Tamer M. Farid

Psychometric properties of the extended Care Dependency Scale for older persons in Egypt

AIM The aim of this study was to determine the validity and reliability of the modified Arabic Care Dependency Scale for self-assessment of older persons in Egypt and to compare these self-assessments to proxy assessments by care givers and family members. BACKGROUND The Care Dependency Scale is an internationally used instrument to measure care dependency. The Arabic version may improve data collection on this phenomenon in the Middle East where the population is ageing. DESIGN A cross-sectional study with a sample of 611 older persons living in Greater Cairo. Participants belonged to three groups: nursing home residents, home care recipients and non-care recipients; 459 participants were also rated by proxies and 171 repeated their self-assessment after two weeks. METHODS The correlation between sum scores of the Care Dependency Scale and the Activities of Daily Living scale was calculated to establish criterion validity. Construct validity was determined by comparing care recipients and non-care recipients with regard to their Care Dependency Scale sum scores and by exploratory factor analysis. Intraclass coefficients were used to assess test-retest reliability of self-ratings for each item. Mean differences between self and proxy assessment were calculated. RESULTS The Care Dependency Scale had a strong correlation to the Activities of Daily Living scale and is able to distinguish between care recipients and non-care recipients. Factor analysis revealed one factor for basic needs and one factor for psychosocial needs. ICC values were >0.7 for most items related to the factor for basic needs among care recipients. Proxy assessment yielded higher care dependency than self assessment. CONCLUSION Care Dependency Scale items for basic needs are suitable to assess care dependency among Egyptian care recipients. RELEVANCE TO CLINICAL PRACTICE Assessment of care dependency is useful to obtain data for appropriate resource allocation among care recipients.

Cultural Adequecy of the Care Dependency Scale for Older Persons in Egypt: A Delphi Study

Purpose: The aim of this study is to determine the cultural adequateness of the Arabic version of the Care Dependency Scale (CDS), an internationally used instrument to measure care needs by either self-reports or external assessment. Method: A Delphi study in two rounds about the Arabic version was performed with 37 panelists in Cairo. Acceptance of CDS items was rated on a 4-point Likert-type scale. Results: Agreement among panelists in the second round was found for 11 CDS items, but 2 items had decreased acceptance after rephrasing and 2 were rejected. Discussion: Rejected items seem to reflect a heterogeneous perception in the target population. Despite some limitations, the CDS is a promising instrument to detect care needs among older Egyptians.

Performance Evaluation of Different d-Dimer Cutoffs in Bedridden Hospitalized Elderly Patients

A rapid and accurate diagnosis of venous thromboembolism (VTE) in the elderly individuals represents a dilemma due to nonspecific clinical presentation, confusing laboratory results, and the hazards of radiological examination in this age-group. d-Dimer test is used mainly in combination with non-high clinical pretest probability (PTP) to exclude VTE. d-Dimer testing retains its sensitivity, however, its specificity decreases in the elderly individuals. Raising the cutoff level improves the specificity of the d-dimer test without compromising its sensitivity. The current study aimed to explore the reliability of higher d-dimer cutoff values for the diagnosis of asymptomatic VTE in a population of bedridden hospitalized elderly patients with non-high clinical PTP. This retrospective study included 252 bedridden hospitalized elderly patients (>65 years) who were admitted to the Ain shams University Specialized Hospital with non-high clinical probability and developed later reduced mobility; all underwent quantitation of d-dimer and Doppler examination. Considering the whole population (>65 years), the age-adjusted cutoff achieved the best performance in comparison with the conventional and receiver operating characteristic (ROC)–derived cutoffs. When stratified according to age, the age-adjusted cutoff showed the best performance in the age-group 65-70 and comparable performance with the ROC-derived cutoff in the age-group 71-80, however, its sensitivity compromised in those older than 80 years. In conclusion, it is recommended to use age-adjusted cutoff value of d-dimer together with the clinical probability score in elderly individuals (65-80 years).

Attitudes of Egyptian nursing home residents towards staying in a nursing home: a qualitative study.

Aim.  The aim of this study was to identify the attitudes of Egyptian nursing home residents towards staying in a nursing home and to differentiate between various types of these attitudes. Background.  The number of older persons in Egypt who require nursing care is increasing. In response, nursing homes in bigger cities like Cairo were founded, although family care seems to be the prevalent norm. Methods.  Semi-structured guideline interviews were performed with 21 residents from four different nursing homes in Cairo. Interviews were analyzed using qualitative content analysis. Findings.  One category of resident was those who were sent to the nursing home by persons closely related to them. Another category made their own decision to move to a nursing home. Relationships with social networks and self-help abilities are factors of importance in influencing decision-making. Conclusion.  Nursing homes in Egypt fulfil different functions for different types of older persons. Charitable institutions are a last resort for those with no income and a disrupted social network. For better-off older persons, nursing homes may provide the benefits of socialising with peers and receiving medical treatment.

Factors related to the acceptance of home care and nursing homes among older Egyptians: A cross-sectional study

BACKGROUND Socio-demographic changes may deprive older Egyptians from receiving care by family members and raise the question of how they react if they become dependent on help. OBJECTIVE The objective of this study was to determine factors related to the acceptance of home care and nursing homes among older Egyptians. DESIGN A two group comparative design based on self-reports. PARTICIPANTS The sample was composed of 344 older persons receiving home care or staying in a nursing home and 267 non-care recipients. SETTING The study was conducted in Greater Cairo. METHODS Factors related to the acceptance of home care and nursing homes were determined separately for each group by logistic regression. RESULTS Lesser feelings of shame while receiving care from non-family members were related to an increased acceptance of both kinds of care. For non-care recipients disagreement to the traditional idea of family care had a similar effect. For care recipients the experience made with a particular kind of care was strongly related to its acceptance. DISCUSSION Home care is a new phenomenon in Cairo and in contrast to nursing homes it was unknown to most study participants. For this reason any conclusion about which kind of service is preferred by older Egyptians would be a premature one. CONCLUSION Feelings of shame while receiving care from a non-family member are more important than functional limitations when older Egyptians are considering the options of home care and nursing homes.

Socio-demographic factors related to functional limitations and care dependency among older Egyptians

AIM This paper is a report of a study determining the relationship of socio-demographic factors to functional limitations and care dependency among older care recipients and non-care recipients in Egypt. BACKGROUND The population is ageing in Egypt and age-related functional limitations are increasing. Age and gender influence this phenomenon, but its relationship to socio-economic status has not yet been demonstrated for Egypt. Functional limitations are an antecedent to care dependency, which also may be associated with these socio-demographic factors. METHOD A cross-sectional study with a two-group comparative design was conducted in Greater Cairo. The sample was composed of 267 non-care recipients and 344 care recipients. Path analysis was used to determine the relationship between variables. Age, gender and acceptance of care were covariates in the multiple regressions. Analyses were conducted separately for care recipients and non-care recipients. RESULTS Among non-care recipients, lower socio-economic status was related to more functional limitations and higher care dependency. This relationship was not found among care recipients. CONCLUSION Older persons from low income groups are more likely to become care dependent but are less able to pay for required care. Currently, untrained volunteer groups of religious organizations try to support these older people in the poorer strata of Egyptian society. Training in the basics of care might help to make their work more effective.

Chronic Diseases and Outcome in Critically Ill Elderly Admitted to ICU

Background: Elderly patients are a significant and increasing proportion of ICU patients. With advancing age, the comorbidities critically ill elderly patients have substantial mortality. The early recognition of patients at high risk of mortality is needed to plan care in advance and to control healthcare costs. Aim: To find out the relation between chronic diseases and outcome in critically ill elderlyadmitted to ICU. Study design: A prospective study. Participants: seventy elderly patients aged 60 years and above. Method: This study was performed in Geriatric ICU in Ain Shams University Hospitals including 70 critically ill elderly patients admitted for 24 hours or more. Each patient was subjected to on admission clinical assessment including detailed history taking, in addition to laboratory investigations. Results: The results of our study showed that ischemic heart disease was the only chronic diseases that had significant statistical effect on mortality in critically ill elderly admitted to ICU with p. value= 0.002. Conclusion: In the current study we found that mortality was associated with history of ischemic heart disease.

Prevalence of Functional Impairment among Frail Elderly

Background Frailty is a state of vulnerability describes a syndrome characterized by progressive multi system decline, loss of physiologic reserve, and increase vulnerability to disease and death. Frailty has emerged as a condition associated with an increased risk of functional decline among the elderly population, which may be differentiated from aging, disability, and comorbidity. Objectives: The aim of this study is to assess the prevalence of functional impairment and cognitive functions among frail elderly. Methods:We examined104 frail elderly. Frailty criteria included unintentional weight loss, exhaustion, weakness, low physical activity, and slow walking speed. physical function was assessed using Activities of daily living (ADL) and Instrumental activities of daily living (IADL). The cognitive function was assessed using the Mini-Mental State Examination (MMSE). Results:The mean age of the studied population was 69 years, 53.85% were males, 46.15% were females, the majority of our participants were illiterates (89.4%), and were living with family (84.62%), only 6.73% were smokers. 36.5% of frail participants were assisted in activity of daily living (ADL) and 7.7% were dependents, while 63.5% were assisted in instrumental activity of daily living (IADL) and 8.7% were dependents; the sample participants in general had borderline scores for MMSE, indicating a cognitive performance in the lower normal range. Conclusions Frail elderly had low normal score on MMSE, and high prevalence of functional impairment.

Insulin-Like Growth Factor-1 As a Predictor of Mortality in Frail Egyptian Elderly Adults

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Inflammatory Markers in Frail Elderly Egyptian Adults and the Difference between the Sexes

erol vs cholecalciferol). Furthermore, screening guides clinicians in optimizing regimens for loading doses or maintenance supplementation, which could negate deleterious consequences of deficiency such as falls, fragility fractures, and osteoporosis, which are common in this study population. Local guidelines on screening and supplementation should be developed. Full ADL dependence was associated with a serum 25hydroxyvitamin D level of less than 30.0 ng/mL, which may be attributable to comorbidities and inadequate sunlight exposure. Similarly, low ADL scores were associated with vitamin D inadequacy in elderly Japanese adults. Further research is needed on the effect of improving functional status on serum 25-hydroxyvitamin D level. Conversely, improving vitamin D status may enhance rehabilitation outcomes. Participants with renal impairment had a higher risk of low vitamin D levels, consistent with studies in individuals with chronic kidney disease Stages 3 and 4 and those undergoing hemodialysis. Hence, screening and supplementation should be considered in them. Study limitations included small sample size; crosssectional design; lack of information on serum parathyroid hormone and calcium levels, dietary vitamin D intake, and sunlight exposure; and inability to generalize the findings to the general elderly population. The findings of this pioneer study in Singapore will help clinicians appreciate the magnitude of vitamin D deficiency in elderly inpatients; exercise vigilance in management; and give impetus to further research in prevention, screening, and supplementation.