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Lee J.S.W.,Chinese University of Hong Kong | Auyeung T.-W.,Chinese University of Hong Kong | Chau P.P.H.,University of Hong Kong | Hui E.,Shatin Hospital | And 3 more authors.
Journal of the American Medical Directors Association | Year: 2014

Objective: Weight loss has been considered predictive of early mortality in nursing home residents. Lower body mass index, irrespective of weight loss, has also been considered detrimental for survival in community-dwelling older persons. We examined which of the 2 is more important for survival in nursing home residents and at what body mass index (BMI) cut-offs survival benefits are gained or lost. Design: Prospective study. Setting: Nursing homes. Participants: One thousand six-hundred fourteen nursing home residents. Measurement: Minimum Data Set at baseline and mortality status assessed at 6 months, 1, 2, 4, and 9 years later. Relationship between mortality and significant weight loss (≥5% over 30 days or ≥10% over 180 days), and BMI, was studied by Cox regression with both variables in the same model, adjusted for age, sex, medical conditions (cancer, renal failure, heart disease, dementia, hip fracture, diabetes mellitus), tube-feeding, 25% food left uneaten, swallowing problem, and the activities of daily living hierarchy scale. Results: One thousand six-hundred fourteen residents (69.5% female) with mean age 83.7 ± 8.4 years and mean BMI 21.7 ± 4.8 were studied. Mortality rates were 6.3% (6-month), 14.3% (1-year), 27.1% (2-year), 47.3% (4-year), and 78.1% (9-year). Significant weight loss was not associated with higher mortality at all follow-up durations, whereas higher BMI was significantly protective: mortality reduction per 1 unit increase in BMI were 9% at 6 months, 10% at 1 year, 9% at 2 years, 7% at 4 years, and 5% at 9 years, all at P < .001. Having ≥25% of food left uneaten (51.2% of participants) had no relationship to survival at all follow-up durations. At 9 years, compared with those with BMI < 18.5kg/m2, the normal weight (BMI 18.5-22.9 kg/m2, Asia Pacific cut-off), overweight (BMI 23-25 kg/m2, Asia Pacific cut-off) and obese (BMI 25 kg/m2, Asia Pacific cut-off) had significantly lower mortality (hazard ratio 0.65, 0.62, and 0.47, respectively, all P < .001). Conclusions: Significant weight loss as defined by the Minimum Data Set was not associated with short- or long-term survival in Chinese nursing home residents. BMI, however, is predictive of short- and long-term survival irrespective of weight loss in this population. Low BMI, detectable at a single point of time, may be another readily available alternative trigger point for possible interventions in reducing mortality risk. Obese residents had the lowest mortality compared with those with normal weight. © 2014 American Medical Directors Association, Inc. Source

Luk J.K.H.,Fung Yiu King Hospital | Tsang R.C.C.,MacLehose Medical Rehabilitation Center | Leung H.B.,Queen Mary Hospital
Hong Kong Medical Journal | Year: 2014

The pathogenesis and management of lateral epicondylalgia, or tennis elbow, a common ailment affecting middle-aged subjects of both genders continue to provoke controversy. Currently it is thought to be due to local tendon pathology, pain system changes, and motor system impairment. Its diagnosis is usually clinical, based on a classical history, as well as symptoms and signs. In selected cases, additional imaging (X-rays, ultrasound, and magnetic resonance imaging) can help to confirm the diagnosis. Different treatment modalities have been described, including the use of orthotics, nonsteroidal anti-inflammatory drugs, steroid injections, topical glyceryl trinitrate, exercise therapy, manual therapy, ultrasound therapy, laser therapy, extracorporeal shockwave therapy, acupuncture, taping, platelet-rich plasma injections, hyaluronan gel injections, botulinum toxin injections, and surgery. Nevertheless, evidence to select the besttreatment is lacking and the choice of therapy depends on the experience of the management team, availability of the equipment and expertise, and patient response. This article provides a snapshot of current medical practice for lateral epicondylalgia management. Source

Luk J.K.H.,Fung Yiu King Hospital | Chan T.Y.,Kwong Wah Hospital | Chan D.K.Y.,University of New South Wales
Hong Kong Medical Journal | Year: 2015

Falls are a common problem in the elderly. A common error in their management is that injury from the fall is treated, without finding its cause. Thus a proactive approach is important to screen for the likelihood of fall in the elderly. Fall assessment usually includes a focused history and a targeted examination. Timed up-and-go test can be performed quickly and is able to predict the likelihood of fall. Evidence-based fall prevention interventions include multi-component group or home-based exercises, participation in Tai Chi, environmental modifications, medication review, management of foot and footwear problems, vitamin D supplementation, and management of cardiovascular problems. If possible, these are best implemented in the form of multifactorial intervention. Bone health enhancement for residential care home residents and appropriate community patients, and prescription of hip protectors for residential care home residents are also recommended. Multifactorial intervention may also be useful in a hospital and residential care home setting. Use of physical restraints is not recommended for fall prevention. © 2015, Hong Kong Academy of Medicine Press. All rights reserved. Source

Luk J.K.H.,University of Hong Kong | Chan C.F.,University of Hong Kong | Chan F.H.W.,Fung Yiu King Hospital | Chu L.W.,University of Hong Kong
Archives of Gerontology and Geriatrics | Year: 2011

The relationship between cognitive function and geriatric day hospital (GDH) rehabilitation has not been explored. This study investigated this association in 547 older Chinese patients attended GDH. Cognitive status was assessed by Cantonese version of mini-mental state examination (C-MMSE). Functional independence measure (FIM) upon GDH admission and discharge were measured, with FIM gain = FIM discharge -FIM admission while FIM efficiency = FIM gain/by number of GDH visits. FIM discharge ≥90 was defined as satisfactory outcome of rehabilitation. Positive correlation was observed between C-MMSE admission and FIM discharge (p< 0.001). There were significant differences in the FIM admission and FIM discharge among the three C-MMSE groups, with lower discharge scores in low C-MMSE groups (p< 0.001). The FIM gain and FIM efficiency during GDH rehabilitation were not different among different C-MMSE groups. C-MMSE admission (p= 0.03) and FIM admission (p< 0.001) were both positive independent predictors for a satisfactory rehabilitation outcomes (FIM discharge ≥90). Cognitive function was not associated with FIM gain and efficiency. This suggested that selected patients with impaired cognition could still benefit from GDH rehabilitation. © 2010 Elsevier Ireland Ltd. Source

Chan W.C.,University of Hong Kong | Fai Yeung J.W.,Chinese University of Hong Kong | Man Wong C.S.,University of Hong Kong | Wa Lam L.C.,Chinese University of Hong Kong | And 4 more authors.
Journal of the American Medical Directors Association | Year: 2015

Objective: Numerous studies have reported the prevention of falls through exercise among cognitively healthy older people. This study aimed to determine whether the current evidence supports that physical exercise is also efficacious in preventing falls in older adults with cognitive impairment. Methods: Two independent reviewers searched MEDLINE; EMBASE; PsycINFO; the Cumulative Index to Nursing & Allied Health Literature; the Cochrane Central Register of Controlled Trials; the Cochrane Bone, Joint, and Muscle Trauma Group Specialized Register; ClinicalTrials.gov; and the UK Clinical Research Network Study Portfolio up to July 2013 without language restriction. We included randomized controlled trials that examined the efficacy of physical exercise in older adults with cognitive impairment. The methodological qualities of the included trials were appraised according to the criteria developed for the Cochrane review of fall prevention trials. The primary outcome measure was the rate ratio of falls. A meta-analysis was performed to estimate the pooled rate ratio and summarize the results of the trials on fall prevention through physical exercise. Results: Seven randomized controlled trials involving 781 participants were included, 4 of which examined solely older people with cognitive impairment. Subgroup data on persons with cognitive impairment were obtained from the other 3 trials that targeted older populations in general. The meta-analysis showed that physical exercise had a significant effect in preventing falls in older adults with cognitive impairment, with a pooled estimate of rate ratio of 0.68 (95% confidence interval 0.51-0.91). Conclusions: The present analysis suggests that physical exercise has a positive effect on preventing falls in older adults with cognitive impairment. Further studies will be required to determine the modality and frequency of exercise that are optimal for the prevention of falls in this population. © 2015 AMDA - The Society for Post-Acute and Long-Term Care Medicine. Source

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