Malnutrition among community dwelling older adults in a rural block area of South India

Background:

Kerala state has highest proportion of older adults in India. There is paucity of information on burden of malnutrition (under-nutrition) among them in the state. This study aimed to measure prevalence and associated factors of malnutrition among older adults in a rural community of Kerala.

Methods:

A community based cross-sectional study was conducted in 2018, among randomly selected 245 older persons (age ≥ 60 years) across rural area of Nemom block panchayath in Thiruvananthapuram district of Kerala. Nutritional status was determined by Mini Nutritional Assessment tool. Other components of the interviewer-administered questionnaire were Barthel Index, Geriatric Depression Scale-15, socio-demography, morbidity and substance abuse details. Chi Square test and binary logistic regression were done appropriately.

Results:

Prevalence of malnutrition was 14.3% (95% CI – 9.9% to 18.7%) and 44.1% (95% CI – 37.9% to 50.3%) were at risk of malnutrition. Older-old (70-79 years), oldest-old (≥80 years), unmarried or widowed, those with chewing and swallowing difficulties, those who screened positive for depression and those who had higher grade of dependency in any activities of daily living were more likely to be malnourished (p < 0.05). Older-old age (aOR – 3.358), depression (aOR – 4.859) and higher grade of dependency in activities of daily living (aOR – 2.940) were the attributes independently associated with malnutrition after adjusting for other factors.

Conclusions:

The older persons in the rural area of Kerala had high burden of malnutrition. Older-old, dependent and depressed individuals are more likely to be affected.

A systematic chart review of the naturalistic course and treatment of early-onset bipolar disorder in a child and adolescent psychiatry center

Studies on the naturalistic course of early-onset bipolar disorder are few and studies evaluating the efficacy of pharmacotherapy consist largely of open trials of thymoleptics and neuroleptics on small samples. The current study was undertaken to map the course of the disorder and the prevailing prescribing practice in early-onset bipolar disorder at a child and adolescent psychiatry center in India. A chart review of 139 children and adolescents (<16 years) with a DSM-IV diagnosis of bipolar disorder-mania was performed and the baseline demographic and clinical characteristics, episode characteristics, and treatment and follow-up details were collected and the data analyzed. The index episode remitted in all 133 (96%) subjects for whom the information was available. One hundred twenty-five (90%) subjects received thymoleptics for the index episode, of which lithium was used in 85%. Valproate was the next most commonly used thymoleptic (18%). Eighteen (13%) subjects received combination thymoleptics. Sixty-eight percent received neuroleptics either alone or as adjuncts in the acute phase. During the follow-up period, which ranged from 3 to 56 months (mean +/- SD, 15 +/- 14), 35% of subjects relapsed, 89% within the first 2 years. Twenty-eight percent of subjects relapsed despite being on apparently adequate doses of lithium. The limitations of the study are that it is retrospective in nature, and that structured diagnostic tools and rating scales were not used. We conclude that lithium is the most commonly used thymoleptic in early-onset bipolar disorder. Lithium alone or in combination with neuroleptics appears to have good efficacy in the acute phase of the disorder. The majority of relapses occurred in the first 2 years and the efficacy of currently used thymoleptics in prophylaxis is uncertain.

The index manic episode in juvenile-onset bipolar disorder: the pattern of recovery

OBJECTIVE

Recent studies of patients with juvenile bipolar disorder report low rates of recovery and high rates of chronicity. However, we lack data on the short-term outcome. This study examines the pattern of recovery from the index episode in an aggressively treated juvenile sample.

METHOD

We assessed 25 subjects (< 16 years) with a diagnosis of mania, using the Diagnostic Interview for Children and Adolescents-Revised) (DICA-R), Young Mania Rating Scale (YMRS), and Children's Global Assessment Scale (CGAS) at intake and at 3 and 6 months. We studied the time taken to recover from the index episode, the level of functioning, and the factors predicting them.

RESULTS

After 6 months, 24 (96%) subjects had recovered from the index manic episode. The median time to recovery was 27 days. Total episode length was significantly longer among those with previous affective episodes.

CONCLUSIONS

The findings suggest that juvenile-onset mania has high rates of recovery and low rates of chronicity. These differences from the existing literature need further exploration.