An Arabic Version of the Geriatric Depression Scale (30 Items): Psychometric Properties and Some Findings in a Lebanese Elderly Sample

Effectiveness of a Telerehabilitative Home Exercise Program on Elder Adults’ Physical Performance, Depression and Fear of Falling

Our aim in this study was to analyze the effects of a home exercise program of calisthenic exercises delivered through telerehabilitation on physical performance, depression, and risk of falling in elder adults. Our participants were elder adults aged 65 and over, divided into exercise and control groups. We initiated a 4-week telerehabilitation calisthenic exercise program in the exercise group following initial assessments, while our control group received no formal exercise training. Both groups were evaluated online before and after this 4-week period with the Geriatric Depression Scale (GDS), Modified Falls Efficacy Scale (MFES), and Short Physical Performance Battery (SPPB). In total, 255 elder adults participated, with 132 (males = 72, females = 60) allocated to calisthenic exercise and 123 (males = 66, females = 57) allocated to the control group. While the groups did not differ significantly on any of our parameters before the exercise, there were statistically significant post-exercise group differences in GDS ( p ≤ .001) and MFES ( p ≤ .001) scores related to remarkable physical improvements achieved in the calisthenic exercise group. The exercise group showed significant increases in their scores on the SPPB Balance Test ( p = .049), SPPB Chair Test ( p = .009), and SPPB Total ( p = .002) while there was no significant increase in any of these scores among control group participants ( p > .05). Thus, calisthenic exercises performed via telerehabilitation significantly improved elder adults’ physical performance, fear of falling, and depression. Telerehabilitation is a useful remote means of assessing, inducing, and following-up exercise training, particularly during the ongoing COVID-19 pandemic.

COVID-19 pandemic and mental health in Lebanon: a cross-sectional study

OBJECTIVES

To evaluate depression, stress, anxiety and obsessive-compulsive behaviours in the Lebanese population in response to COVID-19 pandemic.

METHODS

This cross-sectional study was conducted between March and April 2020 on 386 participants randomly recruited from Lebanese general population.

RESULTS

Following the evolution of the COVID-19 pandemic in Lebanon compared to was not significantly associated with higher stress, higher depression, lower obsessive-compulsive traits, higher anxiety. Moreover, higher compulsion (Beta = 0.092), having a university level of education (Beta = 0.573), intermediate income (Beta = 1.889), following the evolution of the COVID-19 pandemic in Lebanon all of the time (Beta = 7.064), most of the time (Beta = 5.592), sometimes (Beta = 4.235) and little of the time (Beta = 7.676) were significantly associated with a higher hygienic prevention practices score. Higher age (Beta = -0.051), being a male (Beta = -1.432), higher depression (Beta = -0.083) and practicing religion some of the time (Beta = -0.826) were significantly associated with a lower hygienic prevention practices score.

CONCLUSION

This study found a strong interrelationship between psychological stress, depression, anxiety and obsessive-compulsive traits during the COVID-19 pandemic and identified the most vulnerable sub-groups in the Lebanese population. Additional measures should be deployed by health authorities in Lebanon and worldwide to face the impact of COVID-19 pandemic on mental health.Key pointsFollowing the evolution of the COVID-19 pandemic in Lebanon compared to not was significantly associated with higher stress, higher depression, lower obsessive-compulsive disorder, higher anxiety.Higher compulsion, having a university level of education, following the evolution of the COVID-19 pandemic in Lebanon were significantly associated with a higher hygienic prevention practices score.Higher depression, male gender, and practicing religion some of the time were significantly associated with a lower hygienic prevention practices score.Additional measures should be deployed by health authorities in Lebanon and worldwide to face the impact of COVID-19 pandemic on mental health.

Nutritional Assessment in Older Adults : MNA® 25 years of a Screening Tool and a Reference Standard for Care and Research; What Next?

A tool to assess nutritional status in older persons was really needed. It took 5 years to design the MNA® (Mini Nutrition Assessment) tool, complete the first validations studies both in Europe and in the U.S. and to publish it. After the full MNA®, the MNA® short form and the self-MNA® have been validated. As well as Chinese and other national MNA® forms. Now more than 2000 clinical research have used the MNA® all over the world from community care to hospital. At least 22 Expert groups included the MNA® in new clinical practice guidelines, national or international registries. The MNA® is presently included in almost all geriatric and nutrition textbook and part of the teaching program for medicine and other health care professional worldwide. The urgent need is to target the frail older adults more likely to have weight loss and poor appetite and to prevent frailty and weight loss in the robust. We present in this paper the review of 25 years of clinical research and practice using the MNA® worldwide.

Developing Core Competencies for Pharmacy Graduates: The Lebanese Experience

BACKGROUND

In the absence of a national qualification framework for health professionals, the Lebanese Order of Pharmacists (OPL) took the initiative of developing a pharmacy competency framework to standardize pharmacy education in all universities. The objective of this manuscript is to describe the steps that led to the Lebanese Pharmacy Core Competencies Framework.

METHODS

Based on a primer developed by a group of academic instructors, following international reference documents from different parts of the world, the Academic board appointed by the OPL, reviewed, streamlined, and validated the suggested primer using the Delphi technique over three rounds, to come up with the final framework.

RESULTS

The framework encompassed competencies distributed over 7 domains: fundamental knowledge, professional practice, personal skills, supply of medications, safe and rational use of medications, pharmaceutical public health competencies, and organization and management competencies. Its structure was similar to that of the International Pharmaceutical Federation (FIP), with cultural and legal adaptations and the addition of some behaviors related to OPL specific practice and research projects.

CONCLUSION

This work describes the elaboration of the Lebanese Pharmacy Core Competencies Framework, a project considered to be an essential step forward for the profession and a first step toward providing information on human resource planning and professional development of the pharmacy workforce. Instead of adapting existing international educational standards from resource-rich contexts, which may not meet the actual needs of Lebanon, universities can draw our findings to develop relevant programs targeting the skills needed for health workers in Lebanon.

Geriatric Mental Health and COVID-19: An Eye-Opener to the Situation of the Arab Countries in the Middle East and North Africa Region

While the detrimental ramifications of the COVID-19 outbreak on the mental wellbeing of the general public continue to unravel, older adults seem to be at high risk. As the geriatric population continues to grow in the Middle East and North Africa (MENA) region, it is essential to explore the influence of this outbreak on geriatric mental health, a topic often neglected. In this review, we depict the status of geriatric psychiatry in the Arab countries of the MENA region, exploring the variations from one nation to another. While some have a null exposure to the field, resources and expertise in other countries range from very limited to extensive. Furthermore, we highlight the measures implemented in the Arab region to address mental health during the COVID-19 outbreak; these tend to be insufficient when targeting the geriatric population. Finally, we provide short- and long-term recommendations to stakeholders that aim at enhancing the mental healthcare of older adults in the Arab countries of the MENA region, particularly during this pandemic.

Individualized intervention for frail non-dialysis elderly patients with chronic kidney disease: protocol for a randomized controlled trial

Background

Frailty describes an age-related clinical state and can be regarded as a predictive factor for fall, disability, hospitalization, and death in the elderly. Previous studies proved that frailty could be reversed or attenuated by multi-disciplinary intervention. However, only a few studies have been performed in non-dialysis patients with chronic kidney disease.

Methods

A randomized parallel controlled trial will be conducted to compare an individualized intervention according to the consequence of the comprehensive geriatric assessment with routine treatment. A total of 242 individuals aged ≥65 years, who fulfill the Fried Phenotype of frailty and have chronic kidney disease stage 3–5 without dialysis will be recruited from the Department of Nephrology and Department of Internal Medicine, Beijing Chaoyang Hospital, Capital Medical University. The participants will be followed-up for 30 days and 12 months.

Discussion

This protocol would be established to examine the efficiency of targeted intervention for frailty. If a positive consequence could be obtained, a novel treatment for frail elderly patients with chronic kidney disease who have never undergone dialysis can be carried out in routine clinical practice.

Trial registration

The trial was prospectively registered at the Chinese Clinical Trials Registry with the registration number ChiCTR-IOR-17013429 on November 17, 2017.

Reliability and validity of Azeri Turkish version of geriatric depression scale

Background: In older adults, depression symptoms may be masked by physical complaints and be even attributed to the natural aging process, which may be resulted in improper diagnosis. Native-language scales can be highly effective in the detection of depressive disorders. In this study we attempted to assess the reliability and validity of the Azeri Turkish version of the geriatric depression scale (GDS). Methods: In this psychometric study, the GDS and the Structured Clinical Interview for DSM IV(SCID) questionnaires were administered to a sample of 387 older adults (60 years and older)from the member households of Tabriz health centers. The English version of GDS was translated into Azeri Turkish. Translation-back translation process was conducted. The receiver operating characteristics (ROC) curve, as well as sensitivity and specificity, were used to determine the validity of the questionnaire, and the test-retest method was used to calculate reliability. Results: The mean age of participants was 69.30. The area under the ROC curve for the scores higher than five was 0.832 and for the scores equal to ten and above was 0.871. The sensitivity and specificity for the scores higher than five were 90.9% and 73.4%, respectively. The reliability of this scale was confirmed based on intraclass coefficient (ICC) = 0.79. Conclusion : The Azeri Turkish version of GDS was found with appropriate levels of validity and reliability.

Measuring Anxiety in Older Adults: Development, Diagnostic Accuracy, and Preliminary Validation of a Short-Form of the German Geriatric Anxiety Scale (GAS-G-SF)

Anxiety symptoms and anxiety disorders are highly prevalent among older adults, and are associated with considerable distress, functional impairment, and burden. Also, there is growing need for brief instruments to measure anxiety symptoms in primary care and geriatric medical settings. Therefore, the current study focuses on the development and psychometric evaluation of a short-form of the Geriatric Anxiety Scale (GAS-G), a well-established anxiety instrument for use with older adults. Study 1 draws on the original data from the GAS-G validation study (N = 242) to develop the short-form (GAS-G-SF) and determines whether the results replicate with the short-form. Study 2 extends the validation of the GAS-G-SF to a clinical sample (N = 156; 62 patients with heart disease, 94 patients with Parkinson's disease). Overall, the GAS-G-SF showed promising psychometric properties in terms of internal consistency and validity. Also, the GAS-G-SF showed good discriminatory power based on receiver operating characteristic curve analysis in both studies. These results support the utility of the GAS-G-SF as a brief assessment measure for anxiety.

Correlates associated with mental health and nutritional status in Lebanese older adults: A cross-sectional study

OBJECTIVE

To assess correlates of mental and nutritional health among elderly in Lebanon, inside nursing homes compared to their private homes.

METHODS

This cross-sectional study was conducted between June and August 2016 on 500 elderly.

RESULTS

Higher somatic (Beta = 0.259) and cognitive anxiety (Beta = 0.508), increased age (Beta = 0.174) were significantly associated with higher depression, whereas having a secondary (Beta = -4.006) and a university (Beta = -6.829) levels of education compared to illiteracy, living home (Beta = -2.557) compared to living in a nursing home and male gender (Beta = -1.280) were significantly associated with lower depression. Increased BMI (Beta = 0.056), a married (Beta = 0.687) and a widowed (Beta = 1.022) status compared to a single status were associated with a better nutritional status, whereas an increased somatic anxiety (Beta = -0.061), secondary (Beta = -0.79) and university (Beta = -1.196) educational levels compared to illiteracy were significantly associated with a worse nutritional status. Increased cognitive (Beta = 1.160) and affective (Beta = 0.788) anxiety and age (Beta = 0.191) were associated with higher stress, whereas a primary (Beta = -6.991), secondary (Beta = -11.812) and university (Beta = -13.927) educational levels, male gender (Beta = -2.015) were significantly associated with lower stress compared to females. A significantly higher mean depression score was found in patients living in nursing homes compared to those living at home (13.74 vs. 11.18). No difference was found between the two groups concerning the nutritional status and stress score.

CONCLUSION

Living in nursing homes was associated with more malnutrition and depression. An increased awareness of the personnel working in nursing homes and family members of these older adults can help improve their psychological status.

Validation of the Arabic version of the MADRS scale among Lebanese patients with depression

AIM

To use the Arabic version of the MADRS in Lebanese depressed patients, check its validity and reproducibility compared to other versions of the questionnaire and assess risk factors affecting the total MADRS score.

METHODS

This case-control study, performed between September 2016 and January 2017, included 200 patients (100 patients, 100 controls). The questionnaire included two parts, the first one concerning the socio-demographic characteristics another one that included the Montgomery-Asberg Depression Rating Scale (MADRS) questions, which was translated from English to Arabic through an initial translation and back translation process.

RESULTS

The MADRS scale items converged over a solution of one factor that had an Eigenvalue over 1, explaining a total of 83.90% of the variance. A Kaiser-Meyer-Olkin measure of sampling adequacy of 0.953 was found, with a significant Bartlett's test of sphericity (P<0.001). A stepwise linear regression, using the total MADRS score as continuous variable, showed that a university level of education would significantly decrease the total MADRS score by 20 points (beta=-20.02, CI: from -26.337 to -13.709, P<0.001). Unemployment was significantly more associated with an increase in the total MADRS score level by 10.23 points (beta=10.23, CI: 3.944-16.526, P=0.002).

CONCLUSION

This study shows that the Arabic version of the MADRS has promising psychometric properties, and thus it is a good tool to use for the diagnosis of patients with depression. Based on this study, health care professionals and researchers can readily use the MADRS questionnaire to estimate the overall severity of depression among psychiatric patients in Lebanon.

Nutritional status is associated with the degree of cognitive impairment and depressive symptoms in a Greek elderly population

Introduction: Cognitive impairment and malnutrition are two important public health issues in the elderly, which have been associated with their mental health.Aims: This study aims to evaluate the nutritional status of an elderly population in Greece, and its association with the grade of cognitive decline, anthropometric measures and psychological status.Materials and Methods: A total of 2092 elderly men and women were enrolled from seven Greek cities. Mini Nutritional Assessment (MNA), Mini Mental State Examination (MMSE) and Geriatric Depression Scale (GDS) questionnaires were used to assess the impact of nutritional status on cognitive abilities and psychological status of the participants.Results: Of the elderly, 35.0% were at risk of malnutrition and 11.3% were malnourished, while 34.4% of the participants had impaired cognitive function, and 32.3% showed depressive symptoms. Malnutrition was more frequently observed in participants presenting cognitive impairment, and depressive symptoms. In multiple regression analysis, nutritional status was independently associated with cognitive and psychological status.Conclusions: A high prevalence of malnutrition was recorded in this elderly population sample, which was directly associated with cognitive impairment and depression. Diagnostic tools such as MNA, MMSE, and GDS are strongly recommended to be applied as a routine clinical practice in the elderly to timely and effectively address these health problems.