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Objectives: Frailty is a state of homeostenosis associated with adverse outcomes. Chronic kidney disease (CKD) increases considerably by aging and shares the common risk factors with frailty. We aimed to examine the prevalence and independent associates of frailty status in CKD patients., Design: In this single-centre, cross-sectional study, we used the five-item Fatigue, Resistance, Ambulation, Illnesses and Loss of Weight (FRAIL) scale to evaluate frailty. A binary logistic regression analysis model including the parameters found to have relationship with frailty in univariate analyses was used to detect independent associates of frailty status. Odds ratio (OR) and 95% confidence interval (CI) were given., Participants: Study included 148 patients aged 18-80. Sixty (60) patients were end stage renal disease (ESRD) patients on maintenance hemodialysis (HD) (at least for 3 months) and 88 were stage 3-4 CKD patients. Thirty-seven (37) patients (42%) were eGFR G3a, 31 patients (35.3%) were eGFR G3b and 20 patients (22.7%) were eGFR G4 in stage 3-4 CKD patients., Measurements: Demographics, etiology of CKD, comorbidities, regular drugs, dialysis-related and laboratory data were recorded. FRAIL scale was scored as follows; 0=robust, 1-2=prefrail, and ≥3= frail. The frailty status was compared between frail+prefrail group vs robust (non-frail) group., Results: The prevalences of prefrailty and frailty were 68.3% and 3.3% in HD group and 53.4% and zero in stage 3-4 CKD group, respectively (p = 0.025). In the multivariate logistic regression analysis, being in HD group (OR=3.87, 95% CI= 1.06-14.19, p=0.04), older age (OR=1.09, 95% CI= 1.04-1.13) and female sex (OR=9.13, 95%CI= 2.82-29.46) were independent risk factors for frailty (p<0.001, for both)., Conclusion: Prefrailty and frailty are quite common among HD and CKD stage 3-4 patients. Being an HD patient is an independent risk factor for non-robust (frail or prefrail) status. Our findings point out a remarkably high prevalence of frailty severity (prefrailty/frailty) phenotype among patients with advanced CKD stages., Competing Interests: The authors declare that they have no conflict of interest.

Background/objectives: The physical phenotype of frailty, described by Fried et al., shows significant overlap with sarcopenia. EWGSOP2 recommends the SARC-F questionnaire to screen for sarcopenia. Considering common features between both conditions, we aimed to investigate whether the SARC-F questionnaire could also be a valid and reliable tool to screen or evaluate frailty., Design: Retrospective, cross-sectional., Setting: Istanbul University Istanbul Faculty of Medicine., Participants: A total of 447 older adults (70.7% female, mean age: 74.5±6.6 years)., Measurements: Frailty was assessed by the modified Fried scale. SARC-F questionnaire was performed by all participants. We used a receiver operating characteristics curve to obtain SARC-F cut-off values to detect frailty, and calculated the area under the curve and 95% confidence interval., Results: There were 93 (20.8%) older adults with frailty according to the modified Fried scale. SARC-F cut-off ≥1 had 91.4% sensitivity and 44.9% specificity. SARC-F cut-off ≥2 presented the best balance between sensitivity and specificity (sensitivity: 74.1% vs. specificity: 73.7%) to identify frailty (area under curve: 0.807; 95% confidence interval: 0.76-0.84, p<0.001). SARC-F ≥4 had high specificity of 92.6% with a sensitivity of 46.2%., Conclusion: We suggest that SARC-F ≥1 point can be used to screen for frailty with high sensitivity, and SARC-F ≥4 can be used to diagnose frailty with high specificity. SARC-F may be used to evaluate frailty in usual geriatric practice., Competing Interests: There are no other relationships/conditions/circumstances that present a potential conflict of interest.

Objective: Fried frailty scale is the very first and most commonly used assessment scale for an operational definition of frailty with its demonstrated success as a predictor of mobility limitations and mortality. However, it is impractical for use in routine clinical practice. We aimed to study whether a simpler modified Fried frailty scale could predict mortality among nursing home residents., Design: Retrospective longitudinal follow-up study., Setting: Nursing home. Baseline evaluation was performed in 2009. Mortality was assessed after 4 year., Participants: Two hundred-twenty-four participants were included., Measurements: Residents were assessed for demographic characteristics, falls, dementia, the number of regular medications and chronic diseases, body composition by bioimpedance analysis, basic and instrumental activities of daily living besides frailty status by a modified Fried frailty scale. The residents were assessed for mortality after a median follow-up time of 46 months. The association of frailty with mortality was analyzed by the Kaplan-Meier Log-rank test and multivariate Cox Regression analysis., Results: Mortality occurred in 90 (40.2%) of the residents. In multivariate analysis, frailty was an independent predictor of death (Hazzard ratio= 1.4, 95% confidence interval= 1.03-2.6, p=0.03) when adjusted by age, sex, presence of malnutrition, low muscle mass, number of chronic diseases and regular medications., Conclusion: Our results suggest that the simpler modified Fried frailty scale can be used as a screening tool for frailty in everyday practice as a tool to identify risky patients for mortality. Future reports studying its role in predicting other adverse outcomes associated with frailty are needed., Competing Interests: The authors declare no conflict of interest.

Background/objective: While assessment of sarcopenia has drawn much attention, assessment of low muscle power has not been studied widely. This is, to a large extend, due to a more difficult assessment of power in practice. We aimed to compare the associations of low power and sarcopenia with functional and performance measures., Material and Methods: We designed a retrospective and cross-sectional study. Community-dwelling outpatient older adults applied to a university hospital between 2012 and 2020 composed the population. We estimated body composition by bioimpedance analysis. Other measures were handgrip strength, timed-up-and-go-test (TUG), usual gait speed (UGS), activities of daily living (ADL) and instrumental activities of daily living (IADL) tests. We assessed muscle power by a practical equation using a 5-repetition sit-to-stand power test. We adjusted the power by body weight and defined low muscle power threshold as the lowest sex-specific tertile. We noted demographic characteristics, number of medications, and diseases. We defined sarcopenia by EWGSOP2 definition., Results: Cut points for low relative muscle power were <2.684 and <1.962 W/kg in males and females, respectively. Low muscle power was related with both measures of disability (impaired ADL and IADL) (OR=2.4, 95% CI= 1.4-4.0, p=0.001; OR=2.4, 95% CI= 1.4-4.1, p=0.001; respectively). Low muscle strength (i.e. probable sarcopenia) was only related with disability in IADL (OR=3.6, 95% CI= 1.6-8.; p=0.002); confirmed sarcopenia was related with neither measures. Low muscle power was not related with impaired TUG (p=1) but with impaired UGS (OR=6.6, 95% CI= 3.6-11.0; p<0.001). Probable sarcopenia was not related with impaired TUG (p=0.08) but with impaired UGS (OR=2.4, 95% CI= 1.1-5.3; p=0.03) and confirmed sarcopenia was related with neither measures (p=1, p=0.3; respectively)., Conclusion: Low muscle power detected by simple and practically applicable CSST (Chair Sit To-Stand Test) power test was a convenient measure associated with functional and performance measures. It was related to functionality and performance measures more than sarcopenia. Future longitudinal studies are needed to examine whether it predicts future impairment in ADL, IADL, and performance measures., Competing Interests: There are no other relationships/conditions/circumstances that present a potential conflict of interest.

Background/objective: In 2018 EWGSOP2 has suggested low muscle strength as the primary parameter of sarcopenia. The consensus has recommended SARC-F questionnaire as a screening test to find cases with low muscle strength which has been designated as probable sarcopenia. We aimed to study the ability of SARC-F to find probable sarcopenia cases in older patients., Design: Retrospective, cross-sectional., Setting: Istanbul University Istanbul Faculty of Medicine., Participants: A total of 456 older adults (71.1% female, mean age: 74.6±6.6 years)., Measurements: We diagnosed probable sarcopenia by EWGSOP 2 criteria, i.e., presence of low handgrip strength (HGS). SARC-F questionnaire was performed by all participants. We used a receiver operating characteristics curve to obtain SARC-F cut-off values to detect probable sarcopenia and calculated the area under the curve and 95% confidence interval (CI)., Results: We included 456 participants (71.1% female; mean age: 74.6 ± 6.6 years). Probable sarcopenia was present in 58 (12.7%). SARC-F cut-off ≥ 2 presented the best balance between sensitivity and specificity (sensitivity: 64.9% vs specificity: 67.9%) to detect probable sarcopenia [the area under the receiver operating characteristics curve (AUC) = 0.710; 95% Cl: 0.660-0.752, p< 0.001]. SARC-F with a cut-off point ≥ 1 had sensitivity 84.2% and specificity 40.5% and SARC-F ≥ 4 had high specificity 88.2% with 40.3% sensitivity., Conclusion: SARC-F is a good screening tool for sarcopenia in practice. Our findings suggest SARC-F ≥ 1 cut-off point to be used as the probable sarcopenia screening tool regarding its high sensitivity. Consequently, SARC-F ≥ 4 cut-off is better to be used if one prefers to exclude probable sarcopenia., Competing Interests: There are no other relationships/conditions/circumstances that present a potential conflict of interest.

Objective: Older adults have been continuously reported to be at higher risk for adverse outcomes of Covid-19. We aimed to describe clinical characteristics and early outcomes of the older Covid-19 patients hospitalized in our center comparatively with the younger patients, and also to analyze the triage factors that were related to the in-hospital mortality of older adults., Design: Retrospective; observational study., Setting: Istanbul Faculty of Medicine hospital, Turkey., Participants: 362 hospitalized patients with laboratory-confirmed Covid-19 from March 11 to May 11, 2020., Measurements: The demographic information; associated comorbidities; presenting clinical, laboratory, radiological characteristics on admission and outcomes from the electronic medical records were analyzed comparatively between the younger (<65 years) and older (≥65 years) adults. Factors associated with in-hospital mortality of the older adults were analyzed by multivariate regression analyses., Results: The median age was 56 years (interquartile range [IQR], 46-67), and 224 (61.9%) were male. There were 104 (28.7%) patients ≥65 years of age. More than half of the patients (58%) had one or more chronic comorbidity. The three most common presenting symptoms in the older patients were fatigue/myalgia (89.4%), dry cough (72.1%), and fever (63.5%). Cough and fever were significantly less prevalent in older adults compared to younger patients (p=0.001 and 0.008, respectively). Clinically severe pneumonia was present in 31.5% of the study population being more common in older adults (49% vs. 24.4%) (p<0.001). The laboratory parameters that were significantly different between the older and younger adults were as follows: the older patients had significantly higher CRP, D-dimer, TnT, pro-BNP, procalcitonin levels, higher prevalence of lymphopenia, neutrophilia, increased creatinine, and lower hemoglobin, ALT, albumin level (p<0.05). In the radiological evaluation, more than half of the patients (54.6%) had moderate-severe pneumonia, which was more prevalent in older patients (66% vs. 50%) (p=0.006). The adverse outcomes were significantly more prevalent in older adults compared to the younger patients (ICU admission, 28.8% vs. 8.9%; mortality, 23.1% vs. 4.3%, p<0.001). Among the triage evaluation parameters, the only factor associated with higher mortality was the presence of clinically severe pneumonia on admission (Odds Ratio=12.3, 95% confidence interval=2.7-55.5, p=0.001)., Conclusion: Older patients presented with more prevalent chronic comorbidities, less prevalent symptomatology but more severe respiratory signs and laboratory abnormalities than the younger patients. Among the triage assessment factors, the clinical evaluation of pulmonary involvement came in front to help clinicians to stratify the patients for mortality risk., Competing Interests: Alpay Medetalibeyoğlu declares that there is no conflict of interest. Naci Şenkal declares that there is no conflict of interest. Murat Köse declares that there is no conflict of interest. Yunus Çatma declares that there is no conflict of interest. Emine Bilge Çaparali declares that there is no conflict of interest. Mustafa Erelel declares that there is no conflict of interest. Mustafa Oral Öncül declares that there is no conflict of interest. Gülistan Bahat Öztürk declares that there is no conflict of interest. Tufan Tükek declares that there is no conflict of interest.

Objectives: Dysphagia is described as a geriatric syndrome that occurs more frequently with aging. It is associated with the deterioration in functionality however, it is usually ignored. Frailty is a geriatric syndrome that is recognized more with its well-known adverse consequences. Very recently, dysphagia has been suggested to accompany frailty in older adults. We aimed to investigate the association between dysphagia and frailty in the community dwelling older adults., Design: Prospective, cross-sectional study., Setting: Geriatric outpatient clinic., Participants: Older adults aged ≥60 years., Measurements: Dysphagia was evaluated by EAT-10 questionnaire and frailty by FRAIL scale. Handgrip strength (HGS) was evaluated by hand-dynamometer. Gait speed was evaluated by 4-meter usual gait speed (UGS). Nutritional status was assessed by mini-nutritional assessment-short form (MNA-SF)., Results: 1138 patients were enrolled. Mean age was 74.1±7.3 years. EAT-10 questionnaire was answered by all and FRAIL-scale by 851 subjects. EAT-10 score >15 points was regarded as significant dysphagia risk. The participants with EAT-10>15 points were older when compared to the participants with EAT-10<=15 points (p=0.002). Among participants with EAT-10>15 points, women gender and neurodegenerative diseases were more prevalent (p=0.04, p=0.002; respectively); number of chronic diseases, number of drugs and FRAIL score were higher (p=0.001 for each), and HGS, UGS, MNA-SF scores were lower (p=0.002, p=0.01, p<0.001; respectively). In multivariate analyses, the factors independently associated with presence of EAT-10 score>15 were FRAIL score and the number of drugs., Conclusion: Dysphagia is associated with frailty irrespective to age, presence of neurodegenerative diseases, number of chronic diseases and drugs. To our knowledge, this is the largest serie in the literature providing data on independent association of dysphagia with frailty., Competing Interests: The authors have no conflicts.