Background Understanding the perceptions regarding what constitutes a "good death" among cancer patients and their families could help healthcare teams to ensure proper palliative and supportive care. Objectives To demonstrate and compare the wishes cancer patients and the perceptions of their relatives regarding end-of-life care, and to identify factors associated with patients' preferences regarding place of death. Methods A sample of cancer patients and their relatives who attended the Srinagarind Hospital (Thailand) oncology clinic or day chemotherapy from September 2017 to August 2018 were enrolled. Questionnaires were given to the participants, in which the patients were asked to respond based on their own end-of-life preferences, and relatives were asked to imagine how the patients would respond to the questions. Results One hundred eighty pairs of patients and relatives were recruited. Respondents in both groups placed importance on place of death, relationship with family, physical and psychological comfort, and relationship with the medical staff. Both groups generally agreed with the statements on the questionnaire (10/13 statements). Relatives underestimated the preferences of the patients in 3 areas: “not being a burden to others,” “preparation for death,” and “physical and psychological comfort.” Being married (adjusted odds ratio (AOD) 6.4, 95%confidence interval (CI) 1.1,36.5), having had more than 6 years of education (AOD 6.5, 95%CI 1.8,23.7), having lung cancer compared to colon cancer (AOD 12, 95%CI 1.2,118.7), duration after cancer diagnosis (AOD 0.9, 95%CI 0.93,0.99), previous hospital admission (AOD 5.7, 95%CI 1.5,21.2), and life satisfaction (AOD 17.6, 95%CI 2.9,104.9) were factors associated with preference for home death. Conclusion Thai cancer patients and their relatives indicated similar preferences with regard to what constitutes a good death and patients' wishes for their end-of-life period. However, the patients' relatives underestimated the importance patients placed on statements in three domains. Factors that influenced a preference for a home death were identified.
Background: Early mild neurocognitive disorder (mild NCD) detection can allow for appropriate planning and delay disease progression. There have been few studies examining validated mild NCD detection tools. One such tool that may be of use is the Mini-Cog, which consists of the clock drawing test (CDT) and three-item recall. Methods: This study aimed to compare the diagnostic properties of the Mini-Cog, the CDT alone, and the three-item recall test alone in mild NCD detection according to DSM-5 criteria. The participants were older patients attending the medicine outpatient clinic. Area under receiver operating characteristic (ROC) curve (AUC) analysis was used to compare the tools’ accuracy. Results: A total of 150 patients were enrolled, 42 of whom were diagnosed as having mild NCD. The AUCs of ROC curves of the three-item recall, CDT, Mini-Cog1, and Mini-Cog2 were 0.71, 0.67, 0.73, and 0.71, respectively (p = 0.36). The sensitivity of the tools was 85.7%, 66.7%, 57.4%, and 69% respectively. The tests performed similarly in participants with ≤6 years of education (p = 0.27) and those with >6 years of education (p = 0.49). Conclusions: All tools exhibited similar acceptable performance in detecting mild NCD and were not affected by education. These convenient tools might be suitable for use in clinical practice.
Background Sleep problem is a common geriatric condition that can result in various outcomes, both physical and mental, that reduce quality of life. The studies regarding the prevalence and impact of insomnia on daily activities in Thailand in pre-elderly and elderly adults are few. Objectives The primary objective of this study was to determine the prevalence of insomnia among pre-elderly and elderly populations and the secondary objective was to study the impact of insomnia on their daily lives. Methods This study included the participants from the urban middle class in the pre-retirement age of 50 years or older adults who worked for Khon Kaen University (KKU), Khon Kaen, Thailand, and their elderly relatives. Information on baseline characteristics, sleep problems, and outcomes were collected. Descriptive analytical statistics were used to analyze baseline data. Multivariate analysis was used to analyze associated factors of the impact of insomnia. Results A total of 491 participants were recruited. The prevalence of insomnia was 60%. The significant consequences related to insomnia were feeling unrefreshed (adjusted odds ratio (AOD) 2.22, 95% confidence interval (CI) 1.44-3.04), daytime sleepiness (AOD 2.04, 95% CI 1.29-3.22), need for a sedative drug (AOD 4.23, 95% CI 2.09-8.55), depression (AOD 4.74, 95% CI 1.73-13), and impaired attention (AOD 2.29, 95% CI 1.52-3.45). Conclusions Insomnia was found in the majority of pre-elderly and elderly participants and resulted in several poor outcomes. Early detection of insomnia may prevent some inevitable outcomes.
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