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Background Masked hypertension is described as high ambulatory blood pressure measurements (ABPM) where office blood pressure measurements are normal. Effect of hypertension on cognitive functions is well known. However, the effect of masked hypertension on cognitive functions is unclear. The aim of this study is to examine the relationship between masked hypertension and cognitive functions. Methods One hundred-two normotensive patients admitted to the Geriatric Medicine outpatient clinic were included. Exclusion criteria were hypertension, dementia, major depression, and usage of antihypertensive medication. All patients underwent ABPM procedures and average daytime blood pressure, mean blood pressure at night and the 24-hour average blood pressure measurements were recorded. Comprehensive geriatric assessment tests and neuropsychological tests were administered. The diagnosis of masked hypertension was based on the definitions in the 2013 guideline of the European Society of Cardiology. Results Forty-four patients (43%) were diagnosed with masked hypertension. Patients with masked hypertension had significantly lower scores on Mini-Mental State Examination (MMSE) test, Quick Mild Cognitive Impairment Test (QMCI), and Categorical Fluency Test than the normotensive patients (p = .011; p = .046; and p = .004; respectively). Montreal Cognitive Assessment Scale test score was lower in masked hypertension, although this was not statistically significant. Conclusion This study may indicate that geriatric patients with masked hypertension, compared to normotensive patients have decreased cognitive functions. Masked hypertension should be kept in mind while assessing older adults. When masked hypertension is detected, cognitive assessment is essential to diagnose possible cognitive dysfunction at early stage.

Background Dysphagia is an important and frequent symptom in Alzheimer's dementia (AD). We hypothesized that dysphagia could be seen in the early stages of AD and sarcopenia presence rather than the severity of the AD affecting dysphagia. The main aim of this study was to investigate swallowing functions in AD patients according to stages. The second aim was to investigate the correlation between sarcopenia and dysphagia in AD. Methods This study involved 76 probable AD patients. For all participants, diagnosis of sarcopenia was based on definitions from the revised version of European Working Group on Sarcopenia in Older People at 2018. Dysphagia symptom severity was evaluated by the Turkish version of the Eating Assessment Tool, a videofluoroscopic swallowing study (VFSS) was performed for instrumental evaluation of swallowing. The patients were divided into 3 groups according to the clinical dementia rating (CDR) scale as CDR 1 (mild dementia), CDR 2 (moderate dementia), and CDR 3 (severe dementia). Swallowing evaluation parameters were analyzed between these groups. Results Mean age was 78.9 ± 6.4 years, and 56.4% were female. Twenty-six patients had mild dementia, 31 patients had moderate dementia, 19 patients had severe dementia (CDR 3). We found that sarcopenia rates were similar between AD stages according to CDR in our study population and dysphagia could be seen in every stage of AD. In a multivariate analysis, polypharmacy and sarcopenia were found to be independently associated factors for dysphagia, irrespective of stage of AD (OR: 6.1, CI: 1.57-23.9, P = 0.009; OR: 4.9, CI: 1.24-19.6, P = 0.023, respectively). Conclusion Aspirations may be subtle so that AD patients and caregivers may not be aware of swallowing difficulties. Therefore, all AD patients, especially those who have polypharmacy and/or sarcopenia (probable-sarcopenia-severe sarcopenia), should be screened for dysphagia in every stage.

This study aimed to investigate the lifetime prevalence and risk factors for allergic rhinitis and asthma in geriatric outpatients in three big cities of our country. Elderly patients visiting geriatric outpatient clinics at university hospitals were included in this study. Two questionnaires were completed by trained investigators in face-to-face interviews of 236 people aged 65100 years. The median age was 73.71±7.09 year, and 63% participants were female. The prevalence of allergic rhinitis and asthma was found 15.3 % (n=36) and 10.2 % (n=24), respectively. The frequency of allergic rhinitis and asthma was high in females, in those with low education levels, in city, in persons having family history of atopy and in smokers, but it wasnt statistically significant. Allergic diseases affect the elderly as well as young people. Female sex, low educational level, smoking, and living in a city are among the important risk factors for allergic rhinitis and asthma in the elderly. [Med-Science 2020; 9(2.000): 334-7]

Background: The novel molecule endocan, which is released by endothelium and is regulated by proangiogenic and proinflammatory cytokines, may have a role in the pathophysiology of Alzheimer disease (AD). The aim of this study was to evaluate the relationship between serum endocan levels and AD. Methods: A total of 134 patients (47 AD, 42 amnestic mild cognitive impairment [aMCI], and 45 control patients) 65 years of age and older were recruited in this study. Cognitive status of the patients was evaluated by performing the Montreal Cognitive Assessment (MOCA) and the Mini-Mental State Examination (MMSE). Serum endocan levels were measured with an enzyme-linked immunosorbent assay kit. Results: Median serum endocan level was significantly higher in AD patients (380.1 ng/mL) than in both aMCI patients (247.7 ng/mL) and controls (277.6 ng/mL; p < 0.01). Serum endocan level had a weak but significant correlation with MMSE and MOCA scores (r = –0.219 and r = –0.232; p = 0.012 and p = 0.01, respectively). Serum endocan level was detected as a factor independently associated with AD. The cutoff serum level of endocan predicting AD was >288.94 ng/mL in receiver operating characteristic curve analysis (area under the curve 0.71, 95% CI 66.7–90.9, sensitivity 80.9%, specificity 59.8%; p < 0.01). Conclusion: Higher serum endocan levels may be associated with the pathogenesis of AD.

Background: Percutaneous endoscopic gastrostomy (PEG) tube placement is a common procedure performed to provide a route for enteral feeding. We aimed to examine the survival after PEG in older adults with neurologic disease and to demonstrate the factors associated with mortality. Methods: We analyzed the data of 500 patients who underwent PEG placement between 2005 and 2015 at a university hospital. The data included age, sex, follow-up duration, comorbidities, medications, indications for PEG, complications, and laboratory results. Related risk factors and mortality rates were analyzed. Results: Median age was 77 years. Median survival time after PEG placement was 13.9 months. The 30-day, 3-month, 1-year, 2-year, 3-year, and 5-year mortality rates were 11.3%, 28.3%, 46.8%, 56.3 %, 63.0%, and 67.8%, respectively. Stroke was independently correlated with mortality (odds ratio [OR], 2.20; 95% confidence interval [CI], 1.52-3.19; P < .001). Overall survival time after PEG placement was shorter in patients with stroke than without stroke (11.4 vs 27.1 months, P = .014). In multivariate logistic regression analyses, preprocedural neutrophil percentage (OR, 1.10; 95% CI, 1.02-1.17, P = .015) and late complications (OR, 9.2; 95% CI, 1.80-46.90; P = .008) were independent risk factors for mortality in the stroke subgroup. Prophylactic antibiotic usage (OR, 0.07; 95% CI, 0.17-0.29; P < .001) and hyperlipidemia (OR, 0.30; 95% CI, 0.86-1.00; P = .048) were independently and inversely correlated with mortality in stroke patients. Conclusions: Stroke patients had higher mortality rates than other neurological indications for PEG. In stroke patients with PEG, neutrophil percentage was independently correlated with mortality, while hyperlipidemia and preprocedural antibiotic usage were independently related with survival.

Objective: To determine the prevalence and the factors associated with urinary incontinence (UI) among inpatients in Turkey. Method: the population of this study comprised of patients screened by the "National Prevalence Measurement of Quality of Care (LPZ)" study in 2017 and 2018. Age, gender, comorbidities, length of hospital stay, sedative medications, SARC-F score, anthropometric measurements, and care parameters such as malnutrition, falls, UI-fecal incontinence (FI), restraints, and care dependency score (CDS) were noted. the LPZ questionnaire was performed by trained researchers, and multiple logistic regression analysis was performed to determine the factors associated with UI. Results: the prevalence of UI was 29.4 % among 1176 inpatients, and 41.6 % in patients >= 65 years. Urinary incontinence was associated with older age (OR, 1.966, 95 % CI 1.330-2.905), female sex (OR, 2.055, 95 % CI 1.393-3.030), CDS (OR, 3.236, 95 % CI 2.080-5.035), the number of comorbidities (OR, 1.312, 95 % CI 1.106-1.556), end-of life management (OR, 3.156, 95 % CI 1.412-7.052), sedative medications (OR, 1.981, 95 % CI 1.230-3.191), and FI (OR, 12.533, 95 % CI 4.892-32.112) in all adults, where CDS (OR, 2.589, 95% CI 1.458-4.599), end-of life management (OR, 2.851, 95 % CI 1.095-7.424), sedative medications (OR, 2.529, 95 % CI 1.406-4.548), and FI (OR, 13.138, 95 % CI 4.352-39.661) were associated with UI among geriatric patients. Conclusions: the factors associated with UI in geriatric and all adult inpatients are CDS, sedative medications, end-of life management, and FI plus older age, female sex, and comorbidities for the latter. the factors associated with UI vary in different age groups., Nutricia Turkey, This work was supported by Nutricia Turkey.

Objective Katz Index of Independence in Activities of Daily Living Scale (Katz ADL) is a widely used tool to assess the level of independency in older adults. The objective of this study was to assess the validity and reliability of the Turkish version of the six item Katz ADL in geriatric patients aged 65 years and older. Methods The participants were recruited in a geriatric medicine outpatient clinic (n = 211). The Katz ADL was translated to Turkish and it was administered with the Barthel index (BI) and SF-36 physical functioning subscale (SF-36 PF) which are already validated in Turkish. Reliability was assessed by internal consistency, interrater and test–retest analysis. Construct validity was assessed by Spearman correlations between the Katz ADL and other functional status indices. Results The internal consistency was high (Cronbach’s α = 0.838). The test–retest reliability and inter-rater reliability were excellent (ICC 0.999 [0.999–1.000 95% CI]). Regarding the convergent validity strong associations between Katz ADL, BI and SF-36 PF were demonstrated (rs = 0.988, p Conclusion Validating an instrument, which has originally been developed in a different culture, is a complex but neccessary task. It provides an opportunity for comparison of information across different cultures. To our knowledge, this is the only study to demonstrate reliability and validity of the Katz ADL-six item version in the geriatric population living in Turkey. Turkish version of the Katz ADL is a valid and reliable scale to detect the disability status in the basic activities of daily living in older adults.

Incidences of overactive bladder (OAB) and cognitive dysfunction increase with aging. Treatment of OAB with antimuscarinic agents may result in cognitive decline, especially in patients with Alzheimer's disease (AD). The aim of this study is to evaluate the effect of antimuscarinic treatment on cognitive functions, depression, and quality of life (QOL) of patients with OAB.This non-interventional prospective observational study was conducted in a geriatric medicine outpatient clinic. Overall, 168 OAB patients were enrolled. Patients were followed up in five groups: oxybutynin, darifenacin, tolterodine, trospium, and control groups. Follow-up visits were done at second, third, and sixth months. Comprehensive geriatric assessment, cognitive and mood assessment, QOL scales (IIQ-7, UDI-6) were performed.Mean age of the patients was 73.5 ± 6.1. Of the 168 patients, 92.3% were female, 83.3% benefited from the treatment, and 37.1% discontinued the medication. Discontinuation rate and frequency of side effects were more frequent in the oxybutynin group. Mini Mental State Examination scores did not decline after treatment, even in AD patients. Geriatric Depression Scale scores, Activities of Daily Living scores, and QOL scores significantly improved after treatment.Antimuscarinic agents are effective in OAB treatment. They have a positive impact on daily life activities, depression, and QOL indices. Furthermore, they do not have a negative effect on cognitive function in older adults with or without AD.

Determining predictors of mortality among older adults might help identify high-risk patients and enable timely intervention. The aim of the study was to identify which variables predict geriatric outpatient mortality, using routine geriatric assessment tools. We analyzed the data of 1141 patients who were admitted to the geriatric medicine outpatient clinic between 2001 and 2004. Comprehensive geriatric assessment was performed by an interdisciplinary geriatric team. Mortality rate was determined in 2015. The parameters predicting survival were examined. Median age of the patients (415 male, 726 female) was 71.7 years (53–95 years). Mean survival time was 12.2 years (95 % CI; 12–12.4 years). In multivariate analysis, age (OR: 1.16, 95 % CI: 1.09–1.23, p

Background: The objective of this study was to validate the Turkish version of the Quick Mild Cognitive Impairment (Q mci-TR) screen. Methods: In total, 100 patients aged ≥65 years referred to a geriatric outpatient clinic with memory loss were included. The Q mci was compared to the Turkish versions of the standardized Mini-Mental State Examination and the Montreal Cognitive Assessment (MoCA). Results: The Q mci-TR had higher accuracy than the MoCA in discriminating subjective memory complaints (SMCs) from cognitive impairment (mild cognitive impairment [MCI] or dementia), of borderline significance after adjusting for age and education ( P = .06). The Q mci-TR also had higher accuracy than the MoCA in differentiating MCI from SMC, which became nonsignificant after adjustment ( P = .15). A similar pattern was shown for distinguishing MCI from dementia. Test reliability for the Q mci-TR was strong. Conclusion: The Q mci-TR is a reliable and useful screening tool for discriminating MCI from SMC and dementia in a Turkish population.

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.

Purpose The mini-nutritional assessment (MNA) has been used most frequently for the determination of malnutrition in older adults; however it is not suitable for some hospitalized patients. The aim of this study was to identify the nutritional status of the elderly hospitalized patients by MNA and by other assessment methods including anthropometric measurements, bioelectrical impedance analysis (BIA) and laboratory parameters and to demonstrate the correlation of them with MNA. Patients A total of 100 patients were included in the study. Linear regression analysis was performed to compare the effects of parameters on MNA scores. Results By MNA; 69% of the patients were found to have nutritional risk, 12% were malnourished and 19% were well nourished. Skinfold thicknesses, calf circumference, prealbumin, albumin, C-reactive protein (CRP), glomerular filtration rate (GFR) and some of the BIA parameters including body fat, free fat mass index, extracellular, intracellular and total body water were significantly correlated with MNA score in univariate analysis. On the other hand; only suprailiac skinfold thickness (OR: 0.106, 95%CI: 0.031–0.181, P : 0.006), prealbumin (OR: 0.256, 95%CI: 0.158–0.354, P P : 0.01) were significantly correlated with MNA in multivariate analysis. Conclusions These parameters or their combinations can be used for the evaluation of nutritional status in hospitalized older adults when the MNA cannot be used.

Decline in MM and MS with aging, defined as sarcopenia, is related with physical disability, poor quality of life and death. Its mechanisms are not fully understood. Testosterone increases muscle protein synthesis. However, the effects of in utero androgen exposure to MM and MS in older adults have not been studied. In utero androgen exposure is inversely related with 2D:4D ratio. The aim of this study was to investigate the relationship between 2D:4D ratio as an indicator of in utero androgen exposure and MM and MS in elderly patients. A total of 151 older adults were included. Calf-circumference (CC) and skeletal muscle mass index (SMI) were used for the assessment of MM and hand grip strength for the assessment of MS. Mean age ± SD of the patients was 73.72 ± 6.23. Fifty-two (34.4%) of patients were male, 99 (65.6%) were female. Right and left 2D:4D were significantly and negatively correlated with hand grip strength (r=-0.365, p=0.018 and r=-0.434, p=0.005, respectively), CC (r=-0.422, p=0.002 and r=-0.459, p=0.001, respectively) and SMI (r=-0.354, p=0.018 and r=-0.348, p=0.022, respectively) in men. In women, right and left 2D:4D were significantly and negatively correlated with hand grip strength (r=-0.252, p=0.022 and r=-0.234, p=0.033, respectively), CC (r=-0.229, p=0.024 and r=-0.302, p=0.003, respectively) and SMI (r=-0.382, p

Septic arthritis is the suppurative inflammation of the joints that is usually caused by bacteria. It is a medical emergency that should be rapidly diagnosed and treated appropriately for optimized prognosis. Staphylococcus aureus is the most common isolated bacterial pathogen; knee, hip, and shoulder joints are the most commonly affected sites by infection [1]. The prevalence of bacterial arthritis among adults has been estimated to range between 8–27% [2,3]. However, sternoclavicular joint septic arthritis is a rare condition. In this case report, a geriatric female patient diagnosed with sternoclavicular, first costosternal joint septic arthritis accompanied by pyogenic myositis will be presented.

The aim of this study was to demonstrate the prevalence and possible predictors of potentially inappropriate medications (PIMs) and potentially prescription omissions (PPOs) according to the Screening Tool of Older Person’s Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment (START) criteria in geriatric patients. A total of 374 patients (140 male, 234 female) aged ≥65 years were included. Comprehensive demographic and clinical data including age, gender, current diagnoses/medications, comorbid diseases and medical problems were noted. There were 154 (41.2 %) patients with at least one PIM. Most common PIMs were proton pump inhibitors for peptic ulcer disease (9.6 %), calcium-channel blockers (6.4 %) and anticholinergic/antispasmodic drugs (5.9 %) in chronic constipation. There were 274 (73.3 %) patients with at least one PPO. Most common PPOs were calcium–vitamin D supplement in osteoporosis (OP) (39.6 %), statin (22.5 %) and antiplatelet therapies (16.0 %) in diabetes mellitus (DM) with cardiovascular risk factors. PIM was independently associated with female gender (OR = 2.21, p = 0.003), number of medications (OR = 1.35, p

Background and aim Ferritin level is decreased in iron deficiency (ID) and increased in inflammation as an acute-phase reacting protein. In the case of inflammation ferritin, level may not decrease even if ID is present. Inflammation is regarded as one of the mechanisms of aging. This subclinical systemic inflammatory state is named as “inflammaging”. The aim of this study is to assess whether serum ferritin levels could indicate aging-associated inflammation rather than ID in older adults. Methods Consecutive 1310 patients admitted to the geriatric medicine outpatient clinic were enrolled. The clinical conditions, which could alter acute-phase reactants, were excluded. ID diagnosis was made by transferrin saturation ( Results Mean age was 71.8 ± 6.9 years and 827 (63.1%) were female. Ferritin levels were significantly higher in patients with subclinical inflammatory state and significantly lower in patients with ID. The interrelationships of the ferritin with acute-phase reactants were stronger than its relationship with the ID. Conclusion The results of this study suggested that the ferritin level can increase with aging as a part of the ongoing asymptomatic chronic systemic inflammatory state called inflammaging. Inflammaging can result with increased ferritin levels, even if there is ID. Normal or elevated levels of ferritin in the geriatric population should not exclude ID in clinical practice.

Cardiovascular disease (CVD) and OP are common age-related conditions. In both cross-sectional and longitudinal epidemiologic studies, low bone mass has been related to increased frequency of CVD. But available data in geriatric population is limited. In this study we aimed to seek the possible relationship between CAD and low bone mineral density (BMD) in a large number of geriatric patients. A total of 2235 patients aged 65 years or more were included in this cross-sectional study. All patients underwent a complete geriatric assessment and evaluated for CAD and cardiovascular risk factors. BMD was measured by dual-energy X-ray absorptiometry at the lumbar spine (L1-L4) and femoral neck. BMD results were classified into three groups; normal (T-score: ≥-1.0×S.D.), osteopenia (T-score between -1.0 and -2.5×S.D.), and OP (T-score: ≤-2.5×S.D.). CAD was present in 397 (29.7%) of 1335 patients with OP, in 199 (27.4%) of 726 patients with osteopenia and in 34 (19.5%) of 174 patients with normal BMD. Multivariate regression analysis revealed that presence of OP or osteopenia increased the prevalence of CAD as an independent correlate (OR=1.643; 95% CI=1.068-2.528, p=0.030). This study highlights the need for careful evaluation of elderly patients with low BMD for possible CAD.

Background Autonomic nervous system disturbance and cardiovascular disorders may be underestimated causes of falls. Heart rate turbulence (HRT), heart rate variability (HRV) and QT dynamicity parameters are noninvasive cardiac autonomic activity markers. The aim of this study was to evaluate autonomic cardiovascular markers in falling older adults. Methods This was a case-control study conducted at a geriatric medicine outpatient clinic of a university hospital. Study group consisted of 33 older adults who had falls in the last 12months and the control group included 31 subjects who had never experienced falls. The patients in the study group were examined with 24-hour Holter electrocardiogram (ECG) and carotid sinus massage was done under monitorization. The 24-hour Holter ECG data were recorded and assessed with the ELATEC software. HRV, QT dynamicity and HRT parameters were analysed. Results Thirty-three faller and 31 non-faller patients were examined in this study. Age and gender were similar between groups. All patients and control subjects had normal ejection fraction. Carotid sinus massage was done to the patients in the study group and three of 33 were positive (9.09%). There was no significant difference in HRV and QT dynamicity parameters between groups. Both HRT onset (2.51±1.48 vs. 7.29±3.28 P P =0.031) were significantly different between the groups. Conclusion Elderly subjects with recent falls have significantly worse HRT parameters than matched non-falling counterparts. Blunted baroreflex sensitivity and impaired cardiac autonomic function can be an important reason for falls in the geriatric age group.

Background/Aim: Dementia is one of the most common health problems in the world. Alzheimer’s disease (AD) is the most common form of dementia. The relation between blood pressure (BP) and dementia has been the subject of numerous epidemiological studies, and midlife hypertension (HT) is a risk factor for AD. The association between BP and risk of dementia is lower in the older population. The aim of this study was to examine the association between the prevalence of HT and AD in elderly individuals. Methods: In this cross-sectional study, 193 patients with AD and 1,860 patients with normal cognitive function were evaluated. Results: The prevalence of HT was lower in the AD group (60.6 vs. 70.5%; p = 0.005). In multivariate analysis, AD was found to be negatively correlated with HT (OR = 0.649; 95% CI 0.461–0.916). Conclusion: The prevalence of HT was lower in patients with AD compared to subjects without AD. Physicians who deal with AD patients must keep in mind that the need for antihypertensive medication may decline during the dementia process.

There is growing consensus in the literature that inflammation plays a significant role in the pathophysiology of Alzheimer's disease (AD). The blood neutrophil-lymphocyte ratio (NLR) is a new, inexpensive and easily applicable marker of inflammation. The aim of this study was to investigate the association between NLR, as an inflammatory biomarker, and AD.241 AD patients and 175 patients with normal cognitive function were evaluated in this study.The mean ± SD NLR of AD patients was significantly higher than that of patients with normal cognitive function (3.21 ± 1.35 vs. 2.07 ± 0.74, p0.001, respectively). Receiver operating characteristic curve analysis suggested that the optimum NLR cutoff point for AD was 2.48 with 69.29% sensitivity, 79.43% specificity, 82.30% positive predictive values and 65.30% negative predictive values. Logistic regression analysis showed that elevated NLR (OR: 4.774, 95% CI: 2.821-8.076, p0.001) was an independent variable for predicting AD.Elderly people with AD have higher NLR than healthy controls. Elevated NLR levels are usually considered as an inflammatory marker. The results of this study suggested that inflammation plays a role in the pathogenesis of AD.

Objective To determine risk factors for nosocomial bloodstream infection (BSI) and associated mortality in geriatric patients in geriatric and internal medicine wards at a university hospital. Methods Single-center retrospective (1992–2007), pairwise-matched (1:1-ratio) cohort study. Geriatric patients with nosocomial BSI were matched with controls without BSI on year of admission and length of hospitalization before onset of BSI. Demographic, microbiological, and clinical data are collected. Results One-hundred forty-two BSI occurred in 129 patients. Predominant microorganisms were Escherichia coli (23.2%), coagulase-negative Staphylococci (19.4%), Pseudomonas aeruginosa (8.4%), Staphylococcus aureus (7.1%), Klebsiella pneumoniae (5.8%) and Candida spp. (5.8%). Matching was successful for 109 cases. Compared to matched control subjects, cases were more frequently female, suffered more frequently from arthrosis, angina pectoris and pressure ulcers, had worse Activities of Daily Living-scores, had more often an intravenous or bladder catheter, and were more often bedridden. Logistic regression demonstrated presence of an intravenous catheter (odds ratio [OR] 7.5, 95% confidence interval [CI] 2.5–22.9) and being bedridden (OR 2.9, 95% CI 1.6–5.3) as independent risk factors for BSI. In univariate analysis nosocomial BSI was associated with increased mortality (22.0% vs. 11.0%; P = 0.029). After adjustment for confounding co-variates, however, nosocomial BSI was not associated with mortality (hazard ratio 1.3, 95% CI 0.6–2.6). Being bedridden and increasing age were independent risk factors for death. Conclusion Intravenous catheters and being bedridden are the main risk factors for nosocomial BSI. Although associated with higher mortality, this infectious complication seems not to be an independent risk factor for death in geriatric patients.

Summary Background & aims Older adults are poorly assessed for malnutrition risk although malnutrition is not an uncommon problem in this population. The aim of this study was to determine the malnutrition risk and its correlates in geriatric outpatients. Method The study was performed in 2327 patients ≥65 years old who were admitted to our Geriatric Medicine outpatient clinic. Together with comprehensive geriatric assessment, nutritional assessment with short version of mini nutritional assessment test (MNA-SF) was performed. MNA-SF score ≤11 was determined as malnutrition risk. Results Mean age of patients was 72.14 ± 6.11 and 1479 (63.6%) were female. Mean MNA-SF score was 12.31 ± 2.18. The number of patients with MNA-SF score ≤11 was 651 (28%). Depression, haematocrit, plasma fasting glucose, albumin, erythrocyte sedimentation rate, instrumental activities of daily living scores and bone mineral density measured from total femur were found to be significantly associated with malnutrition risk. Conclusion In this study malnutrition risk was detected in 651 (28%) patients. This ratio was similar to the literature. In older adults malnutrition risk is found to be increased due to majority of chronic illnesses and physical dependency. In conclusion, nutritional assessment should be a part of comprehensive geriatric assessment.

We reviewed the literature concerning the prevalence and correlates of metabolic syndrome (MetS) in older adults and assessed the impact of MetS with regard to life expectancy and comorbidity in the elderly (aged 65 years and over). Using the PubMed database and the Cochrane Library, we found 16 eligible studies, of which 8 were prospective cohort studies, 7 cross-sectional studies, and 1 a case-control study. The World Health Organisation (WHO) and National Cholesterol Education Program (NCEP) are the most popular definitions to describe MetS experienced by the elderly. The prevalence of metabolic syndrome in an elderly population varied from 11% to 43% (median 21%) according to the WHO, and 23% to 55 % (median 31%) according to NCEP. Obesity and hypertension are the most prevalent individual components. MetS in an elderly population is a proven risk factor for cardiovascular (CV) morbidity, especially stroke and coronary heart disease (CHD), and mortality. Preventing and treating MetS would be useful in preventing disability and promoting normal aging. Results from the different studies of elderly population-based cohorts provide support for earlier investigations in middle-aged populations to prevent MetS components. In conclusion, it is possible to say that the results from the different elderly study populations link the presence of the MetS with the development of cardiovascular disease (CVD) and functional disability, and further underscore the importance of recognising and treating its individual components, particularly high blood pressure.

Background: Gamma glutamyltransferase (GGT) plays a role in cellular glutathione uptake, which is an important element of antioxidant mechanisms. An increase in serum GGT is thought to be an early and sensitive marker of oxidative stress. Oxidative stress has a role in the pathogenesis of Alzheimer's disease (AD). The aim of this study was to investigate the GGT levels in AD.Method: In this cross-sectional study, 132 patients with AD (mean age: 74.1 ± 7.4, female 62.9%) and 158 age- and gender-matched normal controls (mean age: 74.5 ± 6.3, female 67.1%) were evaluated. For cognitive assessment, MMSE and clock drawing tests were performed; DSM-IV and NINCDS-ADRDA criteria were used. Serum GGT, aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase concentrations were determined.Results: Median (min-max) GGT levels were 18 (9–70) in AD group and 17 (5–32) in normal controls. Mann-Whitney U test showed that GGT levels were significantly higher in AD patients (p = 0.012). Linear regression analysis revealed AD was an independent correlate of elevated GGT levels. Hypertension, diabetes mellitus, total cholesterol, and low density lipoprotein cholesterol were not associated with GGT levels.Conclusion: GGT levels were increased significantly in AD patients. To evaluate the role of GGT as a marker of oxidative stress in AD, further studies are needed.

The most efficient strategy for combating Alzheimer's disease (AD) is to prevent the onset of clinically significant symptoms. Determining the clinical characteristics, risk factors, and indices of cognitive reserve would help in achieving this goal. The aim of this study was to determine the risk factors for AD and vascular dementia (VD) in the elderly and to highlight the importance of risk factor modification in the early diagnosis. Consecutive 1436 patients (mean age = 72.7 ± 6.9 years, 34.2% male) were enrolled in the study. After a comprehensive geriatric and cognitive assessment, patients were grouped as AD group (n = 203), VD group (n = 73) and normal cognitive status (NCS) group (n = 1160). Thirty-three possibly related factors including demographic characteristics, co-existing diseases and laboratory parameters were examined. The results revealed that female sex, advanced age, depression, and intake of vitamin supplements were independent related factors for AD; whereas depression and low-density lipoprotein-cholesterol (LDL-C) were independent related factors for VD. For every geriatric patient admitted for any reason, cognitive assessment should be performed, risk factors should be determined and the patients at high risk should be followed up carefully.

Inflammation may play an important role in Alzheimer disease (AD) pathogenesis. A growing amount of evidence indicates that resistin has hallmark regulatory functions such as inflammatory states. The aim of this study was to determine whether plasma resistin levels would be useful in the diagnosis of patients with AD and to investigate the relationships between resistin and other inflammatory markers such as hs-CRP and TNF-α. Materials and methods: In this cross-sectional study, 38 AD patients and 32 control subjects with normal cognitive function aged 65 years and over were included. The diagnosis of AD was made according to DSM-IV and NINCDS-ADRDA criteria. Serum levels of resistin were measured with an enzyme-linked immunosorbent assay method using the human resistin E50 kit. Results: The median resistin level of AD patients was significantly higher than in the control group (86.3 vs. 70.8 pg/mL, P = 0.002). Overall accuracy of resistin in determining AD was 70.66%, with sensitivity, specificity, PPV, and NPV of 75.0%, 65.5%, 73.0%, and 67.9%, respectively. There was no statistically significant difference between AD patients and control subjects with respect to hs-CRP and TNF-α levels. Conclusion: Resistin levels may be considered as a predictor of AD and it may predict activation of the immune system in AD pathophysiology.

Background/aim: To compare plasma vitamin D concentrations among patients with normal cognitive function (control group), mild cognitive impairment (MCI), and Alzheimer disease (AD). Materials and methods: In total, 158 patients with AD, 228 patients with MCI, and 603 control subjects were included. Plasma levels of 25-hydroxyvitamin D were measured after comprehensive geriatric assessment and compared among groups. SPSS 15.0 was used for statistical analysis. Results: Mean levels of 25-hydroxyvitamin D were significantly different among the 3 groups of AD patients, MCI patients, and controls (P < 0.001). Post hoc analysis revealed that the levels were significantly lower in the MCI group than the control group (P = 0.002) and significantly lower in the AD group than the control group (P = 0.003). Multivariate analysis showed that age (OR: 1.070, 95% CI: 1.025-1.116, P = 0.002), instrumental activities of daily living score (OR: 0.920, 95% CI: 0.850-0.995, P = 0.037), 25-hydroxyvitamin D level (OR: 0.959, 95% CI: 0.932-0.987, P = 0.004), and diabetes mellitus (OR: 2.476, 95% CI: 1.153-5.319, P = 0.020) were factors independently associated with AD. Conclusion: This study demonstrated that there is a correlation between plasma 25-hydroxyvitamin D levels and cognitive functions.

OBJECTIVES: To compare endothelial function of people with Alzheimer's disease (AD) with that of people without. DESIGN: Case-control study. SETTING: Geriatric medicine outpatient clinic of a university hospital. PARTICIPANTS: Twenty-five patients with AD who were free of vascular risk factors and 24 healthy elderly controls were enrolled. Exclusion criteria were diabetes mellitus, hypertension, dyslipidemia, evident stroke, smoking, documented coronary artery disease, history of myocardial infarction, heart failure, acute or chronic infection, malignancy, peripheral artery disease, renal disease, rheumatologic diseases, alcohol abuse, and certain drugs that may affect endothelial function. Both groups underwent comprehensive geriatric assessment and neuropsychiatric assessment. MEASUREMENTS: Endothelial function was evaluated according to flow-mediated dilation (FMD) from the brachial artery. RESULTS: Mean age ± standard deviation was 78 ± 5.9 in the group with AD (11 female and 14 male) and 72.1 ± 5.8 in the control group (9 female and 11 male). Multiple linear regression analysis revealed that FMD was significantly lower in patients with AD (median 3.45, range 0–7) than controls (median 8.41, range 1–14) (P < .001), independent of age. It was also found that FMD values were inversely correlated with the stage of the disease as determined according to the Clinical Dementia Rating scale (r=−0.603, P < .001). CONCLUSION: Endothelial function is impaired in patients with AD. Endothelial function was worse in patients with severe AD. These findings provide evidence that vascular factors have a role in the pathogenesis of AD.

Background: Strontium ranelate offers significant clinical benefits in terms of efficacy, tolerability, and ease of administration in the treatment of postmenopausal osteoporosis. However, there are some data revealing an association between strontium ranelate treatment and increased incidence of venous thromboembolism (VTE), suggesting possible adverse prothrombotic effects of the drug. Objective: To assess the effect of strontium ranelate treatment on primary hemostasis, secondary hemostasis, and the natural anticoagulant defense system, together with prothrombotic markers, in elderly women with osteoporosis. Methods: This study was designed in a prospective manner. Thirty-five elderly women diagnosed with osteoporosis were included. During a 2 month treatment period, participants received strontium ranelate 2 g. Platelet Function Analyzer-100 (PFA-100) in vitro bleeding time was performed to depict primary hemostasis. Secondary hemostatic parameters including prothrombin time, international normalized ratio, activated partial thromboplastin time, anti-cardiolipine immunoglobulin (Ig) M and IgG, antiphospholipid IgM and IgG, protein C, protein S, anti-thrombin III, lupus anticoagulant, fibrinogen, thrombin, activated protein C resistance, and plasma levels of d-dimer were assessed. These parameters were tested before and after 2 month treatment with strontium ranelate. Results: Mean ± SD age of the patients was 72.82 ± 5.69 years. After 60 days of treatment, there was no statistically significant prolongation in PFA-100 in vitro bleeding time and no statistically significant change in the critical hemostatic parameters in patients receiving strontium ranelate that led to discontinuation of the treatment. None of the subjects developed clinical VTE during the 2 month period of strontium ranelate treatment. Conclusions: The hemostatic safety of strontium ranelate in the elderly population with osteoporosis was shown over 2 months of treatment; however, its long-term hemostatic safety should be evaluated further.

Background/aim: Inflammation may play an important role in Alzheimer disease (AD) pathogenesis. A growing amount of evidence indicates that resistin has hallmark regulatory functions such as inflammatory states. The aim of this study was to determine whether plasma resistin levels would be useful in the diagnosis of patients with AD and to investigate the relationships between resistin and other inflammatory markers such as hs-CRP and TNF-α. Materials and methods: In this cross-sectional study, 38 AD patients and 32 control subjects with normal cognitive function aged 65 years and over were included. The diagnosis of AD was made according to DSM-IV and NINCDS-ADRDA criteria. Serum levels of resistin were measured with an enzyme-linked immunosorbent assay method using the human resistin E50 kit. Results: The median resistin level of AD patients was significantly higher than in the control group (86.3 vs. 70.8 pg/mL, P = 0.002). Overall accuracy of resistin in determining AD was 70.66%, with sensitivity, specificity, PPV, and NPV of 75.0%, 65.5%, 73.0%, and 67.9%, respectively. There was no statistically significant difference between AD patients and control subjects with respect to hs-CRP and TNF-α levels. Conclusion: Resistin levels may be considered as a predictor of AD and it may predict activation of the immune system in AD pathophysiology.

To sonographically assess the muscle mass and architecture of sarcopenic elderly subjects, and to explore the utility of ultrasound (US) measurements in predicting sarcopenia.One hundred elderly subjects were enrolled in this cross-sectional study. Mean age value of our study population was 73.08±6.18years. The diagnosis of sarcopenia was confirmed by measuring fat-free mass index (using bioelectrical impedance analysis) and handgrip strength. Calf circumference was measured and US evaluations comprised bilateral gastrocnemius muscle (MG) thickness, fascicle length and pennate angles; subcutaneous fat and dermis thicknesses in the calf.Bilateral muscle thickness and fascicle length values were significantly lower in patients with sarcopenia (both p0.05). Sarcopenic and nonsarcopenic subjects had similar pennate angles, subcutaneous fat and dermis thicknesses. Median thickness ratio (100×t (MG)/[t (subcutaneous tissue)+t (dermis)+t (MG)]) values were 64% (40-88%) in the right and 64% (38-86%) in the left calf. Bilateral MG thickness and fascicle length values showed high sensitivity in predicting sarcopenia (all values76.92%).Gastrocnemius muscle thickness and fascicle length values are lower in sarcopenic elderly and these two parameters can serve as alternative measurements for predicting/quantifying sarcopenia. Calf circumference measurements alone may not be appropriate for assessing sarcopenia. Instead, US imaging can conveniently be used to evaluate different compartments of the musculoskelal system in (sarcopenic) elderly.

Phase angle (PhA) value determined by bioelectrical impedance analysis (BIA) is an indicator of cell membrane damage and body cell mass. Recent studies have shown that low PhA value is associated with increased nutritional risk in various group of patients. However, there have been only a few studies performed globally assessing the relationship between nutritional risk and PhA in hospitalized geriatric patients. The aim of the study is to evaluate the predictive value of the PhA for malnutrition risk in hospitalized geriatric patients. One hundred and twenty-two hospitalized geriatric patients were included in this cross-sectional study. Comprehensive geriatric assessment tests and BIA measurements were performed within the first 48 h after admission. Nutritional risk state of the patients was determined with NRS-2002. Phase angle values of the patients with malnutrition risk were compared with the patients that did not have the same risk. The independent variables for predicting malnutrition risk were determined. SPSS version 15 was utilized for the statistical analyzes. The patients with malnutrition risk had significantly lower phase angle values than the patients without malnutrition risk (p = 0.003). ROC curve analysis suggested that the optimum PhA cut-off point for malnutrition risk was 4.7° with 79.6 % sensitivity, 64.6 % specificity, 73.9 % positive predictive value, and 73.9 % negative predictive value. BMI, prealbumin, PhA, and Mini Mental State Examination Test scores were the independent variables for predicting malnutrition risk. PhA can be a useful, independent indicator for predicting malnutrition risk in hospitalized geriatric patients.

The phenomenon of falls is not well studied in developing world. However, being aware of possible correlates for falls specific to different populations and trying to eliminate these factors is very important to prevent falls. This study investigated occurrence and correlates of falls among elderly in a developing country, Turkey. A total of 2322 patients aged 65 years and over presented to outpatient clinics of a reference hospital were included in this cross-sectional study. All patients had a complete comprehensive geriatric assessment and questioned for fall history. Correlates for falls were analyzed by using logistic regression. The mean age of participants was 71.8 years; 63.5% were female and 28.5% were found to have fallen within one year. Female sex, visual problems, auditory problems, use of mobility aids, mobility problems and depression were the only independent correlates for falls. Although the cross-sectional design of this study may not prove the causal role of the risk indicators, the size of the study group as well as the large number of possible correlates examined enriches the study. The results from this cross-sectional study form a basis for further prospective study on falls in the Turkish elderly population.

Summary Objectives To investigate fever of unknown origin (FUO) in 97 patients and compare geriatric and adult population. Methods We investigated 97 (22 elderly) patients with FUO using the criteria of Petersdorf and Beeson [Medicine 40 (1961) 1] hospitalized between January 1990 and May 2005 at Hacettepe University Hospital. Results Infectious diseases were the most common cause in the adult (33.3%) and the elderly (45.5%) patients both. Neoplasms were seen in 18.7; 4.5% and collagen vascular diseases were diagnosed in 9.3; 4.5% of the adults and the elderly respectively. Tuberculosis accounted for 60% of all the infectious causes and empirical anti-tuberculous treatment served as a diagnostic method in 43% of the cases with tuberculosis. Lymphadenopathy was more common among the adults with FUO. A diagnosis could be reached in all the elderly patients with a very high erythrocyte sedimentation rate (ESR>100mm/h). At the end of the hospitalization, 14.7% (11/75) of the adult patients and 13.6% (3/22) of the elderly patients died. Conclusion Geriatric patients with FUO usually have characteristics similar to the adult patients with respect to the hospitalization time, diagnosis, and inpatient mortality. Lymphoid organ hyperplasia might be expected less frequently and very high ESR might be a more reliable indicator of systemic disease in the elderly. Empirical anti-tuberculous treatment plays an important diagnostic role in the developing countries with a higher prevalence of tuberculosis.

Metabolic syndrome (MS) is known to increase risks for cardiovascular disease. Risks for cardiovascular disease also increase with aging. The aim of the study was to describe prevalence and correlates of MS in older adults. Patients aged 65 years and over without any acute illness that were referred to our geriatrics unite for comprehensive geriatric assessment were included in this cross-sectional study. MS was defined by using the WHO and the National Cholesterol Education Program (NCEP) definitions. The correlates were age, gender, low-grade inflammation as assessed by C-reactive protein (CRP) levels, high-homocysteine, total and LDL cholesterol, lipoprotein-a (Lip-a), apolipoprotein-A (Apo-A), apolipoprotein-B (Apo-B), nutrition point, coronary artery disease (CAD) and cerebrovascular event history. Total 1255 patients, 789 (62.9%) females, 466 (37.1%) males with a mean age of 71.8 ± 6.3 years were included in our study. MS prevalence was 16.2% with WHO definition and 23.8% with NCEP definition. Prevalence of CAD in MS and non-metabolic syndrome (non-MS) patients was 38.4% versus 29.5% (p = 0.010) in WHO and 35.3% versus 29.6% (p = 0.066) in NCEP group, respectively. Prevalence of cerebrovascular event history was 11.3% versus 6.2% in WHO (p = 0.008) and 9.9% versus 6.1% (p = 0.026) in NCEP group, respectively. Multiple logistic regression analysis was performed to investigate the independent association of variables with the MS. Female sex, high-homocysteine, low-grade inflammation, CAD and cerebrovascular event history was found to be associated with both modified WHO and NCEP MS groups in the multivariate analysis. This study has shown that MS is common in elderly patients with strongly related to CAD and cerebrovascular events. Low grade inflammation as assessed by CRP and high-homocysteine level is strongly related to MS.

Depression is an important but inadequately diagnosed mood disorder in elderly. Depressed elderly patients often have chronic concomitant diseases. This paper intended to determine the prevalence of depression and its relation with concomitant disorders and social status among the patients admitted to our geriatric unit. Seven hundred and eighty-nine females and 466 males admitted to our unit were examined for the presence of depression by using the geriatric depression scale (GDS) test. The presence of concomitant diseases was assessed. Depression was diagnosed in 273 patients (21.8%), 193 (70.7%) females and 80 (29.3%) males. Depressed patients suffered from a wide range of other diseases the number and prevalence of which were as follows: Alzheimer's disease (AD) (34; 12.5%), vascular dementia (27; 9.9%), hypertension (HT) (211; 77.3%), diabetes mellitus (DM) (64; 23.4%), osteoporosis (182; 66.7%), atherosclerotic coronary artery disease (CAD) (89; 32.6%), cardiac failure (23; 8.5%), bronchial asthma (8; 2.9%), chronic obstructive pulmonary disease (COPD) (25; 9.2%) and osteoarthritis (133; 48.8%). The correlation between depression and concomitant diseases was statistically significant in hypertensive, demented and osteoporotic patients, as determined in a large elderly population. Previous studies examined the correlation of depression with only one concomitant disease, while we performed the analysis on multiple correlations.

Background and aims: Osteoporosis is an important problem for men as well as women, but data and trials for male osteoporosis, prevalence, evaluation and prognosis are limited. There are insufficient randomized placebo-controlled, multicenter trial data. The aim of this study was to determine the frequency of osteoporosis in patients admitted to the Division of Geriatric Medicine of Hacettepe University, to compare osteoporosis in men and women, and to determine risk factors, relations with social and cultural differences, body weight and functional status. Methods: A retrospective study was conducted from February 2002 through July 2003. Participants were 783 female and 464 male patients aged 65 years and over. BMD measures were performed using dual-energy X-ray absorptiometry at femoral neck and lumbar spine. Data on calcium intake, history of fractures, smoking, alcohol habits, other possible risk factors, serum 25OH-Vitamin D and iPTH levels were obtained. Creatinine clearance was calculated with the Cockcroft-Gaut formula. Functional status was evaluated by geriatric evaluation scales. Results: 29.5% of cases of osteoporosis were found in males; 45.9% of male patients had osteoporosis, 36.6% had osteopenia. Risk factors for male osteoporosis were evaluated. Men with low body weight (

Background Malnutrition is a pitfall in older adults despite its high prevalence and serious consequences. There are various screening tests however, none of them have been validated for our country. In this study, we aimed to test the hypothesis that MNA (long form of MNA) and MNA-SF (short form of MNA) are applicable to screen malnutrition in Turkish geriatric patients. Materials and methods Two hundred and thirty-six patients aged 65 years and over who were admitted to our geriatric medicine outpatient clinic were enrolled in the study. Four groups of data (anthropometric measurements, biochemical markers, three-day diet record and geriatric assessment scales) were recorded. Long and short forms of MNA test were performed. Two different geriatricians interpreted the patients’ nutritional status with the aid of aforementioned data. Patients were divided into three groups which were patients with malnutrition, with malnutrition risk and well-nourished. Concordance between the two geriatricians’ clinical assessment was analyzed by kappa statistics. Excellent concordance was found, therefore the first specialist's decisions were accepted as gold-standard. A third physician performed the long and short forms of MNA test. The concordance between the first clinician's assessment and MNA test results were compared subsequently. Results MNA and MNA-SF results were compared with first clinician's decision of malnutrition and kappa coefficients were 0.68 and 0.66, respectively. Sensitivity analysis indicated that MNA was 92% sensitive and 86% specific, whereas MNA-SF was 94% sensitive and 81% specific. Conclusion MNA and MNA-SF are suitable for malnutrition screening in Turkish older adults.