Health Evaluation (APACHE) II and the simplified acute physiology score (SAPS) II scoring systems. Stepwise logistic regression and receiver-operating-characteristic curve analyses were performed. RESULTS The case-fatality rate was 10%. Multivariate analysis showed that APACHE II (P = .0004), SAPS II (P = .0008), the presence of gas-forming abscess (P <.0001), and the presence of anaerobic infection (P <.0001) all were associated with mortality. The area under the receiver-operating-characteristic curve was .884 (95% confidence interval .842 to .918) for APACHE II and .857 (95% confidence interval .812 to .895) for SAPS II, which were not significantly different (P = .490). The optimal cutoff APACHE II value of > or =15 had a sensitivity of 77% and a specificity of 92%, with a 20.3-fold risk of mortality (P <.0001). The SAPS II cutoff value of > or =28 had a sensitivity of 74% and a specificity of 82%, with a 7.2-fold risk of mortality (P = .008). CONCLUSIONS Both the APACHE II and the SAPS II scoring methods are appropriate for assessing mortality of PLA patients.

Healthy Behaviors and Onset of Functional Disability in Older Adults:: Results of a National Longitudinal Study

OBJECTIVES: To examine the combined effect of healthy behaviors on the development of functional disability in an elderly cohort.

Cigarette smoking and cognitive impairment: A 10-year cohort study in Taiwan

The relationship between cigarette smoking and cognitive impairment is not a simple one. Some studies have demonstrated that cigarette smoking is a risk factor for cognitive impairment in the elderly, whereas other studies have shown cigarette smoking to be protective against dementia. This study aims to explore the relationship between cigarette smoking and cognitive impairment in elderly persons without dementia, during a 10-year period. Data were derived from a population-based cohort study of 1436 elderly Taiwanese. Cognitive function was measured by the SPMSQ both in 1993 and in 2003. A total of 1436 participants free of cognitive impairment at baseline (SPMSQ> or =6 in 1993) were included in these analyses. Subsequently, participants were divided into three groups: never, past, and current smokers. The effect of cigarette smoking on cognitive function was assessed using logistic regression. In the logistic regression model adjusted for age, education, hypertension, diabetes, heart disease, and stroke at baseline, persons who had quit smoking (Odds ratio=OR=0.31; 95% CI=0.18-0.53; p<0.001) and those who continued to smoke (OR=0.37; 95% CI=0.20-0.70; p<0.001) were about one-third as likely to develop cognitive impairment as were those who never smoked. However, no dose-response relationship was observed between pack-years and cognitive impairment. Past and current smokers were less likely to develop cognitive impairment during a 10-year follow-up than were those who had never smoked. The present study suggests that smoking may be protective for cognitive function.

Social support and mobility limitation as modifiable predictors of improvement in depressive symptoms in the elderly: Results of a national longitudinal study

Few national longitudinal studies have investigated the predictors of a better depression outcome in geriatric depression. This study examined the predictors of improvement in case-level depressive symptoms in the elderly. In this prospective cohort and population-based study in Taiwan, 206 non-demented and case-level depressed subjects aged 65 and older were interviewed at baseline in 2003 and follow-up in 2007. The independent variables included demographics, chronic medical diseases, and health-related behaviors assessed at baseline. The dependent variable was depressive symptoms, assessed using the 10-item short form of the Center for Epidemiologic Studies Depression Scale (CESD-10) assessed at follow-up. Multivariate analyses were used to identify the predictors of improvement in depression. The independent predictors of improvement in depression over a 4-year follow-up period are more social support and fewer mobility limitations at baseline. With regards to practical health-related behaviors, the 2 items of social support most associated with improvement in depression were willingness of significant others to talk with you and satisfaction with dependence upon significant others; the 2 items of mobility limitations most associated with non-improvement of depression were difficulty in carrying things and squatting. These findings suggested that health-related behaviors were important to the depression outcome in the elderly; moreover, interventions to improve depression should include practical health-related behaviors aimed at these modifiable risk factors.

Evaluating outcomes of Taiwan's first gerontology certification program

The elderly population will approach 20% within the next 20 years. This enhances the need for skilled and experienced health care providers. There is a critical need to strengthen gerontology curricula to prepare health-related professionals for a graying population. The purpose of this article is to investigate student satisfaction with the first National Project for Excellence in Gerontological Care Education (NPEGCE) in Taiwan. A cross-sectional design was used. A sample of 151 medical, nursing, and physical therapy students, who had enrolled in the NPEGCE and had taken at least one core course, completed a satisfaction questionnaire. To ensure content validity, a multidisciplinary, institutional committee of gerontology and geriatric faculty designed the content. Overall satisfaction scores varied between satisfied (4-points) and very satisfied (5-points). Medical students gave higher ratings than others. Two factors (Curriculum and Teaching) were extracted. A strong correlation was found between the subscales and overall satisfaction scores. Internal scale consistency reliability scores ranged from 0.92 to 0.96. Overall, this study demonstrates a moderate level of satisfaction with the NPEGCE. However, these results are from a single institution; they are not generalizable. This is also the first student satisfaction report from Taiwan. There are no similar programs or evaluation results to compare them with. Since the NPEGCE was well received by students and seemed to encourage a more nurturing attitude towards the elderly; it can be regarded as a catalyst for better elderly care in the future.

Epidemiological Transition and Trends of Inequality in Mortality in Aboriginal Areas in Taiwan, 1974-1998

Background: Residents of Aboriginal areas are known to experience a higher mortality than the general population, but little is known about the trends in this gap. We therefore examined the patterns of epidemiological transition and the trends of inequality in cause-specific mortality in Aboriginal areas in Taiwan. Methods: Mortality data from 1974 through 1998 were collected to analyze changes in mortality patterns. Age-specific and age-adjusted mortality rates for selected causes of death in Aboriginal areas and those in Taiwan as a whole were calculated. Mortality rate ratios (Aboriginal areas/Taiwan) were used as the indicator of inequality. Results: In 1974, one-third of deaths in Aboriginal areas were due to communicable diseases; this proportion had decreased to one-tenth by 1998. The proportion of deaths from non-communicable diseases increased from 54% to 70% during the same period. The increase in age-specific mortality rate ratios between Aboriginal areas and Taiwan as a whole between 1974-7 and 1995-8 was most prominent in the 0-9 year and 25-49year age groups. Mortality from lung cancer, cervical cancer, diabetes, ischemic heart disease, liver cirrhosis, and traffic accidents showed steeply increasing trends in Aboriginal areas. Except for suicide all causes of death showed increasing trend of inequality. Conclusions: The pattern of epidemiological transition in Aboriginal areas was different from those in Taiwan. Despite the decreasing of some causes of death, the inequality between Aboriginal areas and Taiwan was increasing.