Background: Multimorbidity, defined as the coexistence of two or more chronic conditions in the same individual, is becoming a crucial health issue in primary care. Patients with multimorbidity utilize health care at a higher rate and have higher mortality rates and poorer quality of life compared to patients with single diseases. Aims: To explore evidence on how to advance multimorbidity management, with a focus on primary care. Primary care is where a large number of patients with multimorbidity are managed and is considered to be a gatekeeper in many health systems. Methods: A narrative review was conducted using four major electronic databases consisting of PubMed, Cochrane, World Health Organization database, and Google scholar. In the first round of reviews, priority was given to review papers summarizing the current issues and challenges in the management of multimorbidity. Thematic analysis using an inductive approach was used to build a framework on how to advance management. The second round of review focused on original articles providing evidence within the primary care context. Results: The review found that advancing multimorbidity management in primary care requires a health system approach and a patient-centered approach. The health systems approach includes three major areas: (i) improves access to care, (ii) promotes generalism, and (iii) provides a decision support system. For the patient-centered approach, four key aspects are essential for multimorbidity management: (i) promoting doctor-patient relationship, (ii) prioritizing health problems and sharing decision-making, (iii) supporting self-management, and (iv) integrating care. Advancement of multimorbidity management in primary care requires integrating concepts of multimorbidity management guidelines with concepts of patient-centered and chronic care models. This simple integration provides an overarching framework for advancing the health care system, connecting the processes of individualized care plans, and integrating care with other providers, family members, and the community.

Background and Objectives: The global population is undergoing rapid aging, resulting in an increase in geriatric syndromes and hidden health issues such as elder abuse. However, the prevalence of elder abuse varies across different settings. The objective of this study is to determine the prevalence and factors associated with elder abuse at the outpatient department of a super-tertiary care hospital in northern Thailand. Materials and Methods: This cross-sectional study involved 210 elderly patients who visited Maharaj Nakorn Chiang Mai Hospital between May and August 2022. The participants completed several assessments, including the Mini-Cog, Thai Geriatric Depression Scale-6, Core Symptom Index-15, FRAIL scale, Barthel Activities of Daily Living, Interview Guideline for Screening for Elder Abuse, and Diagnostic Criteria for Elder Abuse. Fisher’s exact test was used to examine the association between the factors and elder abuse. Results: The Screening for Elder Abuse yielded noteworthy results, with 15.7% of the elderly patients having experienced psychological abuse. However, only a smaller subset of study participants, comprising five individuals or 2.38%, met the diagnostic criteria for elder abuse. Furthermore, statistical analysis revealed no significant correlation between elder abuse and the other factors examined in the study. Conclusions: As a result, it is crucial for hospitals to consider preventive measures and implement routine screening protocols.

Poor family functioning is linked with poor child ADHD symptoms. However, there are many dimensions of family functioning. Thus, this study aims to find the association between each dimension of family functioning and controlled ADHD symptoms in an Asian culture. This cross-sectional study involved caregivers of 113 Thai children with ADHD ages 4–16 years old who visited the Outpatient Department at Maharaj Nakorn Chiang Mai Hospital between October 2017 and March 2018. The caregivers completed the Chulalongkorn Family Inventory and the SNAP-IV Thai version. Logistic regression was used to examine each dimension of family functioning adjusting for potential confounders. In univariate analyses, six of the seven dimensions of family functioning were associated with controlled ADHD symptoms. In multivariate analyses, findings revealed that good family roles (aOR 7.48, 95% CI = 1.56 to 35.85, p = 0.01) and behavior control (aOR 2.56, 95% CI = 1.08 to 6.03, p = 0.03) were associated with controlled ADHD symptoms. In children with ADHD with poor symptom control, the assessment of family functioning could be helpful. Developing a more specific intervention for caregivers that promotes good family roles and behavioral control may be beneficial.

Falls are a leading cause of morbidity and mortality in older adults, with head injuries posing significant risk. Fall-risk-increasing drugs (FRIDs) contribute to falls, but their relationship with head injuries remains unclear. This observational, cross-sectional study aimed to examine the prevalence of fall-risk-increasing drug (FRID) use and the association between specific FRID classes and fall-related head injuries in older adults. We analyzed medical records of 1,085 adults aged ≥ 60 years who presented with falls at a tertiary hospital in Northern Thailand between January and December 2023. Of these, 47.1% sustained head injuries and 71.7% used FRIDs. The most frequently used FRIDs were opioids (33.0%), anticholinergics (26.8%), and antihistamines (22.5%). Multivariable logistic regression revealed that Z-drugs (aOR = 3.09, 95% CI: 1.15–8.26, p = 0.025), antipsychotics (aOR = 2.75, 95% CI: 1.40–5.39, p = 0.003), and benzodiazepines (aOR = 1.76, 95% CI: 1.16–2.66, p = 0.008) were positively associated with head injuries. Conversely, anticholinergics (aOR = 0.54, 95% CI: 0.40–0.72, p < 0.001) and opioids (aOR = 0.39, 95% CI: 0.30–0.51, p < 0.001) showed negative associations. These findings emphasize the need for careful medication management to prevent serious fall-related outcomes in geriatric populations.

Objective: The prevalence of poor sleep quality has been greatly escalating over the past years, along with the surging of type 2 Diabetes Mellitus (DM). The aging population is most concerned as sleep quality is notably impaired and influences the diabetic condition. This study aimed to observe the sleep quality and factors related to poor sleep quality in elderly patients with type-2 DM. Materials and Methods: A cross-sectional study of patients with type 2 DM, aged 60 years and above was conducted. The questionnaires included demographic data, the Thai version of the Pittsburgh Sleep Quality Index (T-PSQI), the Thai version of the Diabetic-39, and the Thai Geriatric Depression Scale-15. Factors associated with sleep quality were analyzed using the logistic regression model. Results: Among 385 participants with a mean age of 67 years old was 63.90% female. The prevalence of poor sleep quality was 9.88%. No association was found between sleep quality and glycemic levels. The related factors for poor sleep quality were sex (aOR = 2.57, p = 0.035, 95%CI = 1.06-5.93), body mass index (aOR =1.09, p = 0.028, 95% CI = 1.00-1.20), and diabetic complications. Diabetic retinopathy showed highest odd ratio (aOR = 6.28, p = 0.021, 95% CI = 1.32-29.94). Conclusion: The prevalence of poor sleep quality was low in the current study. We found a strong association between diabetic complications and poor sleep quality. Evaluation of sleep quality may help to enhance overall health and care for diabetic geriatric patients.