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Thaenpramun R, Komolsuradej N, Buathong N, Srikrajang S. Association between glycaemic control and malnutrition in older adults with type 2 diabetes mellitus: a cross-sectional study. Br J Nutr 2024; 131:1497-1505. [PMID: 38239007 PMCID: PMC11043908 DOI: 10.1017/s0007114524000175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/28/2023] [Accepted: 01/16/2024] [Indexed: 02/13/2024]
Abstract
Malnutrition is a major problem among older adults with type 2 diabetes mellitus (T2DM). Some studies suggest that well glycaemic control increases the risk of frailty due to reduced intake. Therefore, it could be hypothesised that adequate glycaemic controlled patients may be at risk of malnutrition. This study aimed to examine, in older adults with T2DM, the association between adequate glycaemic control and malnutrition as well as identify the risk factors for malnutrition. Data including general characteristics, health status, depression, functional abilities, cognition and nutrition status were analysed. Poor nutritional status is defined as participants assessed with the Mini Nutritional Assessment as being at risk of malnutrition or malnourished. Adequate glycaemic control refers to an HbA1c level that meets the target base in the American Diabetes Association 2022 guidelines with individualised criteria. There were 287 participants with a median (interquartile range) age of 64 (61-70) years, a prevalence of poor nutrition, 15 %, and adequate glycaemic control, 83·6 %. This study found no association between adequate glycaemic control and poor nutrition (P = 0·67). The factors associated with poor nutritional status were low monthly income (adjusted OR (AOR) 4·66, 95 % CI 1·28, 16·98 for income < £118 and AOR 7·80, 95 % CI 1·74, 34·89 for income £118-355), unemployment (AOR 4·23, 95 % CI 1·51, 11·85) and cognitive impairment (AOR 5·28, 95 % CI 1·56, 17·93). These findings support the notion that older adults with T2DM should be encouraged to maintain adequate glycaemic control without concern for malnutrition, especially those who have low income, unemployment or decreased cognitive functions.
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Affiliation(s)
- Rattiyaphon Thaenpramun
- Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla90110, Thailand
| | - Narucha Komolsuradej
- Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla90110, Thailand
| | - Napakkawat Buathong
- Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla90110, Thailand
| | - Siwaluk Srikrajang
- Department of Physical Therapy, Faculty of Medicine, Prince of Songkla University, 15 Kanjanavanich road, Hat Yai, Songkhla90110, Thailand
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Lin WQ, Xiao T, Fang YY, Sun MY, Yang YO, Chen JM, Ou CQ, Liu H. The Association of Malnutrition and Health-Related Factors among 474,467 Older Community-Dwellers: A Population-Based Data Mining Study in Guangzhou, China. Nutrients 2024; 16:1338. [PMID: 38732585 PMCID: PMC11085532 DOI: 10.3390/nu16091338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/25/2024] [Accepted: 04/27/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND This study aimed to examine the prevalence and associated factors of malnutrition in older community-dwellers and explore the interaction between associated factors. METHODS A total of 474,467 older community-dwellers aged 65 or above were selected in Guangzhou, China. We used a two-step methodology to detect the associated factors of malnutrition and constructed logistic regression models to explore the influencing factors and interactive effects on three patterns of malnutrition. RESULTS The prevalence of malnutrition was 22.28%. Older adults with both hypertension and diabetes (RERI = 0.13), both meat or fish diet and hypertension (RERI = 0.79), and both meat or fish diet and diabetes (RERI = 0.81) had positive additive interaction effects on the risk of obesity, whereas those on a vegetarian diet with hypertension (RERI = -0.25) or diabetes (RERI = -0.19) had negative additive interaction effects. Moreover, the interactions of physical activity with a meat or fish diet (RERI = -0.84) or dyslipidemia (RERI = -0.09) could lower the risk of obesity. CONCLUSIONS Malnutrition was influenced by different health factors, and there were interactions between these influencing factors. Pertinent dietary instruction should be given according to different nutritional status indexes and the prevalence of metabolic diseases to avoid the occurrences of malnutrition among older adults.
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Affiliation(s)
- Wei-Quan Lin
- Department of Basic Public Health, Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China; (W.-Q.L.); (Y.-Y.F.); (M.-Y.S.); (J.-M.C.)
- Institute of Public Health, Guangzhou Medical University & Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China
| | - Ting Xiao
- State Key Laboratory of Organ Failure Research, School of Public Health, Southern Medical University, Guangzhou 511436, China;
| | - Ying-Ying Fang
- Department of Basic Public Health, Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China; (W.-Q.L.); (Y.-Y.F.); (M.-Y.S.); (J.-M.C.)
| | - Min-Ying Sun
- Department of Basic Public Health, Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China; (W.-Q.L.); (Y.-Y.F.); (M.-Y.S.); (J.-M.C.)
- Institute of Public Health, Guangzhou Medical University & Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China
| | - Yun-Ou Yang
- Department of Basic Public Health, Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China; (W.-Q.L.); (Y.-Y.F.); (M.-Y.S.); (J.-M.C.)
| | - Jia-Min Chen
- Department of Basic Public Health, Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China; (W.-Q.L.); (Y.-Y.F.); (M.-Y.S.); (J.-M.C.)
| | - Chun-Quan Ou
- State Key Laboratory of Organ Failure Research, School of Public Health, Southern Medical University, Guangzhou 511436, China;
| | - Hui Liu
- Department of Basic Public Health, Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China; (W.-Q.L.); (Y.-Y.F.); (M.-Y.S.); (J.-M.C.)
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Wang LY, Hu ZY, Chen HX, Tang ML, Hu XY. Multiple geriatric syndromes in community-dwelling older adults in China. Sci Rep 2024; 14:3504. [PMID: 38347070 PMCID: PMC10861528 DOI: 10.1038/s41598-024-54254-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 02/10/2024] [Indexed: 02/15/2024] Open
Abstract
This study aims to assess the prevalence of geriatric syndromes and identify factors associated with multiple geriatric syndromes in community-dwelling older adults in China. We utilized a convenience sampling method to recruit older adults and from one rural and one urban community in Chengdu, China, from October 2022 to March 2023. A total of 706 older adults aged 60 years or older were included. Ten geriatric syndromes were investigated including two mental disorders: depressive symptoms, cognitive impairment; and eight somatic disorders: pain, falls, sleep disturbance, constipation, polypharmacy, multimorbidity, malnutrition and frailty. Multiple geriatric syndromes were defined as an individual having two or more geriatric syndromes. The data obtained were analysed using descriptive statistics. The independent risk factors for multiple geriatric syndromes were assessed using a logistic regression model. This study found that 90.5% of the participants had at least one geriatric syndrome, with 72.8% experiencing multiple geriatric syndromes. The top four geriatric syndromes in our study were polypharmacy (58.5%), malnutrition/at risk of malnutrition (43.1%), multimorbidity (42.1%), and frailty/prefrailty (34.3%). Of the older adults, 368(52.1%) had only somatic disorders, 18(2.5%) had only mental disorders and 253 (35.8%) had somatic-mental disorders. According to the logistic regression analysis, residence, age, marriage, BMI, and self-related health were significantly associated with multiple geriatric syndromes among older adults. This study highlights that multiple geriatric syndromes are prevalent among community-dwelling older adults in China, and underscores the significance of certain demographic factors in their occurrence. Future longitudinal studies are needed to establish the temporal relationship between multiple geriatric syndromes and these demographic factors, as well as to explore causal relationships and effective prevention strategies for geriatric syndrome.
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Affiliation(s)
- Ling-Ying Wang
- Innovation Center of Nursing Research and Nursing Key Laboratory of Sichuan Province, West China Hospital, School of Nursing, Sichuan University, Chengdu, 610041, China
- Critical Care Medicine Department, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Zi-Yi Hu
- Nursing Department, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, China
| | - Hong-Xiu Chen
- Innovation Center of Nursing Research and Nursing Key Laboratory of Sichuan Province, West China Hospital, School of Nursing, Sichuan University, Chengdu, 610041, China
| | - Meng-Lin Tang
- Critical Care Medicine Department, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xiu-Ying Hu
- Innovation Center of Nursing Research and Nursing Key Laboratory of Sichuan Province, West China Hospital, School of Nursing, Sichuan University, Chengdu, 610041, China.
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Liu J, Pan M, Sun M, Shi H, Feng R. Nutritional Status and Physical Exercise Are Associated with Cognitive Function in Chinese Community-Dwelling Older Adults: The Role of Happiness. Nutrients 2024; 16:203. [PMID: 38257095 PMCID: PMC10819784 DOI: 10.3390/nu16020203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/29/2023] [Accepted: 01/05/2024] [Indexed: 01/24/2024] Open
Abstract
We aim to assess the relationship between nutrition status, physical exercise, and cognitive function and particularly examine how happiness modifies and mediates the relationship, among 699 seniors aged 60 and above in Shanghai, China. Linear regression models were used to validate the effects of nutrition and exercise on cognitive function and to test their interaction effects with happiness. When the interactions were significant, stratified analyses in sub-groups were conducted. Mediation effects of happiness were examined using two-step causal mediation models. We confirmed that better nutrition (p < 0.001) and exercise (p = 0.009) were significantly associated with less cognitive decline. Furthermore, the effects of nutrition and exercise on cognitive decline were significant in the unhappy (happiness < 20) (p < 0.001) and younger (age < 74) sub-groups (p = 0.015). Happiness partially mediated 11.5% of the negative association of cognitive decline with nutrition (p = 0.015) and 23.0% of that with exercise (p = 0.017). This study suggests that happiness moderates and partially mediates the effects of exercise and nutrition on cognitive status. The beneficial effects of exercise and nutrition were stronger in less happy or younger seniors. Future intervention studies are required to confirm this path relationship.
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Affiliation(s)
- Jianghong Liu
- School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA; (M.P.); (H.S.)
| | - Michael Pan
- School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA; (M.P.); (H.S.)
- School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - McKenna Sun
- School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA; (M.P.); (H.S.)
- College of Arts & Sciences, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Haoer Shi
- School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA; (M.P.); (H.S.)
- School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Rui Feng
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
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Mezgebu GS, Petros L, Alemayew E, Abebaw G, Feleke FW. Magnitude of undernutrition and its association with dietary diversity among older persons in Ethiopia: a systematic review and meta-analysis, 2023. J Nutr Sci 2023; 12:e102. [PMID: 37771505 PMCID: PMC10523292 DOI: 10.1017/jns.2023.84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 08/15/2023] [Accepted: 09/04/2023] [Indexed: 09/30/2023] Open
Abstract
Undernutrition in elders remains under-detected, under-treated, and under-resourced and leads to further weight loss, increased infections, and delay in recovery from illness as well as increased hospital admissions and length of stay. The reports of the findings were fragmented and inconsistent in Ethiopia. Therefore, the main objective of this meta-analysis was to estimate the pooled prevalence of undernutrition and its association with dietary diversity among older persons in Ethiopia. Online databases (Medline, PubMed, Scopus, and Science Direct), Google, Google Scholar, and other grey literature were used to search articles until the date of publication. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed. The random effect model was used to estimate the pooled prevalence; whereas subgroup analysis and meta-regression were performed to identify the probable source of heterogeneity using Stata version 14.0 software. Out of 522 studies accessed, 14 met our criteria and were included in the study. A total of 7218 older people (aged above 60 years old) were included in the study. The pooled proportion of undernutrition among older persons in Ethiopia was 20⋅6 % (95 % CI 17⋅3, 23⋅8). Elders who consumed low dietary diversity scores were strongly associated with undernutrition among older persons. Therefore, promoting appropriate intervention strategies for elders to improve dietary diversity practices and nutritional status is crucial.
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Key Words
- AOR, adjusted odd ratio
- CDC, Centers for Disease Control and Prevention
- CI, confidence interval
- DDS, Dietary Diversity Score
- Dietary diversity
- FAO, Food and Agriculture Organization
- IDA, iron deficiency anaemia
- JBI, Joanna Briggs Institute
- LIC, low-income country
- Malnutrition
- MeSH, Medical Subject Headings
- Meta-analysis
- NGO, Non-Governmental Organization
- Older persons
- PRISMA, Preferred Reporting Items for Systematic Review and Meta-Analysis
- SNNP, Southern Nations, Nationalities, and People's Region
- SSA, sub-Saharan Africa
- Systematic review
- WHO, World Health Organization
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Affiliation(s)
- Getachew Sale Mezgebu
- Department of Human Nutrition, School of Human Nutrition and Food Science Technology, College of Agriculture, Hawassa University, PO Box 05, Hawassa, Ethiopia
| | - Legesse Petros
- Department of Human Nutrition, School of Human Nutrition and Food Science Technology, College of Agriculture, Hawassa University, PO Box 05, Hawassa, Ethiopia
| | - Etaferaw Alemayew
- Department of Human Nutrition, School of Human Nutrition and Food Science Technology, College of Agriculture, Hawassa University, PO Box 05, Hawassa, Ethiopia
| | - Gashaw Abebaw
- Department of Human Nutrition, School of Human Nutrition and Food Science Technology, College of Agriculture, Hawassa University, PO Box 05, Hawassa, Ethiopia
| | - Fentaw Wassie Feleke
- Department of Human Nutrition, School of Human Nutrition and Food Science Technology, College of Agriculture, Hawassa University, PO Box 05, Hawassa, Ethiopia
- Department of Public Health, School of Public Health, College of Medicine and Health Sciences, Woldia University, PO Box 400, Woldia, Ethiopia
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Pons-Novell J, Guillen M. The Autonomous Capacity of the Elderly Population in Spain for Shopping and Preparing Meals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14828. [PMID: 36429546 PMCID: PMC9691086 DOI: 10.3390/ijerph192214828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/05/2022] [Accepted: 11/09/2022] [Indexed: 06/16/2023]
Abstract
A loss of the ability to buy and prepare meals, especially in people aged 65 and over, leads to a deterioration in their optimal level of nutrition. The Index of Autonomy in Food Acquisition (IAFA) was used to identify contributing factors. This is a composite indicator for shopping and meal preparation that can be used to assess the degree of autonomous capacity observed in a specific group. Data from the European Health Survey in Spain (7167 respondents aged 65 and over) show that capacity decreased with age and that women were less affected than men, with very little difference found in levels of autonomous capacity by territory. However, in relation to different income levels, after standardizing for age and sex, no evidence was found for differences in the ability to access and prepare meals in groups that were separated by income level. This result shows the importance of standardizing when analysing food acquisition autonomy in groups of people aged 65 years and over.
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An extended version of the MNA-SF increases sensitivity in identifying malnutrition among community living older adults. Results from the PRONUTRISENIOR project. Clin Nutr ESPEN 2021; 46:167-172. [PMID: 34857191 DOI: 10.1016/j.clnesp.2021.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 06/23/2021] [Accepted: 10/20/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND & AIMS The Mini Nutritional Assessment (MNA) is the most used tool to assess malnutrition and/or its risk among older adults. Its Screening section was proposed as a short form (MNA-SF) but studies comparing the two forms present controversial results. Our main aims were to study the agreement between MNA-SF and its full form (MNA-FF) among Portuguese older adults living in the community and to develop a more sensible version of the MNA-SF. MATERIAL AND METHODS This cross-sectional study used a convenience sample of 456 older adults (54.2% females) aged 65-92 years (mean = 73; SD = 6). Data analyzed included: nutritional status (MNA), social support (Fillenbaum's Social Network Index), level of independency in daily activities (Lawton e Brody's scale) and eating-related quality of life. Both MNA-FF and MNA-SF classify participants as malnourished, at risk of malnutrition or with normal nutrition status. Anthropometric assessments (weight, height, arm and calf perimeters) were carried out and BMI was computed. RESULTS The agreement between the two classifications is 82.7%, but Cohen's k shows a weak agreement (weighted Cohen's k = 0.497; p < 0,001), and the sensitivity of the MNA-SF to detect malnutrition or its risk (as assessed by the MNA-FF) was 42.6% (despite a specificity of 98.8%). Participants classified as normal using the MNA-SF despite at risk using the MNA-FF present lower scores in two items from the Assessment section (number of full meals eaten daily and amount of fluid consumed per day). These were included in MNA-SF to obtain an extended short-version (MNA-SF8). The difference between the ROC curves for MNA-SF and MNA-SF8 justifies the preferential use of the MNA-SF8 with an estimated cut-off of 14 points, which showed high sensitivity (91.8%) and specificity (79.9%). CONCLUSIONS The addition of two items to the MNA-SF provides a more sensible tool to detect the risk of malnutrition among older adults. General eating-related questions seem relevant to assess malnutrition in this age group.
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Lai X, Zhu H, Du H, Huo X, Yu K. Nutritional status of Chinese oldest-old adults (≥80 years of age): a cross-sectional study in Beijing. Eur J Clin Nutr 2020; 75:1040-1046. [PMID: 33323962 DOI: 10.1038/s41430-020-00826-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 10/29/2020] [Accepted: 11/27/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Nutrition is associated with frailty, functional impairments, and mortality in elderly people. Only a few studies focused on oldest-old hospitalized patients with worse health and more comorbidities compared with the general older adults in China. OBJECTIVE This study aimed to investigate the nutritional risk, malnutrition, and nutritional support status of oldest-old hospitalized patients (≥80 years of age) in China, and to provide a basis for implementing an effective nutritional intervention. METHODS This study involved 358 oldest-old patients of Peking Union Medical College Hospital in China. The Nutrition Risk Screening 2002 scale was used to assess nutritional risk. Malnutrition was defined as body mass index (BMI) < 18.5 kg/m2; or unwanted weight loss >10% at any time, or unwanted weight loss >5% in recent 3 months and BMI < 22 kg/m2. Logistic regression analysis was used to identify factors associated with nutritional risk. RESULTS The overall frequency of nutritional risk and malnutrition was 50.3% (180/358) and 36.0% (129/358), respectively. Also, 134 (37.3%) patients received nutritional support; the ratio of parenteral nutrition (PN) to enteral nutrition (EN) was 1.35:1. Further, 106 (58.9%) patients with nutritional risk received nutritional support. The number of chronic diseases and age were protective factors, and activities of daily living (ADL) were risk factors. CONCLUSIONS The overall frequencies of nutritional risk and malnutrition of oldest-old hospitalized patients were high, and the rates of EN and PN were low. Nutritional risk was associated with the number of chronic diseases, age, and ADL.
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Affiliation(s)
- Xiaoxing Lai
- Department of Health Care, Peking Union Medical College Hospital, 100730, Beijing, China.
| | - Hongwei Zhu
- Department of Health Care, Peking Union Medical College Hospital, 100730, Beijing, China
| | - Hongdi Du
- Department of Health Care, Peking Union Medical College Hospital, 100730, Beijing, China
| | - Xiaopeng Huo
- Department of Health Care, Peking Union Medical College Hospital, 100730, Beijing, China.
| | - Kang Yu
- Department of Clinical Nutrition, Peking Union Medical College Hospital, 100730, Beijing, China
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Besora-Moreno M, Llauradó E, Tarro L, Solà R. Social and Economic Factors and Malnutrition or the Risk of Malnutrition in the Elderly: A Systematic Review and Meta-Analysis of Observational Studies. Nutrients 2020; 12:nu12030737. [PMID: 32168827 PMCID: PMC7146387 DOI: 10.3390/nu12030737] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/03/2020] [Accepted: 03/08/2020] [Indexed: 12/31/2022] Open
Abstract
Malnutrition in the elderly could be tackled by addressing socioeconomic factors. This study aimed to determine the magnitude of the relationship between socioeconomic factors and the malnutrition or malnutrition risk (MR) in the elderly. The PubMed and SCOPUS databases were searched for observational studies that included assessment of malnutrition or/and MR and socioeconomic variables (educational level, living alone, marital status, income and occupational level, feeling of loneliness, place of residence, and food expenditure) in ≥60-year-old subjects, published in English among 2000–2018 (PROSPERO: CRD42019137097). The systematic review included 40 observational studies (34 cross-sectional and 4 cohort studies) and 16 cross-sectional studies in the meta-analysis (34,703 individuals) of malnutrition and MR in relation to low educational level (Odds Ratio (OR): 1.48; 95% Confidence Interval (CI): 1.33–1.64; p < 0.001), living alone (OR: 1.92; 95% CI: 1.73–2.14; p < 0.001), being single, widowed, or divorced (OR: 1.73; 95% CI: 1.57–1.90; p < 0.001), and low income level (OR: 2.69; 95% CI: 2.35–3.08; p < 0.001), and considering these four socioeconomic factors, malnutrition and MR is associated with them (OR: 1.83; 95% CI: 1.73–1.93; p < 0.001). Malnutrition and MR could be reduced by increasing economic level, supporting people living alone or being single, widowed, and divorced, and improving lifelong learning.
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Affiliation(s)
- Maria Besora-Moreno
- Universitat Rovira i Virgili, Facultat de Medicina i Ciències de la Salut, Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), 43201 Reus, Spain; (M.B.-M.); (L.T.); (R.S.)
| | - Elisabet Llauradó
- Universitat Rovira i Virgili, Facultat de Medicina i Ciències de la Salut, Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), 43201 Reus, Spain; (M.B.-M.); (L.T.); (R.S.)
- Correspondence: ; Tel.: +34-977-75-89-20
| | - Lucia Tarro
- Universitat Rovira i Virgili, Facultat de Medicina i Ciències de la Salut, Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), 43201 Reus, Spain; (M.B.-M.); (L.T.); (R.S.)
- Centre Tecnològic de Catalunya, Unitat de Nutrició i Salut, Eurecat, 43204 Reus, Spain
| | - Rosa Solà
- Universitat Rovira i Virgili, Facultat de Medicina i Ciències de la Salut, Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), 43201 Reus, Spain; (M.B.-M.); (L.T.); (R.S.)
- Centre Tecnològic de Catalunya, Unitat de Nutrició i Salut, Eurecat, 43204 Reus, Spain
- Hospital Universitari Sant Joan de Reus, Department of Internal Medicine, 43204 Reus, Spain
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Wang X, Liu M, Li Y, Guo C, Yeh CH. Community canteen services for the rural elderly: determining impacts on general mental health, nutritional status, satisfaction with life, and social capital. BMC Public Health 2020; 20:230. [PMID: 32059652 PMCID: PMC7023764 DOI: 10.1186/s12889-020-8305-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 01/31/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The Chinese government is piloting canteen services for older adults, but few studies have explored the influence of canteen services on the health of these older adults. This study aimed to investigate the impact of canteen services on older adults' general mental health, nutritional status, satisfaction with life, and social capital in rural areas. METHODS This study used a cross-sectional design. We selected 14 villages in Jinhua City, Zhejiang Province, China, including seven villages with canteen services and seven villages without canteen services. Participants were 284 senior older adults (aged 75~98), including 140 residing in villages with canteen services (Canteen Group [CG]) and 144 residing in villages without canteen services (Non-Canteen Group [NCG]). We also divided the CG into two sub-groups according to the funding sources (one receiving government support only, the other receiving government support plus enterprise donations). We used a self-designed questionnaire, including sociodemographics, diet-related items (e.g., satisfaction with the meals, diet expenditure, self-evaluation of meal nutrition), and the four scales including the Chinese version of the 12-item General Health Questionnaire (GHQ-12), the Chinese version of the Mini Nutritional Assessment Short-Form (MNA-SF), the Satisfaction with Life Scale (SWLS), and the Social Capital Questionnaire (SCQ). RESULTS The overall mental health, satisfaction with life, and social capital of the CG were better than the NCG (P < 0.05). The nutritional status of these two groups did not show a significant difference. Participants in the CG with financial support from local government and donations from an enterprise with a better dietary diversity exhibited a better nutritional status (P < 0.05); the average satisfaction with diet and self-evaluation of food nutrition of the CG were higher than the NCG (P < 0.05); the ratio of having a diet on time in the CG was higher than that of the NCG (P < 0.05). CONCLUSION The free canteen services provided by the government can improve older adults' satisfaction with life and diet, and mental health status and also enrich their social capital, but this still needs to be future evidenced. More financial support for canteen services is an essential component in promoting successful aging in China.
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Affiliation(s)
- Xiaolei Wang
- Department of Nursing, School of Medicine, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Minhui Liu
- Xiangya Nursing School, Central South University, No. 172 Tong Zi Po Road Yuelu District, Changsha, 410013, Hunan, China.
- Johns Hopkins University School of Nursing, Baltimore, MD, USA.
| | - Yuchen Li
- Department of Nursing, School of Medicine, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Chanyuan Guo
- Department of Nursing, School of Medicine, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Chao Hsing Yeh
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
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Zhang D, Cao L, Wang Z, Feng H, Cai X, Xu M, Li M, Yu N, Yin Y, Wang W, Kang J. Salidroside mitigates skeletal muscle atrophy in rats with cigarette smoke-induced COPD by up-regulating myogenin and down-regulating myostatin expression. Biosci Rep 2019; 39:BSR20190440. [PMID: 31702007 PMCID: PMC6879355 DOI: 10.1042/bsr20190440] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 10/17/2019] [Accepted: 11/06/2019] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES The present study aimed at investigating the therapeutic effect of Salidroside on skeletal muscle atrophy in a rat model of cigarette smoking-induced chronic obstructive pulmonary disease (COPD) and its potential mechanisms. METHODS Male Wistar rats were randomized, and treated intraperitoneally (IP) with vehicle (injectable water) or a low, medium or high dose of Salidroside, followed by exposure to cigarette smoking daily for 16 weeks. A healthy control received vehicle injection and air exposure. Their lung function, body weights and gastrocnemius (GN) weights, grip strength and cross-section area (CSA) of individual muscular fibers in the GN were measured. The levels of TNF-α, IL-6, malondialdehyde (MDA), superoxide dismutase (SOD), glutathione (GSH) in serum and GN tissues as well as myostatin and myogenin expression in GN tissues were measured. RESULTS In comparison with that in the healthy control, long-term cigarette smoking induced emphysema, significantly impaired lung function, reduced body and GN weights and CSA values in rats, accompanied by significantly increased levels of TNF-α, IL-6 and MDA, but decreased levels of SOD and GSH in serum and GN tissues. Furthermore, cigarette smoking significantly up-regulated myostatin expression, but down-regulated myogenin expression in GN tissues. Salidroside treatment decreased emphysema, significantly ameliorated lung function, increased antioxidant, but reduced MDA, IL-6 and TNF-α levels in serum and GN tissues of rats, accompanied by decreased myostain, but increased myogenin expression in GN tissues. CONCLUSION Salidroside mitigates the long-term cigarette smoking-induced emphysema and skeletal muscle atrophy in rats by inhibiting oxidative stress and inflammatory responses and regulating muscle-specific transcription factor expression.
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Affiliation(s)
- Dan Zhang
- Department of Respiratory Medicine, Institute of Respiratory Diseases, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning, China
- Department of Respiratory Medicine, The Second Affiliated Hospital of Dalian Medical University, Dalian 116000, Liaoning, China
| | - Lihua Cao
- Department of Respiratory Medicine, The Second Affiliated Hospital of Dalian Medical University, Dalian 116000, Liaoning, China
| | - Zhenshan Wang
- Department of Respiratory Medicine, The Second Affiliated Hospital of Dalian Medical University, Dalian 116000, Liaoning, China
| | - Haoshen Feng
- Department of Respiratory Medicine, Institute of Respiratory Diseases, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning, China
| | - Xu Cai
- Department of Respiratory Medicine, Institute of Respiratory Diseases, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning, China
| | - Mingtao Xu
- Department of Respiratory Medicine, Institute of Respiratory Diseases, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning, China
| | - Menglu Li
- Department of Respiratory Medicine, Institute of Respiratory Diseases, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning, China
| | - Na Yu
- Department of Respiratory Medicine, Institute of Respiratory Diseases, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning, China
| | - Yan Yin
- Department of Respiratory Medicine, Institute of Respiratory Diseases, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning, China
| | - Wei Wang
- Department of Respiratory Medicine, Institute of Respiratory Diseases, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning, China
| | - Jian Kang
- Department of Respiratory Medicine, Institute of Respiratory Diseases, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning, China
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Aging, Mastication, and Malnutrition and Their Associations with Cognitive Disorder: Evidence from Epidemiological Data. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/s40496-019-0220-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Woo J, Ong S, Chan R, Li L, Sun J, Chan YM, Wee SL, Thu NN, Thang P, Setiati S, Huang YC, Wahlqvist ML, de Groot LCPGM. Nutrition, sarcopenia and frailty: An Asian perspective. TRANSLATIONAL MEDICINE OF AGING 2019. [DOI: 10.1016/j.tma.2019.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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He FY, Chen CG, Lin DZ, Lin XH, Qi YQ, Yan L. A greater glycemic load reduction was associated with a lower diabetes risk in pre-diabetic patients who consume a high glycemic load diet. Nutr Res 2018; 53:77-84. [PMID: 29685626 DOI: 10.1016/j.nutres.2018.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 01/17/2018] [Accepted: 03/19/2018] [Indexed: 12/14/2022]
Abstract
Few prospective studies evaluating the association between dietary glycemic load (GL) and diabetes have accounted for changes in GL. However, the diet of patients could be modified in response to an awareness of pre-diabetes. The aim of this study was to examine the longitudinal associations between changes in GL and the incidence of diabetes among pre-diabetic patients. We hypothesized that subjects with low and high baseline GL would show different correlations with diabetes. A total of 493 pre-diabetic patients (142 men and 351 women) between 40 and 79 years of age were included in this study. Dietary records and oral glucose tolerance tests were conducted every year. The participants were divided into low- and high-GL groups based on baseline GL. During a median 4 years of follow-up, 108 incident cases of diabetes were identified. Among participants with a high baseline GL, the incidence of diabetes increased with decreasing GL reduction, and the multivariate-adjusted HR (95% CI) was 2.34 (1.27-4.29) when comparing the lowest to the highest tertiles; however, among those with a low baseline GL, no significant association was observed. Regardless of baseline GL status, the incidence of diabetes was higher in individuals with a high follow-up GL than in those with a low follow-up GL, and the multivariate-adjusted HR (95% CI) was 1.64 (1.09-2.45). In conclusion, a greater GL reduction was associated with a lower diabetes risk in pre-diabetic patients with a high dietary GL. In patients with pre-diabetes and a low dietary GL, further reductions in GL did not show any additional effects.
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Affiliation(s)
- Feng-Yi He
- Department of Clinical Nutrition, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China.
| | - Chao-Gang Chen
- Department of Clinical Nutrition, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China.
| | - Diao-Zhu Lin
- Department of Endocrinology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China.
| | - Xiu-Hong Lin
- Department of Clinical Nutrition, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China.
| | - Yi-Qin Qi
- Department of Endocrinology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China.
| | - Li Yan
- Department of Endocrinology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China.
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15
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Laudisio A, Marinosci F, Gemma A, Bartoli IR, Montenegro N, Incalzi RA. The Burden of Comorbidity Is Associated with Antibiotic Resistance Among Institutionalized Elderly with Urinary Infection: A Retrospective Cohort Study in a Single Italian Nursing Home Between 2009 and 2014. Microb Drug Resist 2017; 23:500-506. [DOI: 10.1089/mdr.2016.0016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alice Laudisio
- Unit of Geriatrics, Department of Medicine, Campus Bio-Medico di Roma University, Rome, Italy
| | | | - Antonella Gemma
- UOS Accesso e Presa in Carico Assistenziale, Azienda Sanitaria Locale Roma E, Rome, Italy
| | - Isaura Rossi Bartoli
- Unit of Geriatrics, Department of Medicine, Campus Bio-Medico di Roma University, Rome, Italy
| | - Nicola Montenegro
- Unit of Geriatrics, Department of Medicine, Campus Bio-Medico di Roma University, Rome, Italy
- Fondazione San Raffaele-Cittadella della Carità, Taranto, Italy
| | - Raffaele Antonelli Incalzi
- Unit of Geriatrics, Department of Medicine, Campus Bio-Medico di Roma University, Rome, Italy
- Fondazione San Raffaele-Cittadella della Carità, Taranto, Italy
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16
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Lin WQ, Wang HHX, Yuan LX, Li B, Jing MJ, Luo JL, Tang J, Ye BK, Wang PX. The Unhealthy Lifestyle Factors Associated with an Increased Risk of Poor Nutrition among the Elderly Population in China. J Nutr Health Aging 2017; 21:943-953. [PMID: 29083434 DOI: 10.1007/s12603-017-0881-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The associations between nutritional status and lifestyle factors have not been well established. This study aimed to investigate the prevalence of poor nutrition and to examine the relationships between nutritional status and unhealthy lifestyle and other related factors among the elderly. METHODS This cross-sectional study was conducted in Liaobu Town, Dongguan city, China. A total of 708 community-dwelling older adults aged ≥60 years were recruited by stratified random sampling. Data on sociodemographic characteristics, health and lifestyle factors, and the Mini Nutritional Assessment (MNA) scores were collected using structured questionnaires via face-to-face interviews. A multivariate logistic regression model was constructed to identify the risk factors of poor nutrition. RESULTS The prevalence of malnutrition among the elderly adults in this study was 1.3%, and 24.4% were at risk of malnutrition (RM). Poor nutrition was significantly associated with female gender, older age, lower education, a high number of self-reported chronic diseases, and hospitalization in the last year. Unhealthy lifestyle factors associated with poor nutrition included current smoking status, higher alcohol consumption, lack of physical activity, longer duration of sitting, negative attitude towards life, and a poor family relationship. CONCLUSIONS While the prevalence of malnutrition was low, RM was high in the elderly population in China. The determinants of malnutrition were explored and the relationships between nutritional status and unhealthy lifestyle factors were examined. The results of this study provide information for future longitudinal studies with multi-factorial interventional design in order to determine the effects of the causal relationships.
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Affiliation(s)
- W-Q Lin
- Pei-Xi Wang, Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, 510180, China,
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Christner S, Ritt M, Volkert D, Wirth R, Sieber CC, Gaßmann KG. Evaluation of the nutritional status of older hospitalised geriatric patients: a comparative analysis of a Mini Nutritional Assessment (MNA) version and the Nutritional Risk Screening (NRS 2002). J Hum Nutr Diet 2016; 29:704-713. [DOI: 10.1111/jhn.12376] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- S. Christner
- Department of Internal Medicine III (Medicine of Ageing); Geriatrics Centre Erlangen; Hospital of the Congregation of St Francis Sisters of Vierzehnheiligen; Erlangen Germany
| | - M. Ritt
- Department of Internal Medicine III (Medicine of Ageing); Geriatrics Centre Erlangen; Hospital of the Congregation of St Francis Sisters of Vierzehnheiligen; Erlangen Germany
- Institute of Biomedicine of Ageing (IBA); Friedrich-Alexander University Erlangen-Nürnberg (FAU); Nürnberg Germany
| | - D. Volkert
- Institute of Biomedicine of Ageing (IBA); Friedrich-Alexander University Erlangen-Nürnberg (FAU); Nürnberg Germany
| | - R. Wirth
- Institute of Biomedicine of Ageing (IBA); Friedrich-Alexander University Erlangen-Nürnberg (FAU); Nürnberg Germany
- Department of Geriatrics; St Marien-Hospital Borken; Borken Germany
| | - C. C. Sieber
- Institute of Biomedicine of Ageing (IBA); Friedrich-Alexander University Erlangen-Nürnberg (FAU); Nürnberg Germany
- Department of Internal Medicine and Geriatrics; Hospital of the Order of St John of God; Regensburg Germany
| | - K.-G. Gaßmann
- Department of Internal Medicine III (Medicine of Ageing); Geriatrics Centre Erlangen; Hospital of the Congregation of St Francis Sisters of Vierzehnheiligen; Erlangen Germany
- Institute of Biomedicine of Ageing (IBA); Friedrich-Alexander University Erlangen-Nürnberg (FAU); Nürnberg Germany
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Wu D, Feng L, Gao Q, Li JL, Rajendran KS, Wong JCM, Kua EH, Ng TP. Association between Fish Intake and Depressive Symptoms among Community-living Older Chinese Adults in Singapore: A Cross-sectional Study. J Nutr Health Aging 2016; 20:404-7. [PMID: 26999240 DOI: 10.1007/s12603-015-0590-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Our aim of this study was to investigate the association between fish consumption and depressive symptoms in senior ethnic Chinese residents of Singapore. DESIGN A population-based cross-sectional study. SETTING The Singapore Longitudinal Aging Studies (SLAS). PARTICIPANT The study consisted of 2,034 participants from the Singapore Longitudinal Aging Studies (SLAS) project who were at least 55 years old. MEASUREMENTS The presence of depressive symptoms was compared between those who self-reported eating fish at least three times a week versus those who ate fish less often. A score of 5 or greater on the 15-item Geriatric Depression Scale (GDS-15) was the cutoff for being designated as having depressive symptoms. RESULTS Fish intake was associated with a lower prevalence of depressive symptoms ([odds ratio] OR = 0.60, 95% [confidence interval] CI 0.40-0.90; P = .015) after controlling for age, sex, marital status, housing, smoking, alcohol consumption, physical exercise, social and productive activities, self-rated health, hypertension, diabetes, heart failure or attack, stroke, fruit and vegetable intake, and Mini-Mental State Examination (MMSE) scores. CONCLUSION Our results suggest that eating fish at least three times a week is associated with a lower odds of having depressive symptoms among Chinese adults over 55 years old living in Singapore.
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Affiliation(s)
- D Wu
- Daxing Wu, Medical Psychological Institute, The Second Xiangya Hospital of Central South University, 139 Middle Renmin Road, Changsha, Hunan 410011, P.R. China.
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Gündüz E, Eskin F, Gündüz M, Bentli R, Zengin Y, Dursun R, İçer M, Durgun HM, Gürbüz H, Ekinci M, Yeşil Y, Güloğlu C. Malnutrition in Community-Dwelling Elderly in Turkey: A Multicenter, Cross-Sectional Study. Med Sci Monit 2015; 21:2750-6. [PMID: 26371941 PMCID: PMC4576923 DOI: 10.12659/msm.893894] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND This study aimed to investigate the prevalence of malnutrition and explore the somatic, psychological, functional, and social or lifestyle characteristics linked to malnutrition in elderly people at a hospital in Turkey. MATERIAL AND METHODS This study included 1030 patients older than 65 years of age who were seen at the internal medicine and geriatrics outpatient clinics of the study centers in Istanbul, Ankara, Duzce, Corum, Mardin, Malatya, and Diyarbakir provinces between January and December 2014. All patients underwent Mini Nutritional Assessment (MNA) and Geriatric Depression Scale (GDS) tests via one-on-one interview method. The demographic properties of the patients were also recorded during this interview. RESULTS Among 1030 patients included in this study, 196 (19%) had malnutrition and 300 (29.1%) had malnutrition risk. The malnutrition group and the other groups were significantly different with respect to mean GDS score, income status, educational status, the number of children, functional status (ADL, IADL), the number of patients with depression, and the number of comorbid disorders. According to the results of the logistic regression analysis, age (OR=95% CI: 1.007-1.056; p=0.012), BMI (OR=95% CI: 0.702-0.796; p<0.001), educational status (OR=95% CI: 0.359-0.897; p=0.015), comorbidity (OR=95% CI: 2.296-5.448; p<0.001), and depression score (OR=95% CI: 1.104-3.051; p=0.02) were independently associated with malnutrition. CONCLUSIONS Our study demonstrates that age, depression, BMI, comorbidity, and the educational status were independently associated with malnutrition in an elderly population.
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Affiliation(s)
- Ercan Gündüz
- Department of Emergency Medicine, Dicle University, Diyarbakır, Turkey
| | - Fatih Eskin
- Department of Internal Medicine, Hitit University, Çorum, Turkey
| | - Mehmet Gündüz
- Department of Hematology, Ankara University, Ankara, Turkey
| | - Recep Bentli
- Department of Internal Medicine, Inonu University, Malatya, Turkey
| | - Yılmaz Zengin
- Emergency Medicine, Dicle University Medical Faculty, Diyarbakır, Turkey
| | - Recep Dursun
- Department of Emergency Medicine, Dicle University, Diyarbakır, Turkey
| | - Mustafa İçer
- Department of Emergency Medicine, Dicle University, Diyarbakır, Turkey
| | | | - Hüseyin Gürbüz
- Department of Emergency Medicine, Dicle University, Diyarbakır, Turkey
| | - Mustafa Ekinci
- Department of Emergency Medicine, Dicle University, Diyarbakır, Turkey
| | - Yusuf Yeşil
- Department of Geriatrics, Hacettepe University, Ankara, Turkey
| | - Cahfer Güloğlu
- Department of Emergency Medicine, Dicle University, Diyarbakır, Turkey
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