Journal of Primary Care and Family Medicine (PCFM)

Effectiveness of Using Vitamin B Complex for Increasing Appetite in NCDs Older Patients with Loss of Appetite at Bangpoon 1 Sub-district Health Promoting Hospital

Thanyawan Petchnoi — 2026-04-30

Background: Loss of appetite in older adults is a reduction of food desire or low food intake. Oftens not detected or corrected. A decreased appetite can cause malnutrition, dehydration, weight loss, infection, frailty, sarcopenia, poor quality of life. Objections were to study the effect on appetite, changes in body composition, physical performance, cognition, adverse effects after taking vitamin B complex.

Design: Quasi-experimental study with one group pre-posttest design

Methods: The sample size was 40. Aged ≥ 60 years-old with NCDs at Bangpoon 1 Sub-district Health Promoting Hospital who loss of appetite and had a Thai version of the short nutritional assessment questionnaire score ≤14. The sample was selected by convenience sampling. Data were collected for 4 months from March 1st to June 30th, 2024. Data were analyzed using N, %, Mean ± SD., Median ± IQR, Paired sample T-test and Wilcoxon signed-rank test.

Results: Only 30 participants can remain. Women 96.7%. Average age is 73.30±6.65 years old. The study found the appetite score, hip circumference, hand grip strength, gait speed, cognition score were increased at 3 months statistically significant. Meanwhile, body weight, subcutaneous skinfold thickness, calf circumference were decreased at 3 months, statistically significant.

Conclusions: Vitamin B complex helps increase appetite, hip circumference, handgrip strength, gait speed, and cognition. But it causes weight loss. Skin fold thickness and calf circumference decreased. A serious adverse effect was not found.

Keywords: older adults, loss of appetite, vitamin B complex

Prevalence and Associated Risk Factors of Metabolic Syndrome Among Older Adults in the Outpatient Department

Worapon Hatthawetphaiboon — 2026-04-30

Background: Metabolic syndrome is an increasing public health issue among older adults. However, studies in Thailand are limited. This research aims to investigate the prevalence, associated factors, and assess the waist-to-height ratio as a screening tool for this condition in older adults.

Methods: A cross-sectional descriptive study was conducted on adults aged 60 years and older attending outpatient services at Phramongkutklao Hospital between November 2023 and October 2024. Data were collected using questionnaires and analyzed with descriptive statistics, multivariable logistic regression, and receiver operating characteristic (ROC) curves.

Results: The study participants were 330 individuals with an average age of 66.76 years. The prevalence of metabolic syndrome was found to be 42.73%. Associated factors included age ≥ 80 years (OR 3.29, p = 0.043), body mass index ≥ 25 kg/m² (OR 4.73, p < 0.001), and a preference for high-fat foods (OR 1.74, p = 0.038). The Waist-to-Height Ratio (WHtR) for screening metabolic syndrome has an area under the ROC Curve (AUC) of 0.82, with a cut-off point of 0.54 (sensitivity 0.84, specificity 0.66).

Conclusions: Nearly half of older adults have metabolic syndrome, and the waist-to-height ratio can be used as an effective screening tool. Health behavior modifications should be recommended, such as reducing the intake of high-fat foods and maintaining a healthy weight.

Keywords: metabolic syndrome, older adults, prevalence, associated factors, waist-to-height ratio

Sensitivity and Specificity of Timed Up and Go Test for Falling Prediction in Older Adults with Non-Communicable Disease in a Primary Care Setting in Surasak, Si Racha, Chon Buri

Palita Chairakwongsa — 2026-04-30

Background: The Timed Up and Go Test (TUGT) has various cut-off values, resulting in different sensitivity and specificity. In Thailand, the cut-off value of ≥ 12 seconds is considered a high risk of falling. This study aims to evaluate the sensitivity and specificity of a cut-off value of 12 seconds and to identify a suitable cut-off value for predicting falls among elderly patients with chronic diseases in a primary care clinic.

Design: Cross-sectional descriptive study

Methods: Two hundred and seventy-six elderly patients with chronic diseases were followed up at a primary care clinic. Divided into high fall-risk group (TUGT ≥ 12 seconds) and low fall-risk group (TUGT < 12 seconds). Fall incidents were monitored during six months. Sensitivity and specificity were calculated for a cut-off value of 12 seconds and other potential cut-off values.

Results: TUGT at the cut-off value of 12 seconds has a sensitivity of 51.8% (95%CI: 45.5-58.0) and specificity 42.1% (95%CI: 20.3-66.5). AUC = 0.5387. The cut-off value of 10 seconds had a sensitivity of 80.9% (95%Cl: 75.6-85.5), and the cut-off value of 15 seconds had a specificity of 89.5% (95%Cl: 66.9-98.7)

Conclusions: The cut-off value of 12 seconds is unsuitable for predicting falls in elderly patients with chronic diseases in primary care settings. TUGT can be adapted for practical use by selecting a cut-off value for suitable applications. For example, the cut-off value of 10 seconds can be used for screening fall risks, while the cut-off value of 15 seconds can predict falls to facilitate intensive prevention. However, Intervention is considered based on the capacity of the healthcare facility.

Keywords: sensitivity and specificity of TUGT, cut-off value of 12 seconds of TUGT, Falling prediction by TUGT

Factors Associated Thai Elderly Falls Who Reside in Silom Community, Bang-rak, Bangkok, Thailand

Noramon Wetchaphiphat — 2026-04-30

Background: Falls are a common issue among the elderly and can lead to disability. This study aimed to examine the factors influencing falls among Thai elderly falls residing in or near Silom, Bang-rak, Bangkok, Thailand.

Design: Prospective cohort study

Methods: Data were collected from 220 elderly individuals aged 60 years and above who visited the family medicine outpatient department or the Geriatric Clinic at Lerdsin Hospital. The data collection included a basic information questionnaire, SARC-F (a screening tool for sarcopenia), the Thai Fall Risk Assessment Tool (Thai-FRAT), the Mini Nutritional Assessment (MNA), and physical performance evaluations using grip strength and the five-time chair stand test. Additionally, serum vitamin D levels were measured. Fall incidents were followed up for six months, and the collected data were analyzed using logistic regression analysis, examining both univariate and multivariate models.

Results: Factors significantly associated with falls within six months in univariate analysis (p < 0.05) included age ≥ 80 years (p = 0.012, 95% CI: 1.272-7.031), female gender (p = 0.027, 95% CI: 1.124-7.087), BMI <18.5 kg/m² (p = 0.045, 95% CI: 1.028-14.282), a history of previous falls (p = 0.003, 95% CI: 1.496-6.950), SARC-F score ≥ 4 (p < 0.001, 95% CI: 1.848-7.383), Thai-FRAT score ≥ 4 (p < 0.001, 95% CI: 2.082-8.458), and vitamin D levels < 30 mU/L (p = 0.019, 95% CI: 0.207-0.866). In multivariate analysis, significant factors associated with falls (p < 0.05) included a Thai-FRAT score ≥ 4 (p = 0.022, 95%CI: 1.175-8.026) and vitamin D levels < 30 mU/L (p = 0.004, 95% CI: 0.133-0.676).

Conclusions: The findings of this study suggest that accurate assessment using the Thai-FRAT score helps predict the likelihood of falls in older adults within six months. Low vitamin D levels are identified as a potential factor contributing to the risk of falls in the elderly. Therefore, vitamin D supplementation is important for fall prevention in older adults with low vitamin D levels.

Keywords: falls, elderly, factors, six months

Comparison of Quality of Life in Elderly Patients with Knee Osteoarthritis Between Non-Surgical and Surgical Groups in an Orthopedic Clinic at a Secondary Hospital

Natthawat Khuttamasoon — 2026-04-30

Background: Knee osteoarthritis affects daily activities and quality of life. Treatment options include both non-surgical management and total knee replacement surgery. Comparing the quality of life outcomes between these two approaches will provide useful insights for patient management. This study aim to compare the quality of life of knee osteoarthritis patients undergoing non-surgical treatment versus surgical treatment.

Design: A cross-sectional descriptive study

Methods: Patients with knee osteoarthritis attending the orthopedic clinic were interviewed using the Thai version of the EQ-5D and the Thai version of the Modified WOMAC Scale. Data were analyzed using descriptive statistics and comparative statistical methods, including the Chi-Square test and T-test.

Results: The study included a total of 162 knee osteoarthritis cases, with an average patient age of 70.35 ± 7.4 years. Of these, 72.22% did not undergo surgery. When comparing quality of life using the Thai version of EQ-5D, the surgical group had a better quality of life, as indicated by the overall health assessment score (EQ-VAS) (non-surgical group: 61.1 ± 24.3 vs. surgical group: 72 ± 23.7, p = 0.011). Regarding the Thai version of the Modified WOMAC Scale, the surgical group had significantly lower pain levels (non-surgical group: 17.38 ± 12.32 vs. surgical group: 10.13 ± 13.47, p = 0.001). The most significant differences in pain were observed during stair climbing and walking. Additionally, the surgical group demonstrated better joint functionality.

Conclusion: Total knee replacement surgery improves the quality of life of patients compared to the non-surgical group by significantly reducing pain and enhancing daily functional abilities. These findings provide valuable information for healthcare professionals and patients in selecting the most appropriate treatment approach.

Keywords: knee osteoarthritis, quality of life, Thai version of EQ-5D, Thai version of modified WOMAC Scale

A Comparison of Willingness to Deprescribe in Older People with Non-Communicable Diseases with Polypharmacy Between Drug Burden Group and Non-Drug Burden Group at Outpatient Clinic of Family Medicine Department, King Chulalongkorn Memorial Hospital

Patsarin Arayathanitkul — 2026-04-30

Background: Polypharmacy among older patients with non-communicable diseases has many significant negative impacts, including self-deprescribing.Limited data regarding willingness to deprescribe and associated factors in this population led to this study’s initiation. This study aim to compare willingness to deprescribe among non-communicable disease older patients with polypharmacy, among those burdened and not burdened by medication use.

Methods: A cross-sectional study was conducted in non-communicable disease older patients aged 60 and above who were using five or more medications at the Family Medicine Clinic, King Chulalongkorn Memorial Hospital, Bangkok, in January and February 2024. Data on personal information, health status, medication use, attitudes toward deprescribing, and reasons for deprescribing were collected. Inferential statistics were used to compare willingness to deprescribe in groups burdened and not burdened by medication use, while multivariate analysis identified associated factors.

Results: Of 264 participants, the majority were not burdened by medication use (154 participants, 58.3%), while the burdened group consisted of 110 participants (41.7%). In each group, the desire to deprescribe was 48.1% and 72.7%, respectively, with a significant difference (p < 0.001). Factors associated with the willingness to deprescribe included medication burden, education level, presence of other chronic diseases, and self-reported health status. Reasons for willingness to deprescribe include lack of indication for medication use and the type of medication, such as chronic disease medications.

Conclusions: Non-communicable disease older patients with polypharmacy, especially those burdened by medication use, have a strong willingness to deprescribe. Healthcare professionals should understand patient-related factors to collaboratively plan the most effective healthcare management.

Keywords: willingness to deprescribe, polypharmacy, older people, non-communicable disease, drug burden

Comparison Between Gabapentin and Placebo for Insomnia in Primary Care Elderly of Maharat Nakhon Ratchasima Hospital

Maneemai Phuangkhum — 2026-04-30

Background: In primary care units, benzodiazepines are commonly used to treat insomnia disorder in the elderly, despite the significant side effects. However, the medications in this group that are approved by the Food and Drug Administration (FDA) of the United States for treating insomnia disorder are expensive and not reimbursable. Therefore, studies have been performed regarding alternative medications such as Gabapen-tin, which has minimal side effects when started at low doses, no risk of dependency, and is widely used in primary care units. Therefore, it is considered a preferable option for increased usage in the elderly population.

Design: Double-blind, randomized controlled trial

Methods: The research involved 70 participants, divided into a control group of 35 and an experimental group of 35. The Thai version of the Pittsburgh Sleep Quality Index (T-PSQI) was used as the assessment tool. Data analysis of sleep quality between the experimental and control groups utilized multiple logistic regression with results presented as a 95% confidence interval.

Result: The study found the quality of sleep in the experimental group at weeks four and six was significantly better, with quality scores of 7.56 and 7.31 times, respectively, compared to the control group.

Conclusions: The use of Gabapentin for insomnia disorder in the elderly in primary care units improved sleep quality significantly.

Keywords: gabapentin, insomnia disorder, sleep quality, elderly

Harnessing Big Data in Type 2 Diabetes to Estimate Visit Duration and Associated Factors to Reduce Overcrowding in Primary Care Settings

Pathaithat Puwiwatana — 2026-04-30

Background: Efficient visit management in service delivery is crucial for diabetic patient care and helps reduce overcrowding in healthcare units. However, the application of big data analytics to improve visit duration in primary care settings in Thailand has not been adequately explored. To estimate visit durations for type 2 diabetic patients using big data and identify factors influencing visit durations.

Design: Cross-sectional study

Method: Data from type 2 diabetic patients treated at four primary care settings in Southern Thailand (October 2021–September 2023) were analyzed. Visit durations, from registration to completion, were recorded electronically. Descriptive statistics and multiple linear regression assessed influencing factors. Results were presented as coefficients with 95% confidence intervals, with significance set at p < 0.05.

Results: The average visit duration was 76.61 minutes (95%CI: 75.94–77.29 minutes). Session durations for physicians’ examination were 7.59 minutes (95%CI: 7.39–7.78 minutes). Significant factors influencing physician examination duration included walk-in patient status (-3.77 minutes, 95%CI: -5.96 to -1.57 minutes), number of non-antidiabetic medicines (0.43 minutes, 95%CI: 0.21–0.65 minutes), and total visits in one year (0.24 minutes, 95%CI: 0.07–0.41 minutes). Consultation with the physician owner showed no statistically significant effect (-0.18 minutes, 95%CI: -1.53 to 0.40 minutes, p = 0.208).

Conclusion: Multiple factors influence the visit duration for patients with type 2 diabetes. Adjusting these factors can reduce waiting times, alleviate overcrowding in healthcare units, and enhance service efficiency.

Keywords: diabetes mellitus type 2, primary care, visit duration, session duration

Prevalence and Factors Associated with the Risk of Obstructive Sleep Apnea in Diabetes Mellitus Type 2 Patients: A Cross-sectional Study

เธียรสิน ประสิทธิ์สมบัติ — 2026-04-30

Background: Obstructive sleep apnea (OSA) significantly affects many aspects of health. Studies in several countries have found a high prevalence of OSA among patients with type 2 diabetes. However, no research has been identified in Thailand examining the prevalence and risk factors for OSA, using appropriate screening tools at the primary care level. Therefore, this study aimed to determine the prevalence and factors associated with the risks of OSA in patients with type 2 diabetes.

Methods: In a cross-sectional analysis, data were collected from 256 type 2 diabetes patients at a chronic non-communicable disease clinic. Data were gathered through interviews, using a general information questionnaire, and the Thai version of the STOP-BANG Questionnaire to identify OSA risk. Data were analyzed using descriptive statistics, chi-square tests, t-tests, and binary logistic regression analysis.

Results: The prevalence of those at risk for OSA was 73.44%. Binary logistic regression analysis identified several significant risk factors for OSA, including snoring, daytime fatigue and sleepiness, apnea during sleep, hypertension, a body mass index greater than 35 kg/m², being over 50 years of age, with a neck circumference of more than 40 cm, and being male gender. In contrast, factors such as fasting blood-sugar levels, HbA1C, diabetes treatment methods, and achievement of diabetes control goals showed no significant differences between those in the high-risk group and the low-risk group for OSA.

Conclusions: There is a notably high prevalence of OSA risk among patients with type 2 diabetes, highlighting the importance of screening for early diagnosis.

Keywords: screening, obstructive sleep apnea, type 2 diabetes, prevalence

Survival Outcomes in Patients with End-Stage Kidney Disease Treated with Dialysis versus Conservative Management in a Rural Hospital

Siriwan Phanachet — 2026-04-30

Background: Data on survival outcomes of patients with end-stage kidney disease (ESKD) in Thailand remain scarce. This study aimed to compare the survival outcomes of patients managed with dialysis versus conservative management in a rural hospital setting.

Design: A retrospective observational cohort study.

Methods: ESKD patients aged ≥ 18 years who selected their treatment option from January 2017 to December 2023 were followed up until December 2024. Patient data were extracted from medical records and recorded using a data record form. Survival was analyzed on an intention- to-treat basis using Kaplan–Meier estimation and Laplace regression, adjusting for age, Charlson Comorbidity Index, baseline estimated glomerular filtration rate, and erythropoiesis-stimulating agents use.

Results: A total of 192 patients aged 18–90 years (mean ± SD, 61.9 ± 15.0 years) were included. The unadjusted median survival time was longer in the dialysis group than in the conservative management group (5.4, 95% confidence interval (95%CI:) 4.2–6.3 vs 1.9, 95%CI: 1.4–2.6 years; p < 0.001). However, after adjustment, the survival difference was attenuated and no longer statistically significant (adjusted median survival time differences: 1.1 years; 95%CI: -1.7–3.8; p = 0.440). Subgroup analysis revealed that patients younger than 65 years derived greater survival benefit from dialysis (adjusted median survival time differences: 2.7 years; 95%CI: 0.12–5.3; p = 0.04).

Conclusions: Dialysis tended to improve survival, particularly among patients younger than 65 years. Treatment decisions should be guided by clear communication and shared decision-making among physicians, patients, and their families.

Keywords: chronic kidney failure, chronic kidney failure, renal dialysis, conservative treatment, mortality, rural hospital

Comparison of Quality of Life in Patients with Advanced Chronic Kidney Disease Undergoing Hemodialysis, Peritoneal Dialysis, and Comprehensive Conservative Management

Nisarat Taofig — 2026-04-30

Background: End-stage renal disease (ESRD) is a life-threatening condition that significantly impacts patients’ quality of life. While various treatment modalities are available, this research aims to investigate the quality of life among ESRD patients who receive Comprehensive Conservative Kidney Management (CCKM) compared to those undergoing renal replacement therapy (RRT).

Methods: A cross-sectional analytical study was conducted to compare the quality of life between CCKM (n=23) and RRT patients(n=69). The Thai version of KDQOL-SFTM was used as the assessment tool. Independent t-test and Mann-Whitney U-Test were performed for statistical analysis.

Results: The CCKM group had significantly higher mean age, proportion of low-income, and impaired physical function compared to the RRT group (p = 0.002, 0.006, and 0.002, respectively). No significant difference was found in kidney disease-specific quality of life between the two groups. The RRT group demonstrated significantly higher scores in overall general, physical health, and mental health-related quality of life compared to the CCKM group (p = 0.021, 0.012, and 0.025, respectively). However, after adjusting for confounding factors, there were no significant differences between the two groups in kidney disease-specific quality of life, overall generic quality of life, physical health-related quality of life, and mental health-related quality of life.

Conclusions: There were no significant differences in quality of life between the RRT and CCKM groups. Treatment modality selection for end-stage renal disease patients should consider the patient and family context individually.

Keywords: quality of life, kidney replacement, palliative, end-stage renal disease

Patients’ Attitudes and Cooperation with Sexual History Taking in Primary Care and Associated Factors at Vajira Hospital Family Medicine Outpatient Clinic, Vajira Hospital: A Single-Center Cross-Sectional Study

Pornlapat Kulkeartprasert — 2026-04-30

Background: This study aimed to evaluate patients’ attitudes and cooperation in providing sexual health histories and identify factors influencing cooperation during sexual health interviews in outpatient family medicine settings.

Design: A cross-sectional, descriptive study was conducted from March to May 2024 at the Family Medicine Department Outpatient Clinic

Methods: Patients aged 18 years or older completed an anonymous self-report questionnaire. Descriptive statistics and regression analyses were used to explore factors associated with cooperation during sexual health history taking.

Results: Of the 262 participants, 144 (55.0%) provided complete responses. The mean age was 44 years, with a predominance of females (69.5%), and 64.5% of respondents had at least an associate degree. Although 66.1% had never undergone sexual health assessments, nearly half (49.4%) regarded sexual health history as equally important as general health history.

Conclusions: Overall, patients exhibited positive attitudes (>56.8% across all aspects) and a high level of cooperation (>77.1% across all aspects) toward sexual history taking. Factors associated with higher cooperation included positive attitudes, being aged ≤ 48 years, higher education levels, and recognition of the importance of sexual health history.

Keywords: sexual health history, sexual health assessment, patient cooperation, attitudes toward sexual health, primary care

Updated Geriatric Care for Family Medicine: “From Disease Management to Empowerment and Digitally Integrated Care”

สตางค์ ศุภผล — 2026-04-30

ในปัจจุบันประเทศไทยได้ก้าวเข้าสู่ "สังคมสูงวัยระดับสุดยอด" (Super-aged Society) อย่างเต็มรูปแบบในปี 2568-2569 ซึ่งถือเป็นจุดเปลี่ยนสำคัญที่แพทย์เวชศาสตร์ครอบครัวต้องปรับกระบวนทัศน์การดูแลจากเดิมที่เน้นการรักษาโรคแบบแยกส่วน (Fragmented Care) ไปสู่การดูแลเชิงรุกที่มุ่งเน้น "การรักษาศักยภาพภายใน" (Intrinsic Capacity) และการใช้เทคโนโลยีสมัยใหม่

บทความนี้ได้ทำการทบทวนวรรณกรรมเกี่ยวกับองค์ความรู้ด้านการดูแลผู้สูงอายุด้วยแหล่งอ้างอิงทันสมัย (มีการเผยแพร่ในปี 2021-2026) สรุปเป็นแนวคิดทันสมัยและนวตกรรมใหม่ในการดูแลผู้สูงอายุสำหรับแพทย์เวชศาสตร์ครอบครัว