Search

Objective: The Observation and Interview Based Diurnal Sleepiness Inventory (ODSI) is a valid 3-item tool used for assessment of excessive daytime sleepiness (EDS). The aim of this study was to investigate the reliability and validity of the ODSI in the Turkish language.Methods: Linguistic validation of the ODSI was performed by forward-backward translation. The Turkish version of the ODSI and the Epworth Sleepiness Scale (ESS) were administered in EDS and control groups.Results: The ODSI was tested in 106 older patients. The median age of the patients was 73 (65–89) years and 55.7% were female. The EDS group was older and more dependent on instrumental activities of daily living than the control group. The inter-rater reliability of the ODSI was high (interclass correlation coefficient [ICC]: 0.851, 95% confidence interval [CI]: 0.540–0.958, p

We aimed to find out whether the Mini Nutritional Assessment-Short Form (MNA-SF) can predict mortality up to 7 years when compared with the Mini Nutritional Assessment-Long Form (MNA-LF) in geriatric outpatients.This retrospective study was conducted in patients (≥65 years) who were admitted to the geriatric outpatient clinic of a university hospital. MNA-SF and MNA-LF results were available for all patients. Patients were grouped as normal nutrition status (score 12-14), at risk of malnutrition (score between 8 and 11), or malnourished (score ≤7) according to MNA-SF. Based on MNA-LF, patients had normal nutrition status (score ≥24), were at risk of malnutrition (score 17-23.5), or were malnourished (score17). Survival of the patients was assessed retrospectively.The study included 209 patients (62.2% female). During the 7-year follow-up, 77 (36.8%) patients died. After adjusting for age, sex, and Charlson comorbidity index, MNA-SF was significantly associated with all-cause mortality during 6-month, 1-year, 3-year, 5-year, and 7-year follow-up time. MNA-LF was superior to MNA-SF to estimate 6-month (P = 0.004) and 1-year mortality (P = 0.031). There was no difference between MNA-SF and MNA-LF regarding 3-year, 5-year, and 7-year mortality.MNA-SF can predict short-term and long-term mortality in geriatric outpatients as well as MNA-LF. A cut-off value of 11, indicating risk of malnutrition according to MNA-SF, may be used for the risk estimation of 1-year, 3-year, and 5-year mortality. Therefore, this study highlights the importance of screening all geriatric outpatients for malnutrition and especially the risk of malnutrition for early intervention and treatment.

Key summary points Aim To assess the experiences of early career geriatricians during the COVID-19 pandemic. Findings The respondents reported moderate levels of anxiety, work overload, and strong disruption in their work routine and private lives. Message Many early career geriatricians throughout Europe were involved as frontline workers in the care of older adults with COVID-19, and experienced a major impact on their professional and private lives. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00605-1., The COVID-19 pandemic has severely affected older adults and brought about unprecedented challenges to geriatricians. We aimed to evaluate the experiences of early career geriatricians (residents or consultants with up to 10 years of experience) throughout Europe using an online survey. We obtained 721 responses. Most of the respondents were females (77.8%) and residents in geriatric medicine (54.6%). The majority (91.4%) were directly involved in the care of patients with COVID-19. The respondents reported moderate levels of anxiety and feelings of being overloaded with work. The anxiety levels were higher in women than in men. Most of the respondents experienced a feeling of a strong restriction on their private lives and a change in their work routine. The residents also reported a moderate disruption in their training and research activities. In conclusion, early career geriatricians experienced a major impact of COVID-19 on their professional and private lives. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00605-1.

Coronavirus Disease 2019 (COVID-19) is characterized with a wide range of clinical presentations from asymptomatic to severe disease. In patients with severe disease, the main causes of mortality have been acute respiratory distress syndrome, cytokine storm and thrombotic events. Although all factors that may be associated with disease severity are not yet clear, older age remains a leading risk factor. While age-related immune changes may be at the bottom of severe course of COVID-19, age-related hormonal changes have considerable importance due to their interactions with these immune alterations, and also with endothelial dysfunction and comorbid cardiometabolic disorders. This review aims to provide the current scientific evidence on the pathogenetic mechanisms underlying the pathway to severe COVID-19, from a collaborative perspective of age-related immune and hormonal changes together, in accordance with the clinical knowledge acquired thus far.

The current study aimed to screen for delirium in hospitalized older adults and assess the validity of the Turkish version of the 4A's Test (4AT-TR) as a feasible tool to integrate in routine patient care. The point prevalence of delirium according to clinical evaluation in routine practice was detected among all patients aged ≥60 years in 12 pilot wards. Delirium screening was then conducted by two arms: (a) nurses using the 4AT-TR and (b) geriatricians according to Diagnostic and Statistical Manual of Mental Disorders, 5th edition ( DSM-5 ) criteria. Prevalence of delirium according to clinical impression was 3.3% ( n = 4), whereas prevalence was 12.4% ( n = 17) according to DSM-5 criteria and 13.8% ( n = 17) according to the 4AT-TR. The 4AT-TR performed by nurses had a sensitivity of 66.6% and specificity of 93.5%. Area under the receiver operating characteristic curve for delirium diagnosis was 0.819 ( p < 0.001). Most delirium cases remain undetected unless a routine and formal delirium assessment is integrated in hospital care of high-risk patients. The 4AT-TR performed by nurses seems to be a valid tool for determining delirium in hospitalized older adults. [ Journal of Gerontological Nursing, 48 (8), 43–51.]

BACKGROUND Insomnia increases the incidence of falls and impairs executive function. Moreover, falls are associated with executive function impairment. The relationship between falls and executive function in patients with insomnia is not clear. The aim of this study was to evaluate relationship between falls and executive function in individuals with insomnia and a control group. METHODS This study involved 122 patients (47 insomnia, 75 controls). The Mini-Mental State Examination, Quick Mild Cognitive Impairment Screen, Trail Making Test A, clock-drawing test, and digit span test were used to measure executive function. Semantic and working memory dual task was also performed. Fall history was recorded and the Falls Efficacy Scale - International administered. RESULTS The median age of the patients was 71 years (range: 65-89 years), and 60.7% were women. The insomnia group scored lower on the three-word recall than the control group (P = 0.005), but there was no difference between the groups on cognitive tests. Fall history and fear of falling were more frequent in the insomnia group (P = 0.003, P

Atrial fibrillation (AF), the most common sustained arrhythmia in older adults, causes significant complications such as stroke, dementia, and decreased quality of life. Frailty is a geriatric syndrome that is associated with increased risk of poor clinical outcomes including falls, disability, and mortality. We aimed to investigate the relationship between AF and frailty and functionality in older adults. A total of 123 patients 64 with AF and 59 with normal sinus rhythm were enrolled in the study with cross-sectional design. All patients underwent comprehensive geriatric assessment (CGA). Frailty status was assessed using Fried criteria and FRAIL scale. The brief Older People’s Quality of Life questionnaire was applied for quality of life. Results of the laboratory tests were recorded and compared for both groups. Although the frequency of frailty status determined by the Fried criteria and the FRAIL scale was higher in the AF group, this difference was not statistically significant. However, it was found that there was a positive correlation between the European Heart Rhythm Association (EHRA) AF symptom score and frailty according to the FRAIL scale (Goodman and Kruskal gamma coefficient = 0.39, p = 0.020). Comorbidities and polypharmacy were more common in the AF group (p

Background The aim of this study is to identify cutoff values for muscle ultrasound (US) to be used in Global Leadership Initiative on Malnutrition (GLIM) criteria, and to define the effect of reduced muscle mass assessment on malnutrition prevalence at hospital admission. Methods A total of 118 inpatients were enrolled in this cross-sectional study. Six different muscles were evaluated by US. Following defining thresholds for muscle US to predict low muscle mass measured by bioelectrical impedance analysis, malnutrition was diagnosed by GLIM criteria with seven approaches, including calf circumference, mid-upper arm circumference (MAC), handgrip strength (HGS), skeletal muscle index (SMI), rectus femoris (RF) muscle thickness, and cross-sectional area (CSA) in addition to without using the reduced muscle mass criterion. Results The median age of patients was 64 (18-93) years, 55.9% were female. RF muscle thickness had moderate positive correlations with both HGS (r = 0.572) and SMI (r = 0.405). RF CSA had moderate correlation with HGS (r = 0.567) and low correlation with SMI (r = 0.389). The cutoff thresholds were 11.3 mm (area under the curve [AUC] = 0.835) and 17 mm (AUC = 0.737) for RF muscle thickness and 4 cm² (AUC = 0.937) and 7.2 cm² (AUC = 0.755) for RF CSA in females and males, respectively. Without using the reduced muscle mass criterion, malnutrition prevalence was 46.6%; otherwise, it ranged from 47.5% (using MAC) to 65.2% (using HGS). Conclusions Muscle US may be used in GLIM criteria. However, muscle US needs a standard measurement technique and specific cutoff values in future studies.

This study aimed to provide data about the role of muscle ultrasound (US) to predict sarcopenia.A total of 313 geriatric outpatients (age ≥65 y) were enrolled in the study. After a comprehensive geriatric assessment, anthropometric measurement and handgrip strength (HGS) data were obtained and a bioelectrical impedance analysis was performed. Sarcopenia was diagnosed using HGS and bioelectrical impedance analysis data. Gastrocnemius medialis (GC), rectus femoris (RF), and rectus abdominis (RA) muscle thickness as well as the RF cross-sectional area (CSA) were measured with US. The role of muscle US to predict sarcopenia was defined with a receiver operating characteristics analysis.The prevalence of probable and confirmed sarcopenia were 43.8% (n = 137) and 13.4% (n = 42), respectively. All muscle US parameters had positive correlations with both HGS and the fat-free mass index. There were inverse correlations between all muscle US parameters and the five-item sarcopenia questionnaire. The RF CSA had stronger correlations with the five-item sarcopenia questionnaire, HGS, and the fat-free mass index than others. The values of GC, RF, and RA muscle thickness and the RF CSA to predict sarcopenia for women/men were 13.9/13.8 mm (area under the curve [AUC]: 0.817/0.707 mm), 13/15.5 mm (AUC: 0.760/0.736 mm), 4.3/5.2 cmGC, RF, and RA muscle thickness and the RF CSA all may predict sarcopenia accurately in geriatric outpatients.

Background A novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) occurred in China in December 2019 and has spread globally. In this study, we aimed to describe the clinical characteristics and outcomes of hospitalized older adults with coronavirus disease 2019 (COVID-19) in Turkey. Methods We retrospectively analyzed the clinical data of hospitalized patients aged ≥ 60 years with confirmed COVID-19 from March 11, 2020 to May 27, 2020 using nationwide health database. Results In this nationwide cohort, a total of 16,942 hospitalized older adults with COVID-19 were enrolled, of whom 8,635 (51%) were women. Mean age was 71.2 ± 8.5 years, ranging from 60 to 113 years. Mortality rate before and after curfew was statistically different (32.2% vs. 17.9%; p < .001, respectively). Through multivariate analysis of the causes of death in older patients, we found that male gender, diabetes mellitus, heart failure, dementia, were all significantly associated with mortality in entire cohort. In addition to abovementioned risk factors, in patients aged between 60 and 79 years, hypertension, chronic kidney disease and cancer and in patients 80 years of age and older malnutrition were also associated with increased risk of mortality. Conclusions In addition to the results of previous studies with smaller sample size, our results confirmed the age-related relationship between specific comorbidities and COVID-19–related mortality.

Muscle weakness is a nonspecific finding of myopathy of any etiology that include iatrogenic, toxic, endocrinological, infectious, immunologic, and metabolic disorders. Among the metabolic myopathies glutaric aciduria type II (GAII) is an autosomal recessively inherited rare disorder of fatty acid and amino acid metabolisms. The late onset form is heterogeneous in terms of symptomatology and severity and for the cases that chronic manifestations of lipid storage myopathy are the only clues for the disease, differential diagnosis can be challenging. Here we report two cases of GAII: the first one was 18-year old boy who presented with proximal muscle weakness and in another center, he was diagnosed as polymyositis and treated with immunosuppressive therapies. He admitted to our clinic with ongoing muscle weakness and symptoms that were related to the side effects of immunosuppressive therapies. The second case was also presented with muscle weakness. For both cases, muscle biopsies and urinary organic acid analyses were consistent with the diagnosis of GAII. To differentiate inflammatory myositis from non-inflammatory myopathies; rheumatic symptoms, accompanying complaints of the patient and autoantibody positivity can be helpful. To our knowledge this is the first report to underline the differential diagnosis of inflammatory myopathies from metabolic myopathies.

Ankaferd blood stopper is a standardized mixture of the plants Thymus vulgaris , Glycyrrhiza glabra , Vitis vinifera , Alpinia officinarum , and Urtica dioica and has been used as a topical hemostatic agent and with its clinical application established in randomized controlled trials and case reports. Ankaferd has been successfully used in gastrointestinal endobronchial mucosal and cutaneous bleedings and also in abdominal, thoracic, dental and oropharyngeal, and pelvic surgeries. Ankaferd’s hemostatic action is thought to form a protein complex with coagulation factors that facilitate adhesion of blood components. Besides its hemostatic action, Ankaferd has demonstrated pleiotropic effects, including anti-neoplastic and anti-microbial activities and tissue-healing properties; the underlying mechanisms for these have not been well studied. Ankaferd’s individual components were determined by proteomic and chemical analyses. Ankaferd also augments transcription of some transcription factors which is shown with transcriptomic analysis. The independent effects of these ingredients and augmented transcription factors are not known precisely. Here, we review what is known of Ankaferd blood stopper components from chemical, proteomic, and transcriptomic analyses and propose that individual components can explain some pleiotropic effects of Ankaferd. Certainly more research is needed focusing on individual ingredients of Ankaferd to elucidate their precise and effects.