Saudi Cultural Missions Theses & Dissertations
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Item Restricted Heart disease, health outcomes, and healthcare utilisation among middle-aged and older Australians: a longitudinal study using HILDA survey data(The University of Queensland, 2024) Alkalabi, Meshal; Keramat, Syed AfrozSTUDY 1 ABSTRACT Background Heart disease is a major public health concern globally, with substantial impacts on health outcomes among middle-aged and older adults. Understanding its influence on general health, mental health, self-assessed health, and health satisfaction is crucial for developing effective interventions tailored to this demographic in Australia. The study aims to investigate the longitudinal burden of heart disease on self-reported health outcomes among middle-aged and older Australians, focusing on general health, mental health, self-assessed health, and health satisfaction. Methods This study utilised longitudinal data from the Household, Income, and Labour Dynamics in Australia (HILDA) survey, focusing on individuals aged 40 years and older across four survey waves: 2009, 2013, 2017, and 2021. The study included 12,751 participants aged 40 and older, with 32,931 observations. Fixed-effects Generalised Least Squares (GLS) and fixed-effects ordered logistic regression models were applied to assess the association between heart disease and four health outcomes. Robustness checks were conducted using Generalised Estimating Equations (GEE) and random-effect GLS models. The analysis adjusted for sociodemographic, behavioural, and healthrelated variables. Results The results suggest that heart disease was negatively associated with general health, mental health, self-assessed health, and health satisfaction among middle-aged and older Australians. Specifically, participants with heart disease scored lower on general health (β = -4.67, 95% CI: -5.56 to -3.77, p < 0.001), mental health (β = -0.98, 95% CI: -1.84 to -0.12, p = 0.025), self-assessed health (β = -0.76, 95% CI: -0.94 to -0.58, p < 0.001), and health satisfaction (β = -0.50, 95% CI: -0.65 to - 0.35, p < 0.001) compared to those without heart disease. The heterogeneous analysis further revealed that gender differences influenced health outcomes, with females experiencing more pronounced declines across all health measures than males. Additionally, the marginal effects analysis indicated that heart disease reduced the likelihood of achieving the highest levels of self-assessed health and health satisfaction. Conclusion This study found that heart disease is linked to poorer health outcomes, including general health, mental health, self-assessed health, and health satisfaction among middle-aged and older Australians. To enhance the overall well-being of this population, communities, government and nongovernment organisations, and other stakeholders should prioritise routine healthcare prevention, targeted interventions, and treatment strategies, particularly for individuals affected by heart disease.. Keywords: Heart disease; general health; mental health; self-assessed health; health satisfaction STUDY 2 ABSTRACT Background Heart disease poses a significant burden on healthcare systems, particularly among middle-aged and older adults in Australia. Despite existing research on healthcare utilisation patterns, longitudinal studies focusing on how heart disease affects healthcare use over time among older Australians remain limited. The study aims to examine the longitudinal burden of heart disease on healthcare utilisation among middle-aged and older Australians, focusing on the number of doctor visits, hospital admissions, and nights spent in the hospital. Methods This longitudinal observational study utilised data from the Household, Income, and Labour Dynamics in Australia (HILDA) survey, covering the years 2009, 2013, 2017, and 2021. The study included 12,857 participants aged 40 and older, with 33,822 observations. The primary outcomes were the number of doctor visits, hospital admissions, and nights spent in the hospital. Heart disease status was the main exposure variable, and random-effects negative binomial regression models were used to examine associations, adjusting for socio-demographic, behavioural, and healthcare access factors. Results Participants with heart disease had significantly higher healthcare utilisation across all measures. The rate of doctor visits increased by 24% (IRR: 1.24, 95% CI: 1.20–1.28, p < 0.001), while hospital admissions nearly doubled (IRR: 1.91, 95% CI: 1.76–2.07, p < 0.001), and nights spent in the hospital were significantly longer (IRR: 1.89, 95% CI: 1.75–2.04, p < 0.001) compared to those without heart disease. Older age (≥ 70 years), female sex, multiple chronic conditions, and not being in the labour force were significant predictors of increased healthcare utilisation, indicating a compounded healthcare burden in these subgroups. Conclusion Heart This study shows that middle-aged and older Australians with heart disease have higher healthcare utilisation compared to those without the condition. Heart disease is a significant public health concern that necessitates comprehensive, long-term management strategies focused on prevention. Inadequate management of heart disease could lead to worsening health outcomes and place further strain on the healthcare system. Keywords: Heart disease, healthcare utilisation, longitudinal study, older adults, HILDA survey, doctor visits, hospital admissions, Australia.37 0Item Restricted Is Fatigue Associated with Oral Health Outcomes Among American Adults?(King's College London, 2024-08) Alotaibi, Abdulmajeed; Sabbah, WaelBackground: Fatigue is a frequent problem in the American adult population, affecting every aspect of health, from mental to physical wellbeing. Although the negative effects of fatigue on general health are well documented, little research has been identified that investigated its effect on oral health. Among the adverse consequences of fatigue, bad oral habits like neglecting oral hygiene and regular dental check-ups can lead directly to negative outcomes with individual’s teeth, such as tooth loss, tooth decay and periodontal disease. Fatigue is described as the subjective sense of not being able to accomplish a task efficiently owing to decreased effectiveness. Objective: This study examines the correlation between fatigue and oral health among US population. Method: Data were gathered from the 2015-2018 National Health and Nutrition Examination Survey (NHANES), a cross-sectional survey of adults aged 18 and above. The Patient Health Questionnaire-9 (PHQ-9) was used to assess and examine fatigue using a thoroughly validated assessment based on the Prime-MD diagnostic instrument. In NHANES, it is referred to as the Depression Screener Questionnaire (DPQ). The tooth count was established by clinical exams performed by qualified dentists. Logistic regression models were used to determine the relationship between tooth count and fatigue and adjusted for demographic characteristics, socioeconomic status, dental visits, multimorbidity and smoking status. Results: Of the 11,848 participants (mean age: 47.25 years), 52.94% experienced fatigue. The incidence of tooth loss was greater among individuals who reported being 3 fatigued. However, after accounting for demographic characteristics, socioeconomic status, mean poverty income ratio, and multimorbidity, the link between tooth loss and fatigue maintained its statistical significance (Odds Ratio ‘OR’ = 1.21, 95% Confidence Interval ‘CI’: 1.01-1.43). Model 3 found Participants who hadn't seen a dentist in over a year have more chance to experience fatigue (OR = 1.21, 95% CI: 1.04-1.39, p = 0.014). Conclusion: to conclude, having fewer teeth is linked to fatigue among American adults. To manage fatigue and its broader health effects, a multifaceted approach is needed, including regular dental care, reducing socioeconomic disparities, and assessing both physical and mental health. This integrated strategy can improve overall well-being and address the complex link between fatigue and oral health.14 0Item Restricted Is root caries more likely to occur among older adults with multimorbidity?(KING'S COLLEGE LONDON, 2024) Alyamani, Saif; Sabbah, WaelBackground: Root caries, a prevalent dental condition in the older population, substantially impacts oral health and overall quality of life. It leads to tooth surface loss, pain, and increased risk of periodontal disease, affecting nutrition, psychological well-being, and social interactions. Effective prevention and management are crucial. Multimorbidity, is prevalent in older populations and can influence various health outcomes. The aim of this study is to examine the relationship between multimorbidity and root caries in older American adults. Methods: Utilizing data from the National Health and Nutrition Examination Survey (NHANES) 2017-2020, this cross-sectional study focused on adults aged 60 years and older. The presence of root caries or root restoration was assessed through clinical dental examinations. Multimorbidity was identified by the existence of nine chronic diseases, namely, diabetes, asthma, cancer, heart attack, stroke, angina, chronic pulmonary disease, kidney diseases, and arthritis. Logistic regression models were used in this study to evaluate the association between multimorbidity and root caries, adjusting for sociodemographic factors, health behaviours, and dental care access. Results: Among the 2486 participants (mean age: 69.3 years), 23% had root caries, while 43% had multimorbidity (two or more conditions). Root caries prevalence was higher in individuals with multimorbidity. However, after adjusting for confounders, multimorbidity’s association with root caries did not show statistically significant results (OR = 1.02, 95% CI: 0.88-1.18). Significant associations were found between root caries and smoking (OR = 4.67 for current smokers vs. never smokers) and income to-poverty ratio, with lower ratios linked to higher root caries prevalence. Conclusion: While multimorbidity alone did not show a significant impact on root caries prevalence, lifestyle factors, particularly smoking and socioeconomic status, played critical roles. Addressing these modifiable risk factors and improving access to dental care are essential for enhancing oral health outcomes in older adults. Additional studies are required to investigate the intricate interactions of factors influencing oral health in this demographic.19 0Item Restricted The Association between Healthy Lifestyle Behaviors and Polypharmacy in Older Adults: The Loma Linda Longevity Study(Loma Linda University, 2024) Bardesi, Abrar; Dos Santos, HildemarIntroduction: Polypharmacy—defined as taking numerous medications that may not be clinically necessary—is becoming a significant concern among the older adult population. This study examined the associations between lifestyle behaviors and the number of prescribed medications in older adults (75 years and older) living in the counties of San Bernardino and Riverside. Methods: This study employed a cross-sectional survey to assess lifestyle behaviors and medication use in 611 older adults aged 75 or over. Bivariate correlation and linear regression analyses were used to assess potential relationships between lifestyle behaviors and the number of prescribed medications. Results: Fruit consumption (p=0.005), mild physical activity per week (p<.001), and lifestyle index (p=0.003) had a highly significant inverse association with the number of prescribed medications. Fat consumption had a direct positive relationship with the number of prescribed medications (p=0.02). Conclusion: Higher fat intake was directly linked to an increased need for medications, while regular physical activity, a higher fruit intake, and a healthy overall lifestyle were all associated with a lower likelihood of polypharmacy. Future research can explore the mechanisms linking these behaviors with medication usage.37 0Item Restricted Can Exergames be used to improve the physical abilities of older male care home residents in Saudi Arabia?(University of Mancheser, 2024-04-26) Zougar, Mohammad; Stanmore, Emma; Todd, Chris; Mcgarrigle, LisaBackground: MIRA-Rehab-Exergames activities are based on the OTAGO and FaME exercise programmes, which have been shown to minimise the likelihood of falling in older people. It’s applications are recognised as a practical approach to overcoming training barriers, which ultimately leads to advancements in older individuals' well-being. Aim: This study aimed to test the feasibility of Exergames for older men at a care home. Methods: Following the Medical Research Council (MRC) guidance and framework for complex interventions, A feasibility RCT recruited male older adults 65 years and older. They were randomised into two groups. The control group received a Chair-Based Training (CBT) booklet and the intervention group received MIRA-Rehab-Exergames sessions for six weeks followed by another six weeks for follow up. The outcome measures were related to feasibility outcome measures (recruitment, data collection, attrition, retention, adherence, resources, acceptability, and usability), in addition to other outcome measures (e.g. Berg Balance Scale, quality of life, functional reach test, geriatric depression scale, timed up and go test, fear of fall, and short physical performance battery test) at three point assessments. Results: Thirty older male participants were randomised into CG (n = 16) and IG (n = 14). The mean age was 78.70 (SD 10.63). No male participants withdrew during the data collection period. However, due to Covid-19 outbreak, the researcher cancelled the last week of the Exergaming. On one hand, the recruitment and attrition shows no male participants withdrew during the first six weeks. The retention rate was high. Regarding the data collection, all the male participants in both groups successfully completed the three assessments. Adherence was measured based on the attendance of the planned Exergames sessions. Adherence to the IG seems low compared to the adherence to CG. The Exergames seem to be safe, feasible, usable, and acceptable. On the other hand, the statistics showed that only balance, fear of falling, and quality of life were improved through three points scales. Later, the male participants provided some insights and opinions related to the usability and suitability of Exergames for some required modifications. Conclusion: MIRA-Rehab-Exergames was investigated for the older men population in the context of a single care home centre in the KSA. It shows the possibility of applying such novel technology in this fast developing country.34 0Item Restricted An Exploration of the Association Between Polypharmacy and Frailty Among Hospitalized Older Adult Patients(The University of North Carolina at Greensboro, 2024) Yasin, Reham; Kennedy-Malone, LauriePurpose/Objective The study's main purpose is to explore the association between polypharmacy and frailty among hospitalized older adults. Significance Polypharmacy is considered a matter of concern in many U.S. geriatric healthcare settings. Frail older adults are at special risk of experiencing higher rates of medication-related complications, such as drug–drug interactions, worsening morbidity, falls, delirium, and rehospitalization due to physiological changes. Most studies investigated the relationship among community-dwelling older adults. However, the relationship between polypharmacy and frailty among hospitalized older adults has not yet been well described. Design/Methods This retrospective cross-sectional study offers a secondary data analysis of the EHR in adults aged 50 years or older (N=46,645) hospitalized in medical-surgical units in a healthcare system between 2013 and 2017. Polypharmacy was defined as the concurrent use of seven or more prescribed medications. Potential Inappropriate Medications/High-Risk Medications (PIMs/HRMs) were classified using AGS Beers criteria® 2023 and HIDES, and then grouped into 10 classes (Lekan et al., 2022). A Frailty Index (FI) was created based on the accumulation of a deficit theoretical framework (Mitnitski et al., 2001). After a detailed review of components contributing to frailty, the FI was constructed following the guidance provided by Searle et al. (2008) and Theou et al. (2023). This study’s FI was unique because it included indicators from nursing flowsheets, ICD-10 codes, laboratory blood biomarkers, as well as indicators more customarily used, including comorbidities, and functional status, activities of daily living, and psychosocial indicators. The indicators were coded as “1” for present and “0” for absent. FI-35 was calculated by dividing the number of indices in an individual by the total number of indices measured, with frailty defined by a cut-off point of ≥ 0.25. Findings/Outcomes The average age of patients upon admission was 70.0 years (SD=11.4). The prevalence of polypharmacy was 49.6% (n=19,072). Out of the total number of patients included in the study (25,961), 42.0% were identified as frail. The study showed a significant association between polypharmacy and frailty with 54.5% of individuals with polypharmacy classified as frail. The multivariable logistic regression yielded a significant association between polypharmacy and frailty. The odds of frailty were 53.1 % higher for those in the polypharmacy groups relative to non-polypharmacy groups, adjusting for age and ECI score (AOR = 1.531, 95% CI = [1.437, 1.631], p < 0.001). The study found a significant association between 8 PIMs/HRMs classes and frailty (P<0.001) and with using one or more PIMs/HRMs. However, no significant association was found between genitourinary or anti-infective PIMs/HRMs class and frailty (P > 0.05). Conclusion/Implications for Practice By using EHR data, nurses can identify patients at high risk of adverse outcomes. Including measures of frailty and polypharmacy in assessments can aid in reducing these risks and guide interventions by nurses to prevent negative health outcomes. Identifying frail older adults with Frailty, polypharmacy and exposure to PIMs/HRMs is important, emphasizing the need for specialized care, medication review, de-prescribing, and frailty screening. Post-discharge care plans for frail patients with complex medication regimes help ensure recovery and prevent hospital readmission.21 0Item Restricted Social Isolation and Desire for Privacy of Older Adults Living in Private Villa-Type Homes in Riyadh, Saudi Arabia: A Space Syntax Analysis(2023) Almayman, Mayman; Park, Nam-kyuOlder adults spend a significant proportion of their time in their homes' interior spaces, which in turn, have a considerable potential to influence their health and well-being. Studies have emphasized the role of socio-environmental variables, e.g., social interaction and privacy, in fostering healthy aging. Precedent literature applied several approaches to understand the relationship between the built environment and these variables. However, there is a lack of research that addresses this relationship using a holistic, mixed-method approach focusing on the spatial configuration of private homes. Utilizing a sample of 25 villa-type homes in Riyadh, Saudi Arabia, this research aims to understand the association of home spatial configuration with its older adult residents' social isolation and desire for privacy. The study used space syntax metrics (i.e., mean depth, average integration, and average connectivity) to assess the homes' spatial configuration. In parallel, the study used the Desire for Privacy Scale and the English Longitudinal Study of Aging's social isolation measures (Domestic Isolation, Social Contact, and Social Disengagement) to obtain social isolation and desire for privacy levels from the older adult dwellers. The study also incorporated the participants' experiences through semi-structured interviews to explore factors that support achieving their desired interaction and privacy levels. The quantitative findings identified a significant, negative correlation between the homes' average connectivity and the older adults' social disengagement levels and a significant, positive correlation between homes' mean depth and the older adults' desire for privacy levels. The qualitative results confirmed these findings to a great extent and identified three overarching and interrelated themes regarding how older adults achieve their desired social interaction and privacy levels given their homes' spatial configuration. These themes are environmental characteristics, behavioral practices, and social routines and roles. The study concludes that in the context of Riyadh, Saudi Arabia, the spatial configuration's relationship with social isolation and desire for privacy may not be straightforward, and behavioral practices and social routines and roles could influence such a relationship. The findings have implications that could advance the knowledge, policies, and professional practice to support the older adults' quality of life within their homes.37 0