Differences in insomnia-related self-reported outcomes among elderly hospitalized patients

Insomnia is among the most common sleep disorders worldwide.Insomnia in older adults is a social and public health problem.Insomnia affects the physical and mental health of elderly hospitalized patients and can aggravate or induce physical illnesses.Understanding subjective feelings and providing reasonable and standardized care for elderly hospitalized patients with insomnia are urgent issues.AIM To explore the differences in self-reported outcomes associated with insomnia among elderly hospitalized patients.METHODS One hundred patients admitted to the geriatric unit of our hospital between June 2021 and December 2021 were included in this study.Self-reported symptoms were assessed using the Athens Insomnia Scale(AIS),Generalized Anxiety Disorder Scale-7(GAD-7),Geriatric Depression Scale-15(GDS-15),Memorial University of Newfoundland Scale of Happiness(MUNSH),Barthel Index Evaluation(BI),Morse Fall Scale(MFS),Mini-Mental State Examination,and the Short Form 36 Health Survey Questionnaire(SF-36).Correlation coefficients were used to analyze the correlation between sleep quality and self-reported symptoms.Effects of insomnia was analyzed using Logistic regression analysis.RESULTS Nineteen patients with AIS≥6 were included in the insomnia group,and the incidence of insomnia was 19%(19/100).The remaining 81 patients were assigned to the non-insomnia group.There were significant differences between the two groups in the GDA-7,GDS-15,MUNSH,BI,MFS,and SF-36 items(P<0.05).Patients in the insomnia group were more likely to experience anxiety,depression,and other mental illnesses,as well as difficulties with everyday tasks and a greater risk of falling(P<0.05).Subjective well-being and quality of life were poorer in the insomnia group than in the control group.The AIS scores positively correlated with the GAD-7,GDS-15,and MFS scores in elderly hospitalized patients with insomnia(P<0.05).Logistic regression analysis showed that GDS-15≥5 was an independent risk factor for insomnia in elderly hospitalized patients(P<0.05).CONCLUSION The number of self-reported symptoms was higher among elderly hospitalized patients with insomnia.Therefore,we should focus on the main complaints of patients to meet their care needs.

Tear inflammation related indexes after cataract surgery in elderly patients with type 2 diabetes mellitus

BACKGROUND Quantitative studies on the changes in inflammation-related content in tears,especially the effect of diabetes,are lacking.In this study,we measured the preoperative and postoperative tear inflammatory mediator levels in cataract patients,focusing on the expression of inflammatory factors in postoperative cataracts in the diabetic,and investigated the effect of drugs on the control of postoperative inflammation.AIM To study the expression of inflammatory factors in elderly people with type 2 diabetes after cataract surgery.METHODS Patients with a mean age of 70.3±6.3 years were divided into group A(composed of elderly patients with cataracts and type 2 diabetes,n=20 eyes)and group B(patients with age-related cataract,n=20 eyes).Their tears were collected before each operation and on days 1 and 3,and weeks 1,2,3,and 4 post-surgery.Saline(150μL)was dropped into the conjunctival sac of the surgical eye,followed by oculogyration in four directions.The fluid in the conjunctival sac was extracted using a sterile syringe and stored in Eppendorf tubes at-80°C until measurement.The expression levels of matrix metalloproteinase-2(MMP-2),MMP-9,tissue inhibitor of metalloproteinase-1(TIMP-1),TIMP-2,interleukin-6(IL-6),and IL-20 in tear fluid were measured using enzyme-linked immunosorbent assays.RESULTS The postoperative expression levels of MMP-2,MMP-9,TIMP-2,IL-6,and IL-20 in group A were significantly higher than those in group B,whereas the concentration of TIMP-1 in group A remained lower than that in group B.The levels of MMP-2 and IL-6 in both groups continuously increased until the peak in the first postoperative week,and then gradually decreased over the next three weeks.Ultimately,MMP-2 declined to a lower level than that preoperatively at week 4,but IL-6 decreased to the same level as that preoperatively.The level of MMP-9 peaked in the first two weeks postoperative and then returned to the same level as 1-day post-operation.The concentration of TIMP-1 post-operation remained constant at a lower level than before surgery,and TIMP-2 Levels remained stable in both groups.IL-20 content started to increase in the third week after surgery.CONCLUSION Inflammatory factor levels in tears fluctuated before and post-operation,which indicated more severe postoperative inflammation in the first two weeks.

Effects of different doses of metformin on bone mineral density and bone metabolism in elderly male patients with type 2 diabetes mellitus

BACKGROUND Diabetes is a chronic disease,which may cause various complications.Patients with diabetes are at high risk of bone and joint disorders,such as osteoporosis and bone fractures.In addition,it became widely accepted that diabetes has an important impact on bone metabolism.Metformin is a commonly used and effective first-line treatment for type 2 diabetes.Some glucose-lowering agents have been found to have an effect on bone metabolism.The present study explored if different doses of metformin have an effect on bone mineral density(BMD)and bone metabolism in type 2 diabetes.AIM To investigate the effects of different doses of metformin on BMD and bone metabolism in elderly male patients with type 2 diabetes mellitus.METHODS A total of 120 elderly male outpatients with type 2 diabetes mellitus who were admitted to our hospital were included in the study from July 2018 to June 2019.They were randomly assigned to an experimental group and a control group with 60 patients in each group.Patients in the experimental group were given high dose metformin four times a day 0.5 g each time for 12 wk.Patients in the control group were given low dose metformin orally twice a day 0.5 g each time for 12 wk.The changes in bone mineral density and bone metabolism before and after treatment and the efficacy rate of the treatment were compared between the two groups.RESULTS There was no significant difference in the efficacy rate between the two groups(P>0.05).Before the treatment,there was no significant difference in BMD and bone metabolism between the two groups(P>0.05).However,after the treatment,BMD and bone metabolism were improved in the two groups.Moreover,BMD and 25-hydroxyvitamin D were significantly higher in the experimental group than in the control group,and N-terminal/midregion andβ-isomerized Cterminal telopeptides were significantly lower in the experimental group than in the control group(all P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).CONCLUSION Both high and low dose metformin can effectively control the blood glucose levels in elderly male patients with type 2 diabetes mellitus.However,the benefits of high dose metformin in improving BMD and bone metabolism level was more obvious in patients with type 2 diabetes mellitus.

Study on treatment and nursing of elderly patients with gastric cancer complicated with diabetes

Objective To study and analyze the treatment and nursing of elderly patients with gastric cancer complicated with diabetes.Methods:different data were analyzed and summarized.Conclusion:the elderly patients with gastric cancer and diabetes can cooperate with the control of blood glucose during the surgical treatment,and strengthen the nursing before and after the operation.

Caregiver Burden in the Management of Frail Elderly Patients with Diabetes in Internal Medicine

Aim: Advanced age and fragility often lead to dependence, making caregiver assistance necessary for performing the activities of daily living. Patients with diabetes are characterized by an elevated presence of comorbidities and subsequent frailty—a relevant consideration when making decisions regarding treatment goals. Health professionals may overlook the caregiver experience when assessing the circumstances surrounding frail elderly patients with diabetes, but this factor can have a large impact on relevant caregiver and patient outcomes. Methods: An observational, retrospective study was carried out to assess the impact of improved management in diabetes on caregiver burden. We assessed patients’ performance of activities of daily living using the Barthel scale. Our primary outcome was caregiver burden, as assessed using the Zarit scale. Results: At baseline, 81.4% of the caregivers reported severe overburden (>55 points on the Zarit scale). At three months, the proportion of caregivers reporting this level of burden had dropped to 76.7% and remained stable at six months (77.1%). In contrast, 8.5% of the caregivers reported moderate overburden (47 to 55 points) at baseline, compared to 13.3% at three months and 12.5% at six. The proportion of caregivers reporting no overburden (Conclusions: Caregiver burden remained persistently high, decreasing only slightly after six months.

Diabetes onset before or after the age of 65 does it affect the progression of renal and cardiovascular diseases in the elderly patient？

Type 2 diabetes （T2D） is common in the elderly and more than half of the people with diabetes are over 65 years old. Elderly diabetic patients have a higher frequency of hypertension, coronary artery disease and chronic kidney disease than non-diabetic elderly patients and the risk of these complications increases with patient age, duration of the dia- betes and glycated hemoglobin values. Besides the known classical factors of renal disease progression,

Simple Renal Cyst with Clustering of Small Stones in an Elderly Patient withType II Diabetes Mellitus

Intracystic renal stones are rare.The authors wishto report here an aged case of type 2 diabetes mellituscomplicated with sohtary renal cyst with intracysticstones.

A Study on Oral Health-Related Quality of Life and Its Influencing Factors in Elderly Diabetic Patients

Objective:To investigate the oral health related quality of life in elderly diabetic patients and analyze its influencing factors.Methods:Convenience sampling was used to select 190 elderly patients with diabetes under the Department of Endocrinology and Department of Integrated Traditional Chinese and Western Medicine in the Affiliated Hospital of Hebei University as the research subjects.The Chinese version of the Oral Health Influence Scale(OHIP-14)was used to conduct a questionnaire survey,and univariate analysis and multiple stepwise regression analysis were used to analyze the influencing factors of oral health related quality of life in elderly diabetic patients.Results:The elderly diabetic patients'oral health related quality of life score was 34.48±3.23,which is in the middle-lower range.The findings of multivariate stepwise regression analysis revealed that the course of disease,regular visits to the dentist,sleep quality,oral health knowledge,and oral health attitude together explained 58.9%of the total variance in elderly diabetic patients in terms of their oral health related quality of life(p<0.05).Conclusion:The oral health related quality of life of elderly diabetic patients is generally low,and is affected by the duration of diabetes,sleep quality,and oral health knowledge,attitude,and behavior(regular visits to the dentist).Improving patientsJ attention to oral health problems by improving sleep as well as their own oral health knowledge,attitude,and behavior is an effective way to enhance oral health related quality of life.

Number of medications is associated with outcomes in the elderly patient with metabolic syndrome

Background The diagnosis of metabolic syndrome indicates a clustering of metabolic imbalances which in sum have been recognized as a major predictor of cardiovascular and all-cause mortality. The aim of this study was to assess the level of under-pharmacy and poly-pbarmacy and its prognostic impact in elderly patients with metabolic syndrome. Methods Retrospective chart-review at a tertiary medical center, of 324 patients greater than 65 years of age who met the International Diabetes Foundation criteria for metabolic syndrome diagnosis [Body Mass Index （BMI） 〉 30 kg/m2, diagnosis of type 2 diabetes, hypertension, and dyslipidemia]. Results There were 60 （18.5%） patients in the low （〈 5） medication burden group, 159 （49.1%） in the medium （〉 5 and 〈 10） medication burden group, and 105 （32.4%） in the high （〉 10） medication burden group. At baseline, the groups differed only by systolic blood pressure. At two years follow-up, the medium group had significantly better improvement in high density lipoprotein cholesterol （HDL-C）, low density lipoprotein cholesterol （LDL-C）, HbAlc, and systolic blood pressure compared to the low medication burden group and significantly better improvement in triglycerides, Haemoglobin Alc （HbAlc） and systolic blood pressure compared to the high medication group. Decrease in HDL-C was the only variable associated with strokes. High medication burden predicted hospitalization burden. The number of anti-hypertensives, history of tobacco use, low and high medication burdens and decrease in HDL-C were all associated with death. Conclusions Both poly-pharmacy and under-pharmacy are associated with a decreased therapeutic benefit among patients with metabolic syndrome in terms of important laboratory measurements as well as clinical outcomes such as myocardial infarctions, hospitalization, and death.

Effect of Atorvastatin on the levels of adiponectin and leptin and adiponectin-leptin ratio in the elderly and middle-aged patients with type 2 diabetes and combined hyperlipidemia

Objective To evaluate effects of Atorvastatin on the levels of adiponectin and leptin and adiponectin-leptin ratio in the elderly and middle-aged patients with type 2diabetes and combined hyperlipidemia.Methods Totally80 elderly and middle-aged patients with type 2 diabetes and combined hyperlipidemia were treated with Atorvastatin(10 mg/d)for 12 weeks.Fasting plasma levels

The study of the correlation between serum uric acid and insulin resistance in middle-aged and elderly hospitalized patients with type 2 diabetes

Objective To study the relationship between serum uric acid and insulin resistance in type 2 diabetic patients.Methods A total of 728 middle-aged and elderly type 2 diabetic patients were recruited and the anthropometric,clinical and biochemical parameters and

Evaluation of the prognostic ability of serum uric acid for elderly acute coronary syndrome patients with diabetes mellitus:a prospective cohort study

Objective:This study evaluated the prognostic power of serum uric acid(UA)in predicting adverse events in elderly acute coronary syndrome(ACS)patients with diabetes mellitus(DM).Methods:The analysis involved 718 ACS patients>80 years old whose general clinical data and baseline blood biochemical indicators were collected prospectively from January 2006 to December 2012.These patients were classified into two groups based on DM status,and then followed up after discharge.The Kaplan-Meier method was used for major adverse cardiac event(MACE)rates and all-cause mortality.Multivariate Cox regression was performed to analyze the relationship between UA level and long-term clinical prognosis.Receiver operating characteristic(ROC)curves were analyzed to predict the cutoff value of UA in elderly ACS patients with DM.There were 242 and 476 patients in the DM and non-DM(NDM)groups,respectively,and the follow-up time after discharge was 40‒120 months(median,63 months;interquartile range,51‒74 months).Results:The all-cause mortality,cardiac mortality,and MACE rates in both DM and NDM patients were higher than those in the control group(P=0.001).All-cause mortalities,cardiac mortalities,and MACE rates in DM patients with moderate and high UA levels were significantly higher than those in the NDM group(P=0.001).Long-term survival rates decreased significantly with increased UA levels in the ACS groups(P=0.001).UA(odds ratio(OR)=2.106,95%confidence interval(CI)=1.244‒3.568,P=0.006)was found to be an independent risk factor for all-cause mortality and MACE in elderly ACS patients with DM.The cutoff value of UA was 353.6μmol/L(sensitivity,67.4%;specificity,65.7%).Conclusions:Serum UA level is a strong independent predictor of long-term all-cause death and MACE in elderly ACS patients with DM.

Relationship between serum osteocalcin levels and glucolipid metabolism in elderly type 2 diabetic patients with non-alcoholic fatty liver disease

Objective To explore the relationship between serum osteocalcin levels and glucolipid metabolism in elderly type 2 diabetic patients with non-alcoholic fatty liver disease(NAFLD).Methods Data collected from 97 pa-tients with type 2 diabetes mellitus(T2DM)admitted to the Department of Geriatric Endocrinology of the First Affiliated hospital of Zhengzhou University from June

循证护理对老年糖尿病失眠患者血糖及睡眠质量的影响效果研究

目的:探究循证护理对老年糖尿病失眠患者血糖及睡眠质量的影响。方法:选取2020年9月至2023年2月福建中医药大学附属人民医院收治的老年糖尿病失眠患者90例作为研究对象,按照随机数字表法分为观察组和对照组,每组45例。观察组行常规护理联合循证护理,对照组行常规护理,对比2组患者护理前后血糖水平、睡眠质量、自我效能水平差异。结果:护理前2组患者的空腹血糖、餐后2 h血糖、糖化血红蛋白、匹兹堡睡眠质量指数各维度及总分、自我效能评分组间比较,差异无统计学意义(P>0.05),护理后观察组患者空腹血糖、餐后2 h血糖以及血红蛋白水平均显著低于对照组患者,匹兹堡睡眠质量指数各维度及总分低于对照组患者,自我效能评分高于对照组,差异均有统计学意义(均P<0.05)。结论:对老年糖尿病失眠患者开展循证护理有助于改善患者睡眠质量,降低患者血糖水平,同时还可以提高患者的自我效能水平,具有较好的临床推广应用价值。

对门诊老年2型糖尿病患者进行生活方式干预的效果评价

目的探讨生活方式干预对老年2型糖尿病(T2DM)患者的疗效。方法选取60例在该院门诊接受正规降糖药物治疗的老年T2DM患者,按自愿的原则分为干预组和对照组,干预组采用生活方式干预(饮食控制、运动治疗)和药物治疗,对照组仅采用药物治疗,于治疗前及治疗后3个月复查患者体重指数、空腹血糖、餐后2h血糖、血脂、糖化血红蛋白。结果干预组患者治疗后的空腹血糖、餐后2h血糖、糖化血红蛋白、三酰甘油较治疗前改善,差异具有显著性(P<0.05),而对照组治疗后较治疗前的各项指标无明显改善。治疗前两组间比较,各项指标无明显差异;治疗后两组间比较,干预组患者空腹血糖、餐后2h血糖、糖化血红蛋白较对照组改善,差异具有显著性(P<0.05)。结论通过饮食控制、长期规律的量化运动等生活方式干预,可以有效地降低老年T2DM患者的血脂、血糖,使糖化血红蛋白显著下降,患者血糖水平获得较长时间的平稳控制,有利于延缓并发症的发生发展。

前列地尔注射剂治疗高龄老年糖尿病肾病70例疗效观察

目的探讨前列地尔注射剂对高龄老年糖尿病肾病、肾功能不全期的疗效。方法将140例高龄老年糖尿病肾病的患者随机分为前列地尔注射剂治疗组(治疗组)和常规治疗组(对照组),每组70例。治疗组在常规治疗基础上予前列地尔注射剂治疗,疗程为4周,并观察血肌酐及24h尿白蛋白的变化。结果治疗组血肌酐及24h尿白蛋白在治疗前后有明显变化(P<0.01),与对照组比较,差异有统计学意义(P<0.01)。结论前列地尔注射剂对高龄老年糖尿病肾病、慢性肾功能不全有一定的治疗作用。

1例高龄糖尿病足合并肾病患者足部烫伤的护理

糖尿病足是糖尿病的严重慢性并发症之一，是下肢大血管及微血管病变、神经病变和感染共同作用的结果［1］。糖尿病足不仅造成医疗费用増加，因其所致的截肢更导致住院时间延长、家庭护理和社会服务增加［2］。糖尿病肾病是指糖尿病弥漫性或结节性肾小球硬化症，是糖尿病微血管病变的重要表现之一［3］。糖尿病肾病是糖尿病足溃疡发生的危险因素之一［4］。而烧伤是糖尿足的重复危险因素之一［5］。本科室于2016年2月收治1例高龄糖尿病足合并肾病患者足部烫伤，经积极救治及有效护理，患者康复出院，现将护理体会报道如下。

高龄糖尿病患者用药行为与用药依从性调查

目的:了解高龄糖尿病患者用药行为与用药依从性情况,分析高龄糖尿病患者用药行为与用药依从性的相关性。方法:参照戴明俊等引进的Morisky推荐标准对120名高龄糖尿病患者调查用药依从性,现场调查高龄糖尿病患者用药行为,分析高龄糖尿病患者用药行为与用药依从性的相关性。结果:每次服药时是否查看核对书面用药医嘱、药物上有无准确标示服药的时间对于高龄糖尿病患者用药的依从性具有统计学意义(P<0.05)。结论:高龄糖尿病患者用药的依从性是糖尿病专科护士关注的重点,医护人员应当制定可行的措施,帮助高龄糖尿病患者建立正确的用药习惯与方法,提高用药依从性。

缓释糖类系统对高龄2型糖尿病管饲病人糖脂代谢的影响

目的：探讨缓释糖类系统对高龄2型糖尿病管饲病人糖脂代谢的影响。方法：选择确诊为2型糖尿病的住院高龄老年管饲病人11例。在等能量的情况下，用含有缓释糖类系统的肠内营养制剂（益力佳）替代或部分替代原有的肠内营养支持液，1～3个月，观察病人血红蛋白、淋巴细胞计数、血清清蛋白、总蛋白、血糖、餐后2h血糖、糖化血红蛋白、血脂、肾功能、电解质及胃肠道的变化。结果：应用含缓释糖类系统的肠内营养制剂后病人的肾功能和电解质均无影响，总蛋白有所上升，使用前、后有显著性差异（P〈0．05）。空腹血糖、餐后2h血糖均有下降，差异有显著性意义（P〈0．05，〈0．001）。血清三酰甘油、低密度脂蛋白、胆固醇、糖化血红蛋白均有下降，但差异无显著性意义（P〉0．05）。高密度脂蛋白未出现明显的变化。肠内营养支持后，胃肠道4；适症状均有不同程度的改善。结论：含缓释糖类系统的肠内营养制剂，不仅能改善老年2型糖尿病管饲病人的糖代谢和脂代谢，还能帮助改善病人应用肠内营养后出现的胃肠道不适症状。

高龄老人2型糖尿病下肢血管病变相关因素分析

目的探讨75岁以上老人2型糖尿病(DM)患者下肢血管病变的相关因素。方法对门诊及住院的75岁以上2型DM患者131例进行详细病史调查及体格检查,并作生化及双下肢血管彩色多普勒超声检查,均有轻～重度下肢血管病变,另选择无下肢血管病变老年2型DM患者40例,分析临床因素及生化指标与下肢血管病变之间的相关性。结果 131例患者中,轻度血管病变者47例(35.8%),中度血管病变者42例(32.1%),重度血管病变者42例(32.1%)。患者下肢血管病变与年龄、糖尿病家族史、糖尿病病史、高血压病史、冠心病史、糖尿病周围神经病变、视网膜病变、糖尿病足、糖尿病肾病、空腹和餐后2 h血糖、糖化血红蛋白、尿白蛋白均呈正相关(r均>0.243,P<0.05或<0.01),与HDL-C呈负相关(r=-0.140,P<0.05)。结论高龄老人2型DM患者下肢血管病变同年龄、糖尿病病史、高血压、冠心病、血脂、血糖、蛋白尿等多种因素相关。