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Purpose: The aim of the study was to observe the relationship between age, body mass index (BMI), physical activity, and kyphosis angle parameters with respiratory function capacity in community-dwelling older adults and to determine the main predictor. Methods: A prospective cross-sectional study was carried out with 70 older adults. Physical activity level was questioned with the Physical Activity Scale for Elderly (PASE). Thoracic kyphosis degrees were measured with a digital inclinometer. Pulmonary Function Test (PFT) was used to measure pulmonary function capacity. The correlation between age, BMI, PASE, thoracic kyphosis angle with parameters of PFT measurement was analyzed. In addition, a linear multivariate regression model was built to determine the main predictor. Results: The mean age of the participants was 69.88 +/- 4.52 years. There was a low degree but a statistically significant positive correlation between BMI and FEV1 (r=0.258, p, Ege University Scientific Research Projects Coordination Unit [TGA-2019-20857], The authors would like to thank Ege University Scientific Research Projects Coordination Unit for their financial support to this project (TGA-2019-20857) .

Spontan dalak infarktı, yaşlı yetişkinlerde nadir görülen karın ağrısı nedenlerinden biridir. Tanı; klinik bulgular ve görüntüleme yöntemleri ile konur. Geçmiş yıllarda ultrasonografi ve bilgisayarlı tomografinin splenik infarkt tanısındaki yeri önem kazanmıştır. Raporlanmış çoğu dalak infarktı fokaldir ve konservatif tedavi edilmektedir. 82 yaşında kadın hasta, 15 gün önce başlayan karın ağrısı nedeni ile başvurdu ve özgeçmişinde meme kanseri, paroksismal atriyal fibrilasyon ve hipertansiyon olduğuöğrenildi. Fizik muayenede; dalak kot altında palpe edilmekteydi. Bilgisayarlı tomografide; 16 cm uzunlukta ölçülen dalağın içinde subkapsüler infarkt alanları ve periportal alanda 4,5 cm çaplı konglomere lenfadenopati saptandı. Doppler ultrasonografide kama şeklinde infarkt alanları ve heterojen hipoekoik avasküler alanlar olduğu görüldü. Laboratuvar tetkikleri sonrasında altta yatan nedenin marjinal zon lenfoma olduğu saptandı. Hastaya konservatif tedavi verildi ve hematolojikmaligniteye yönelik kemoterapi planı yapıldı. Komorbiditeleri olan yaşlı yetişkinlerde, akut başlangıçlı sol üst kadran ağrısıyla karşılaşıldığında dalak infarktı akılda tutulması gereken bir durumdur., Spontaneous splenic infarction has been rarely reported within aged population. The diagnosis of the condition is based on clinical findings and splenic imaging. In recent years, ultrasonography and computed tomographic scan have gained in popularity for the diagnosis of splenic infarction. Most reported cases are focal infarctions, and treatment is mostly conservative. We described the case of a 82-year-old female with cured breast cancer, paroxysmal atrial fibrillation, hypertension who had left upper quadrant pain within 15 days. Physical examination on admission revealed a palpable splenomegaly. Abdominal computed tomography scan showed many subcapsular infarct zones of the spleen measuring 16 cm in length and 4.5 cm conglomerate lymphadenopathies within periportal region. Doppler ultrasound revealed wedge-shaped heterogeneous hypoechoic avascular areas and lymphadenopathies. After laboratory tests, the underlying cause was found as marginal zonelymphoma. The patient was treated with conservative management and chemotherapy was planned for specific cause. Splenic infarction must be kept in mind for older patients with underlying comorbidities presenting with acute left upper quadrant pain.

Aim: The pandemic of Severe Acute Respiratory Syndrome-Coronavirus-2 was more severe and more fatal for elders and individuals who have chronic diseases. The treatment may be delayed due to the elders’ “fear of infection” in hospitals. This study aimed to evaluate the data of older patients who were admitted to the Geriatrics clinic in the normalization period. Materials and Methods: The data was retrieved between June-August 2020, retrospectively from the file database for older patients who were hospitalized in a geriatrics clinic of a university hospital. Results: 23 patients were included in the study and their mean age was 81.4±7.4 years. The most common symptoms at admission were changes in consciousness, weight loss, and malnutrition, respectively. The duration of symptoms was less than a month in 56.5% of patients, 1-3 months in 17.4% of patients, and more than 3 months in 26.1% of patients. The most common indications were delirium, urinary tract infection, and acute renal failure, respectively 73.9% of patients applied from the outpatient clinics and 26.1% from the emergency clinic. The mean hospitalization duration was 24.2 ± 17,2 days. 43.5% of patients had delirium and 21.7% had pressure ulcers during their hospitalization. Conclusion: The hospitalization indications had variations, outpatient hospitalizations were higher, and the duration of hospitalization was longer during normalization process of SARS CoV-2. Approximately, half of the patients had symptoms for more than a month and it is an important point to be investigated. In addition, geriatric syndromes such as delirium and pressure ulcer increased in this process

Dysphagia is one of the most common and important complications of stroke. It is an independent marker of poor outcome after acute stroke and may become chronic after the acute period and continues to affect all aspects of the patient's life. Patients with stroke may encounter any of the medical branches in the emergency room or outpatient clinic, and as in our country, there may not be specialists specific for dysphagia, such as speech-language pathologists (SLP), in every hospital. This study aimed to raise awareness and create a common opinion of medical specialists for stroke patients with dysphagia. This recommendation paper has been written by a multidisciplinary team and offers 45 recommendations for stroke patients with dysphagia. It was created using the eight-step Delphi round via e-mail. This study is mostly specific to Turkey. However, since it contains detailed recommendations from the perspective of various disciplines associated with stroke, this consensus-based recommendation paper is not only a useful guide to address clinical questions in practice for the clinical management of dysphagia in terms of management, diagnosis, and follow-up, but also includes detailed comments for these topics.

Denosumab is a relatively new medicine that has become the second option in the treatment of biphosphonate-resistant or intolerant osteoporosis. Subcutaneous injection with 6-month intervals, approval of its usage in stage 3-4 CKD and not having gastrointestinal side effects are advantages of denosumab. However, it has some disadvantages like requiring monitoring serum levels of calcium and vitamin D before each injection.

Dysphagia is one of the most common and important complications of stroke. It is an independent marker of poor outcome following acute stroke and it continues to be effective for many years. This consensus-based guideline is not only a good address to clinical questions in practice for the clinical management of dysphagia including management, diagnosis, follow-up, and rehabilitation methods, but also includes detailed algorithms for these topics. The recommendation paper has been written by a multidisciplinary team and offers 117 recommendations for stroke patients with dysphagia. While focusing on management principles, diagnosis, and follow-up in the 1st part (45 items), rehabilitation details were evaluated in the 2nd part (72 items).

Objective Sarcopenia, a geriatric syndrome, is an indicator of poor prognosis in elderly inpatients. In this study, we aimed to determine the effect of sarcopenia on mortality in elderly patients. Materials and methods Mobile/immobile geriatric inpatients, treated in the internal medicine ward between February and November 2018, were included in the study between Days 2 and 7 of hospitalization. The patients' fat-free mass (FFM) was measured by bioimpedance. The FFM index (FFMI) (kg/m2) was determined by dividing fat-free mass by body surface area (FFM/BSA). Sarcopenia was defined as a FFMI value at least two standard deviations below the gender-specific mean of normal young adults. Results The study included 200 geriatric inpatients; 96 (48.0%) were men, and the mean age was 74.49±6.32 years. Sarcopenia was detected in 28 (14%) of the patients. Diabetes mellitus was associated with a significantly lower sarcopenia prevalence (p=0.006). The risk of sarcopenia was 9.046 times higher in malnourished patients. The sarcopenia group had more deaths (p=0.012). Conclusion Sarcopenia in geriatric inpatients increased the length of hospital stay and mortality. Our findings may guide future studies examining the relationship between sarcopenia and mortality among elderly inpatients in other hospitals.

Purpose The aim of this study was to evaluate the effects of Otago exercises on falls, balance, and physical performance in old-aged adults with high fall risk living in a nursing home. Methods This randomized controlled trial included 72 individuals over 65 years of age residing in a single nursing home in Izmir, Turkey. The participants were randomized into the Otago exercise group and walking (control) group. The Otago group performed 45 min of Otago exercises 3 days/week for 12 weeks plus a walking program on 3 other days of the week. The control group did only the walking program (minimum of 30 min 3 days/week). Number of falls, Berg Balance Scale (BBS), 30-s Chair Stand Test (30 s-CST), and 6-min Walk Test (6MWT) were assessed before the intervention and at the end of the 3-month intervention. The primary outcome was number of falls. Results The groups were well matched in terms of age (74.6 +/- 5.9 vs. 75.8 +/- 4.5) and sex (p > 0.05). The Otago group showed a significantly greater reduction in number of falls at the end of the intervention (p < 0.05). of the secondary outcomes, the Otago group had greater median increases in BBS score (p < 0.05) and 30 s-CST score (p < 0.05) post-intervention compared to the walking group. There was no significant difference between the groups in terms of post-intervention change in 6MWT distance (p > 0.05). Conclusion The Otago exercise program improved balance and physical performance and reduced falls in our sample and may be effective in falls prevention interventions for old-aged nursing home residents. Key summary pointsAim This study evaluated the effects of Otago exercises on falls, balance, and physical performance in older adults with high falls risk living in a nursing home. Findings The Otago exercise group showed a significantly greater reduction in number of falls at the end of the 3-month intervention compared to the walking group. Message The Otago exercise program may have a role in the prevention of falls in older persons.

As the older population steadily grows, a corresponding increase in elderly suicides is also expected. In addition, due to differences in the physical and psychosocial characteristics of this age group, the characteristics of elderly suicides are predicted to be different to those of other groups. In this study, we aimed to report the characteristics of suicides 60 years and older according to sex and age subgroups. We retrospectively reviewed the autopsy reports of individuals aged 60 and older who committed suicide in Turkey during the 10-year period between 2005 and 2014. Their age, sex, cause of death, and year, month, season, place, and method of suicide were analyzed. Comparisons were made based on sex, age subgroup, demographic variables, and descriptive characteristics of the suicides. Of 17,942 forensic autopsies, 525 were elderly suicides. Of these, 77.3% were men and the mean age was 71.26 ± 8.16 (range, 60–94) years. There were statistically significant differences in suicide method according to sex (p < 0.001, X = 43.984) and age subgroups (p = 0.001, X = 51.457). For both sexes, hanging was the most common suicide method (59.4%) and the majority of suicides occurred at home (73.1%). The suicides occurred more frequently in the 65–74 age subgroup, in the summer, and in the months of June and July. Identifying the characteristics of elderly suicides, especially by sex and age subgroups, may be beneficial for suicide risk assessment and the development of prediction and prevention programs. © 2020, This study was performed with the permission of Istanbul Forensic Medicine Institute, Turkey.

Objective The empowerment of old people is important in order for them to gain control over their own lives and to raise their quality of life. The purpose of this study was to adapt the Diabetes Empowerment Scale-Short Form (DES-SF) to old people and to the Turkish language, and to determine its validity and reliability. Materials and methods This methodological type study was conducted between 1 January and 30 March 2017 with 106 old people fitting the criteria of acceptance in the study who attended the geriatrics clinic of a university hospital. In determining validity, language equivalence, content, and predictive validity were used, while reliability was tested with temporal invariance, Cronbach's alpha coefficient, and item total correlation. We examined its reliability and validity via item analyses, content validity (expert panel), confirmatory factor analyses, and construct validity (exploratory factor analyses). Results The Cronbach's alpha of the scale was 0.883. The scale items were grouped under a single factor in accordance with the original. Confirmatory and exploratory factor analysis showed good fit signs. Conclusion After conducting validity and reliability testing on the adaptation of the Diabetic Empowerment Scale-Short Form to old people and the Turkish language, it is was concluded that it is a reliable scale to determine the empowerment levels of old people. Based on the statistical analyses applied to evaluate the validity and reliability of the scale obtained by adapting the DES-SF to old people, it was inferred that it is an instrument with high validity and reliability. The scale is a short and practical instrument to evaluate the empowerment levels of old people. The new name of the scale is the elderly empowerment scale.

Yaşla birlikte epigastrik şikâyetler daha yaygın görülmekte ve bu nedenle proton pompası inhibitörlerine (PPİ) yaşlılarda daha sık başvurulmaktadır. PPİ tedavisi, zararsız olduğu yönündeki algı nedeniyle uygunsuz doz ve sürede kullanılmaktadır. Uzun süre PPI kullanımına bağlı ortaya çıkan sık yan etkiler; enfeksiyonlar (Clostridium difficile enteriti, mikroskobik kolit, toplum kaynaklı pnömoni), sindirim ve emilim bozuklukları (vitamin B12, demir, kalsiyum eksiklikleri, hipofosfatemi, hipomagnezemi), kemik kırıkları, akut interstisyel nefrit, demans, kronik böbrek yetmezliğidir. Bu olguda kronik PPİ kullanımının nadir görülen yan etkilerinden biri olan nöroendokrin tümör sunularak uygunsuz ilaç kullanımının sonuçlarına dikkat çekilmek istenmiştir.

The aim of this study was to investigate the prevalence of delirium and its association with mortality rates in elderly inpatients.The medical records of 1435 patients over 65 years old who were treated at a regional university hospital and were referred to the university's Consultation and Liaison Psychiatry Clinic for psychological evaluation were retrospectively analyzed. Patients with and without a diagnosis of delirium were compared. The National Survival Database was used to determine mortality rates.The prevalence of delirium was 25.5%. The delirium group was older (p .0001) and had a larger proportion of males (p .0001). Mortality rate was higher in the delirium group at 1, 2, 3, 4, and 5 years (p .0001 for all). Age, gender, lower urinary system diseases, chronic liver disease, solid hematologic malignancy, infections, and Alzheimer's disease emerged as significant parameters associated with mortality. Multivariate analysis of these parameters indicated that comorbid diseases (lower urinary system diseases, chronic liver disease, solid hematologic malignancy, infections, and Alzheimer's disease) are risk factors for mortality independent of demographic data such as age and gender.Independent of all other factors, delirium is associated with higher mortality risk.

Introduction Clinical and forensic autopsies are the best methods for determining cause of death. The aim of this study was to determine demographic and etiologic characteristics in geriatric forensic cases analyzed in Erzurum, Turkey. Materials and methods Autopsy reports and prosecution documents of decedents aged 65 and older autopsied in the Morgue Specialization Department of the Forensic Medicine Institute, Erzurum Division between January 1, 2010 and December 31, 2015 were screened retrospectively. Results The study included 399 subjects with a mean age of 74.38 ± 7.28 years. A large proportion of the subjects were in the young and middle old age group (n = 218, 54.63%) and male (n = 286, 71.68%). Autopsy was performed on 198 (49.62%) of the subjects, cause of death was determined by post-mortem external examination in 199 (49.87%), and documents were unavailable for 2 subjects. Cause of death was determined as natural in 130 (32.58%) of the decedents and unnatural in 269 (67.42%). The most common natural cause of death was cardiovascular disease (n = 94, 76.4%). Unnatural causes of death included accident in 223 (82.90%), suicide in 25 (9.30%) and homicide in 21 (7.80%) of the decedents. A large proportion of the accidents were traffic accidents (n = 120, 53.80%). The most common method of committing suicide was hanging (n = 15, 60%), whereas homicides were most often committed by blunt force trauma (n = 9, 42.86%). Conclusion Our data are consistent with the literature, allowing for some variation based on regional sociocultural characteristics.

WOS: 000406453100004, PubMed ID: 28725304, Background: Percutaneous endoscopic gastrotomy (PEG) enables long-term enteral feeding. The aim of this study was to identify biomarkers that may guide the decision of whether to perform the elective procedure of PEG. Methods: The medical records of all patients who underwent PEG in our hospital from 2010 to 2016 were screened retrospectively. Patients with mortality within a 30-day follow-up period and those without were compared using the Chi-square test, and continuous variables were compared with the Kruskal-Wallis and Mann-Whitney U tests. Receiver operating characteristic (ROC) curve analysis was used to demonstrate the ability of biomarkers to predict mortality; a cut-off point was determined and its sensitivity, specificity, and positive and negative predictive values were calculated. The Youden index was used to determine the cut-off point. Kaplan-Meier analysis was used to identify PEG-related mortality risk factors and a Cox regression model was applied for risk characterization. Results: A total of 120 patients who underwent PEG were evaluated in the study. The mean age was 67.00 +/- 18.00 years. The most common indication for PEG was cerebrovascular disease, in 69 (57.5%) of the patients. Infection of the PEG site was most common within 14 days after PEG tube placement, occurring in 13 patients (10.3%). The mortality rate among patients with post-PEG infection was 68.2%, significantly higher than in patients without infection (P = 0.012). Thirty-four patients (28.3%) died within 30 days of undergoing PEG. CRP values >= 78.31 mg/ L increased mortality by 8.756-fold, and albumin levels < 2.71 g/dL increased mortality by 2.255-fold. Conclusion: Our results indicate that the presence of both high CRP level and low albumin level were associated with significantly higher rate of mortality (73.1%) in patients who underwent PEG.

WOS: 000472526000006, PubMed ID: 31219491, Objectives: To determine the prevalence of sarcopenia and related factors in individuals aged >= 65 years living in the Bornova district of Izmir, Turkey. Sarcopenia is one of the most serious health problems among elderly individuals. Methods: This cross-sectional study was conducted in the Bornova district of Izmir, Turkey, between February-July 2015. This study participants were comprised of 909 individuals aged >= 65 years. The dependent variable was the presence of sarcopenia and the European Working Group on Sarcopenia in Older People (EWGSOP) approach was used for determining sarcopenia. The independent variables were socio-demographic and economic characteristics, healthy life behaviors and health status/condition. Data were collected at home through face-to-face interviews and measurements, analysed using chisquare test, t-test and logistic regression analysis. Results: The participants' mean age was 72.8 +/- 6.2 (range: 65-100) years, and 60.2% were female (n=582). The prevalence of sarcopenia was 5.2% and that of low gait speed was 41.0%, low grip strength was 57.0%, low calf circumference was 6.1% and the combination of low gait speed and low grip strength was 14.3%. Risk factors of sarcopenia included increasing age, physical inactivity, low body mass index and the presence or risk of malnutrition. Conclusion: The prevalence of sarcopenia was 5.2% in this population and increased with age, physical inactivity, low body mass index and the presence or risk of malnutrition.

Objective Sarcopenia, functional disability, and depression are common problems in the elderly. Sarcopenia is associated with physical disability, functional impairment, depression, cardiometabolic diseases, and even mortality. This study aims to determine the association of sarcopenia with depression and functional status among ambulatory community-dwelling elderly aged 65 years and older. Materials and method The sample of this cross-sectional study consisted of 28,323 people, aged 65 years and older, living in Bornova, Izmir. Multi-stage sample selection was performed to reach 1007 individuals. However, 966 elderly people could be reached, and 861 elderly people who can walk were included in the study. The data were collected by the interviewers at home through face-to-face interview. Results The mean age was 72.2 ± 5.8 (65–100) years. The prevalence of functional disability, depressive symptoms, and sarcopenia were 21.7%, 25.2%, and 4.6%, respectively. In multivariate analysis depression was associated with sarcopenia, being illiterate and divorced, perception of the economic situation as poor/moderate, increased number of chronic diseases, and having at least one physical disability. IADL associated functional disability with sarcopenia, being illiterate/literate and female, increased age and number of medications, and the BMI. Conclusion Sarcopenia in ambulatory community-dwelling elderly is significantly associated with depressive symptoms and functional disability. Elderly people at high risk of sarcopenia should be screened for functional disability and depression. Appropriate interventions should also be implemented.

Purpose This study was conducted to determine the attitudes of nursing students towards elderly people. Methods The study was carried out in a cross-sectional and descriptive design. The Turkish version of UCLA-GA Scale was used to evaluate attitudes towards older people among 931 students attending four schools of nursing located in Aegean, Mediterranean, Marmara regions and Istanbul in Turkey. Results Mean score of UCLA-GA scale was 48.64 ± 5.51 (min: 22, max: 64). Female students were found to have more positive attitudes than male students (t = 2.709, P Conclusion Positive attitudes towards ageism were affected by variables such as: sex, willingness to live with aged parents after starting a family, work with older people after graduation and whether they had previously or currently lived with an aged relative.

Introduction Several studies have attempted to define the diagnostic criteria of the geriatric syndrome sarcopenia. Studies of sarcopenia prevalence in Turkey are limited; one reason for this is the absence of standard diagnostic reference values. The aim of this study was to investigate the prevalence of sarcopenia and its influencing factors in the local elderly nursing home residents in accordance with the EWGSOP consensus report. Materials and methods The study included a total of 211 nursing home residents. Anthropometric measurements, muscle mass, muscle strength and physical performance were examined. Muscle mass of the nursing home residents was compared to an 18–45-year-old healthy control group. Descriptive values for numerical variables are given as mean, standard deviation; categorical variables are shown as frequency and percentage. Results A total of 211 nursing home residents were included in the study. The average age was 77.30 ± 7.20; the participants were 58.8% women and 37.4% young-old. The prevalence of sarcopenia in Turkish nursing home residents was found to be 33.6%. Among sarcopenic participants, 32.4% were women and 67.6% were men. In our study, sarcopenia was more prevalent in men, the young-old, and patients with Parkinson's or chronic obstructive lung disease, while sarcopenia was seen less in obese patients. No relationship was found between the Barthel index and sarcopenia. Conclusions Sarcopenia prevalence was 33.6% when the diagnostic criteria described by the EWGSOP were used. Sarcopenia prevalence was higher in men and the young-old age groups. Sarcopenia was more frequent in nursing home residents with malnutrition or risk of malnutrition.

1 Tepecik Training and Research Hospital, Department of Internal Medicine, Izmir, Turkey 2 Ege University Faculty of Medicine, Department of Internal Medicine, Division of Geriatrics, Izmir, Turkey 3 Tepecik Training and Research Hospital, Department of Cardiology, Izmir, Turkey 4 Tepecik Training and Research Hospital, Department of Biochemistry, Izmir, Turkey 5 Tepecik Training and Research Hospital, Department of Nephrology, Izmir, Turkey 6 Abant Izzet Baysal University Faculty of Medicine, Department of Nephrology, Bolu, Turkey doi: 10.5262/tndt.2014.1003.08

Sarcopenia and sarcopenic obesity (SO) are geriatric syndromes leading to physical disability, poor quality of life and death. The aim of this study was to investigate the prevalence of sarcopenia and SO in nursing homes in Turkey and to define local disparities for diagnosing sarcopenia and SO. This cross-sectional multicenter study was performed in 711 patients in 14 nursing homes. Comprehensive geriatric assessment tests, handgrip strength and calf circumference (CC) measurements were carried out. Sarcopenia was both defined by handgrip strength and CC criteria. According to handgrip strength measurement, 483 (68%) of patients were sarcopenic (male: 72%, female: 63.8%), 228 were non-sarcopenic. The prevalence of SO was 22% (13.7% in men, 30.2% in women). Patients (82.5%) who were diagnosed as sarcopenic by the handgrip strength test were not sarcopenic according to CC sarcopenia criteria. Therefore, we tried to determine the optimal CC value for diagnosing sarcopenia in our population. Both sarcopenia and SO were prevalent among Turkish nursing home elderly residents. Most of the patients with sarcopenia were obese or overweight. We showed that diagnosing sarcopenia with CC measurement underestimated the sarcopenia prevalence assessed by handgrip strength. So we concluded that, although different assessment methods are recommended for the diagnosis of sarcopenia local disparities should be considered.

Objectives The purpose of this study was to examine the reliability and validity of the Social Support Scale in Chronic Diseases (SSCII) Scale Turkish version that was developed by Hilbert-McAllister. Methods This was planning a methodological study. Research group consists of 163 older persons that accepted to participate in this study and who had a chronic disease. Data were collected in 15th June–15th August 2012 period from two homes for aged in Izmir Provinence. The necessary ethical approval was obtained from the institutions and each participant for research. Results SSCII Scale was translated to Turkish for language validity. For content validity, it was obtained of experts view and it was corrected according to expert's suggestions. For content validity, Kendall goodness-of-fit Correlation test was performed (Kendall's Wa = 0.167, χ2 = 49.337, df = 37, p = 0.084). In reliability and validity study, first of all, total item score correlation was examined. All items were upper than 0.20 correlation limit and there were a significant relationship between total item correlation score. Scale originally has 38 items in the latest version in Turkish. For reliability of the scale, it was performed the internal consistency analysis and it was find that Cronbach's alpha coefficient as 0.89. So, the scale has an acceptable level internal consistency coefficient. For the determining of scale's time stability, it was applied to initial 32 older persons after first survey. A significant relation found between test-retest scores (p = 0.000). Conclusion SSCII Scale Turkish version is a reliable and valid scale for the Turkish community.

Infections are a major cause of morbidity and mortality in the elderly. Improvements in health care prevention including vaccinations and treatment have led to an increase in the birth life expectancy. The vaccines that are now recommended for people over 60 are influenza, herpes zoster and a vaccine combining tetanus toxoid, reduced diphtheria toxoid, and pneumococcal vaccine. Our aim was to estimate the prevelance of vaccination among diabetic patients attending in Tepecik Training Hospital and in Ege University Faculty of Medicine. Patients and Methods: Individuals at or over the age of 60 who were attending to Tepecik Training Hospital and at Ege University Faculty of Medicine. Department of Internal Medicine was targeted from February to May 2014. Our data are collected from the patients face to face by questionnaire. Results: A total of 274 elderly patients with a mean ± SD (range) age of 72 ± 6 (62 - 93) years were questioned. The vaccination ratios were determined as 34% (93) for influenza, 9.5% (26) for pneumococcal, 10.6% (27) for tetanus vaccine. The patients were divided in two groups as diabetics and non-diabetics. The influenza vaccination rate is 38.1% in diabetic patients, rate of 31.8% in non-diabetic patients, the pneumococcal vaccine rate is 13.4% in diabetic patients, rate of 7.39% in non-diabetic patients. The tetanus vaccination rate is 9.28% in diabetic patients, rate of 11.36% in non-diabetic patients. No statistically significant difference between two groups was determined.

Background and aim Malnutrition is related with serious morbidity and mortality in institutionalized older adults. The aim of this study is to determine the frequency of malnutrition in nursing homes and care homes and to identify the factors associated with malnutrition in these settings. Methods This multicenter study was conducted in 14 centers of nursing homes/care homes in three different cities. Total number of 1797 residents aged ≥ 65 years was enrolled. Malnutrition screening was made by Mini Nutritional Assessment Short Form (MNA-SF) and full MNA. Statistical analyses were conducted by SPSS 15.0. Results The median age (min–max) of the study population was 78.0 (65.0–108.0) and 917 (51%) were female. MNA-SF score of the residents was 11 (0-14). According to the MNA-SF 850 (49.3%) residents had normal nutritional status, 654 (38.3%) residents were at malnutrition risk, and 204 (11.9%) had malnutrition. Number of medications, gender, duration of stay in the institution, frequency of family visits, social security status, type of nursing home (government or not), daily life activities (ADL), Geriatric Depression Scale (GDS) and MMSE scores, get up & go test, hypertension, dementia, depression, and Parkinson disease were associated with malnutrition. Regression analyses revealed that get up&go test, GDS, hypertension, and ADL were independently related to malnutrition diagnosed by MNA-SF. Conclusion This study provides important information on the prevalence and associated factors of malnutrition in a large multicentered setting of nursing homes and care homes. It will direct the screening plans and interventions taken in order to detect, prevent, and manage malnutrition in these settings.

Background and aim Malnutrition is an important cause of mortality and morbidity in the elderly. The objectives of this study were to determine the malnutrition and food insecurity prevalence in the elderly in the Balcova District of Izmir and to evaluate the risk factors leading to malnutrition. Methods This cross-sectional study ( n =650) was carried out among elderly participants in a lower socio-economic area of the Balcova District in Izmir. Malnutrition was determined using the Mini Nutritional Assessment (MNA) tool. Food insecurity was defined according to the Nutrition Survey of the Elderly in New York State (NSENY) study. Data was collected at home via face-to-face interview and measuring anthropometric indices. Chi-square and logistic regression were used in analysis. Results Among participants, 62.9% of them ( n =409) were female. The mean age was found to be 74.1±6.3 (65-97). Food insecurity prevalence was 21.7%, whereas for malnutrition and malnutrition risk it was 2.7% and 28.0% respectively. The following factors were found to significantly increase the risk of malnutrition: Increased age (OR=1.06 P =0.001) and number of chronic diseases (OR=1.41 P P =0.002), bad-very bad perceived economic (OR=2.49 P =0.002) and health status (OR=4.33 P P =0.047) and presence of food insecurity (OR=2.49 P =0.001). Conclusion Based on our research of previous related studies, we expected food insecurity and malnutrition rates to be lower. In order to determine food insecurity and malnutrition risk in the community-dwelling elderly, first it was necessary to establish a monitoring programme.

Gastrostomy tube feeding is used to maintain or improve nutritional status in older patients with severe dysphagia and/or severe malnutrition due to different diseases. This paper explores the use of gastrostomies within geriatric care in three European countries to better understand the problems underlying variability in its use. Large differences are described in the rates of use of gastrostomies between countries and inside each country, but its incidence has been steadily growing in recent years, apparently peaking in Germany due to better adherence to guidelines. In geriatric care, the most frequent indications for gastrostomies are advanced neurodegenerative diseases. Decision on placing a gastrostomy is not consistent, with different specialists concerned and different decision-making processes. Specialists in geriatric care and nutrition are not always involved, even in complex older patients. The pull endoscopic technique is the preferred method to place gastrostomies, either ambulatory or with a short hospital stay; other insertion techniques are used occasionally. Both gastrostomy insertion and tube feeding are mostly paid by the national health system of each country. The goal of tube feeding is to cover the individual's nutritional needs but, in the context of geriatric medicine, the potential of tube feeding for improving function, quality of life or survival is also considered before a gastrostomy is chosen. Many ethical and cultural issues are involved in tube feeding, and attitudes of patients and caregivers seem to be quite different in different countries and settings.

Background The aim of this study was to evaluate the general characteristics of geriatric patients hospitalized at the internal medicine intensive care unit (IMICU). Methods All patients aged above 65 years and admitted to the intensive care unit of the internal medicine department at Ege University Hospital October 2010 to February 2011 were included in the study. Files of the patients were accessed retrospectively and the following information was recorded: age, gender, main cause of intensive care admission, number of chronic diseases, laboratory results, drug use and other therapeutic procedures, length of stay, outcomes in terms of survival and mortality. Secondary outcomes were defined to compare patients admitted to the intensive care unit from the emergency ward with those transferred from the internal medicine wards. Results The total number of patients admitted to the internal medicine intensive care unit during the study period was 357, of whom 171 (47.99%) were aged above 65 years, a mean age of 74±6.6 years without any statistically significant difference between gender ( P =0.859). Days of hospitalization at the intensive care were 15.7±4.8, in patient mortality was found to be 17.7%, The mean number of chronic diseases per patient was 2.2±1.3. and the most frequent chronic diseases were arterial hypertension 57%. The most frequent pathology of the patients was found to be renal dysfunction 38.6% ( n =66), followed by anaemia 38.0% ( n =65) and liver dysfunction 11.7% ( n =20). The ratio of haemodialysis (HD) was found as 11.7%. When the patients were assessed in terms of invasive interventions by grouping them into those admitted from the emergency unit and those transferring from the internal medicine departments, it was seen that foley, intravenous catheterization, nasogastric tube insertion and HD were significantly higher for the patients admitted from the emergency unit. Mortality rate was found to be significantly higher for same group (44% versus 17, P Conclusion The proportion of elderly in the intensive care unit is increasing. In the present study renal dysfunction is the most common organ failure. Infection seems to be one of the common problems in IMICU. Organ failure and invasive intervention needs are high in elderly patient admitted from the emergency ward to intensive care.

Çiçek, Zeynep (Arel Author) --- Yüksek Lisans Öğrencisi (Klinik Psikoloji), Purpose Malnutrition is one of the most important geriatric syndromes in the elderly. The aim of this study was to investigate the association between anemia and malnutrition in elderly nursing home residents. Materials and methods Local nursing home residents over 60 years old in the Izmir were included in the study. Blood samples were taken from study participants for hemogram, iron, ferritin, total iron-binding capacity, vitamin B12 and folic acid analysis. WHO criteria were used to define anemia. Causes of anemia were classified as iron deficiency, vitamin B12 or folic acid deficiency, anemia of chronic disease or other hematologic causes. Anemia was defined as the dependent variable and malnutrition was defined as the independent variable. Correlation between MNA scores and Hb levels was determined using Pearson correlation analysis. The slope of causality between malnutrition and anemia was determined using the v2 test and logistic regression analysis.Results The study included 257 elderly nursing home residents with a mean age of 78.5 ± 7.8 years. The overall prevalence of anemia was 54.9 %; 35.8 % of the study participants were at risk of malnutrition and 8.2 % were malnourished. Anemia risk was 2.12-fold higher in participants at risk of malnutrition and 5.05-fold higher in those with malnutrition. In the participants with malnutrition or malnutrition risk, the most common cause of anemia was anemia of chronic disease (57.1 and 46.5 %, respectively). Conclusion The prevalence of anemia among elderly nursing home residents is high in Turkey. Malnutrition and malnutrition risk increase the incidence of anemia.

The population of above 65 years of age is increasing fast in societies, as the life expectancy is increasing and it leads to high demands for health care service. Health care service for the elderly should be provided by trained team in this field. Success of health care service to be rendered is related to knowledge, skill and attitudes of team members in different profession group (doctor, nurse, social worker, psychologist, etc.) about health of elderly. The aim of this study is to establish the Turkish validity and reliability of 14-question UCLA-GA scale, validity and reliability of which was proven and used the most frequently among the scales that assess attitudes of health care providers toward elderly. A total 256 people, 150 of them were post-graduates, 106 of them were pre-graduates were involved in the study at Ege University, medical faculty between the dates of December 2010 and February 2011. Majority of the participants (63.67%) were women and in the age group of 18-29 (58.3%). The ratio of the ones undergoing geriatric education is 38.2%. It was found out that the Kaiser-Meyer-Olkin (KMO) sampling adequacy test presented high correlation among the items in both single adult households of 14 items of the scale was 0.72. Cronbach alpha value of the scale was found as 0.67 and satisfying. As a result of examination with Tukey's test of additivity, it was seen that items of the scale have additive quality (F=85.25, p

In this study, transfer functions of electronic expansion valve and variable speed scroll compressor in a chiller system are developed based on an experimental analysis. Dynamic behaviours of water temperature at chiller output and refrigerant superheat at evaporator outlet have either the first- or the second-order linear models, respectively. Different from the existing modelling studies in literature novel models are presented for variable speed refrigeration system with scroll compressor and liquid type evaporator. The scroll compressor used in the current study is not produced for variable speed operation however it is operated with some limitations in the range of 30 to 50 Hz through an inverter. Similar restrictions are presented for the electronic expansion valve as 10 per cent to 35 per cent opening range because of operational limitations. To validate transfer functions of the variable speed scroll compressor and electronic expansion valve, mean square error values for all transfer functions are calculated. The mean square error values vary between 0.0126 and 0.3116. In addition, all transfer functions are designed and tested using corresponding proportional–integral–derivative controllers in order to see their applicability. The results indicate that energy savings are a consequence of operating the chiller at smaller frequencies than the basic 50 Hz while partial load occurred.

Isoniazid is the most important antituberculosis medicine. Adverse effects are generally fever and rash. There are few case reports in the literature which identified high fever without rash associated with INH use. In this case report, we present a case with tuberculosis lymphadenitis and isoniazid-induced fever.

Objective The number of older people is growing fast in Turkey. In this context, internal medicine residents and specialists contact older people more frequently. Thus, healthcare providers’ knowledge and attitudes toward older people is becoming more important. Studies that specifically investigate internal medicine residents’ attitudes toward the elderly are scarce. We aimed to investigate the attitudes of internal medicine residents toward older people. Methods This cross-sectional multicenter study was undertaken in the internal medicine clinics of six university state hospitals that provide education in geriatric care. All internal medicine residents working in these hospitals were invited to participate in this questionnaire study between March 2013 and December 2013. We recorded the participants’ age, sex, duration of internal medicine residency, existence of relatives older than 65 years, history of geriatrics course in medical school, geriatrics rotation in internal medicine residency, and nursing home visits. Results A total of 274 (82.3%) of the residents participated in this study, and 83.6% of them had positive attitudes toward older people. A geriatrics rotation during internal medicine residency was the only independent factor associated with positive attitudes toward the elderly in this multivariate analysis. A geriatrics course during medical school was associated with positive attitudes in the univariate analysis, but only tended to be so in the multivariate analysis. Conclusion Geriatrics rotation during internal medicine residency was independently associated with positive attitudes toward older people. Generalization of geriatrics education in developing countries may translate into a better understanding and improved care for older patients.

Background The objectives of this study were to examine the prevalence and risk of pressure ulcers (PrUs) among hospitalized patients 65 years or older in a university hospital setting and to assess the potential for prevention and healing in that population. Methods The retrospective study conducted at the general medicine departments of Ege University Hospital in Izmir, Turkey, included 209 patients (115 females, 94 males) 65 years or older, who had been admitted to the hospital for a variety of reasons between April 1, 2011, and October 1, 2011. The following tools were used to collect data: a data collection form to identify the sociodemographic and medical characteristics of the patients, the Braden Risk Assessment Scale to assess the risk of PrUs, and a form to monitor PrUs, which included the site of the PrU, the category, and the PUSH (Pressure Ulcer Scale for Healing) score, a tool for tracking changes in PrUs status applied at weekly intervals. Results The mean patient age was 73 (6.4) years. The prevalence of PrUs was 5.8% during the hospital stay. Pressure ulcers appeared most frequently in the ischeal tuberosity area (40%), and 45.2% of all PrUs observed were category II. The comorbidities of the patients who had PrUs were as follows: rheumatoid arthritis, 40% (n = 5); acute renal failure, 24% (n = 3); multiple myeloma, 8% (n = 1); chronic renal failure, 8% (n = 1); pneumonia, 8% (n = 1); and acute lymphoblastic leukemia, 8% (n = 1). Conclusions Pressure ulcers are a common healthcare complication in the older adult population, with potentially severe consequences. The most important intervention that healthcare professionals can make to reduce PrUs is to determine and address risk factors.

To investigate the influence of two insulin administration modalities, continuous subcutaneous insulin infusion (CSII) and multiple daily insulin injections (MDI) therapy with insulin analogues, on the development of insulin antibodies (IAs) in patients with type 1 diabetes mellitus and to assess the impact of IAs on glucose control and hypoglycaemia. 96 patients with type 1 diabetes mellitus treated with CSII (n = 48) or MDI (n = 48) were included in the study. Age, duration of diabetes, A1c, preprandial and postprandial blood glucose and hypoglycaemic events were compared between IA positive and negative patients. IA levels were higher in the CSII group (% 24.6 ± 14.2) than the MDI group (% 13.2 ± 9.9). Duration of diabetes and age were not associated with IA positiveness. While A1c, preprandial blood glucose and the frequency of hypoglycaemic events were similar in two groups, postprandial blood glucose was lower in IA positive group (P = 0.03). Patients with type 1 diabetes mellitus treated with CSII with insulin analogues had higher IA levels when compared to MDI therapy. However, the development of IAs did not impair the glycaemic control.

234 he role of neutrophil gelatinase-associated ipocalin (NGAL) in assessing contrast-induced ephropathy (CIN) in patients undergoing ercutaneous coronary angiography . Colak Guloglua, M. Tanrisevb, O. Ozdoganc, A. Alpa, H. Colakb, . Kurtulmusd, S. Sahine,∗ Department Of Internal Medicine, Tepecik Education and Research ospital, Izmir, Turkey Department Of Nephrology, Tepecik Education and Research ospital, Izmir, Turkey Department Of Cardiology, Tepecik Education and Research ospital, Izmir, Turkey Department Of Biochemistry, Tepecik Education and Research ospital, Izmir, Turkey Departmant Of Internal Medicine Division Of Geriatric Medicine, ge University Hospital, Izmir, Turkey