Mini nutritional assessment test long and short form are valid screening tools in Turkish older adults

Assessment of nutritional status in elderly hospitalised patients with Parkinson's Disease: validation of CONUT and GNRI

INTRODUCTION

In elderly patients with Parkinson's Disease (PD), many motor and non-motor symptoms negatively affect nutritional status and increase the risk of malnutrition. It is important to select a screening tool that is objective, rapid, and reliable for the assessment of nutritional status. The aim of this study is to evaluate the sensitivity and specificity of the Geriatric Nutritional Risk Index (GNRI) and the Controlling Nutritional Status (CONUT) score indices in determining malnutrition in elderly hospitalised patients with PD by comparing them with the Mini Nutritional Assessment-Long Form (MNA-LF).

METHODS

The data for the study were collected by the researcher using the face-to-face interview technique. The MNA-Long Form, the GNRI, and the CONUT was calculated.

RESULTS

The study included a total of 94 participants aged between 67 and 78 years. When using CONUT versus MNA-LF, the sensitivity of CONUT was 52.9 % but the specificity was 83.3 %, with a PPV of 90.2 % and a NPV of 37.7 %. When using GNRI versus MNA-LF, the sensitivity of GNRI was 45.7 % but the specificity was 83.3 %, with a PPV of 88.9 % and a NPV of 34.5 %.

CONCLUSION

Elderly hospitalised patients with Parkinson's Disease, when MNA-LF cannot be used, CONUT, an objective, rapid and practical tool, may be an effective approach to assessing malnutrition.

Impact of geriatric syndrome burden on healthcare services utilization and mortality among community-dwelling older adults: is it still too late to do something?

PURPOSE

The increasing longevity of the population emphasizes the need for a deeper understanding of geriatric syndromes and their implications for healthcare usage and mortality among older adults. This study aimed to identify risk factors associated with healthcare service utilization and mortality of community-dwelling adults aged 80 and older in YASAM project.

METHODS

This prospective cohort study was part of the HEAT-YASAM trial, which focused on the community-based integrated healthy aging program for individuals aged 80 years and older in Balıkesir, Türkiye. The burden of geriatric syndromes was assessed based on a comprehensive evaluation at least two domains of the nutrition, cognitive, physcological and locomotor capacities. The study outcome was healthcare services utilization (inpatient, outpatient, emergency admission) and all-cause mortality data obtained during follow-up period (9 months).

RESULTS

The cohort consisted of 5018 participants with a mean age of 85.8 years, predominantly female (53.1%). On the multivariable analysis, geriatric syndrome burden and Deyo Charlson Comorbidity index (D-CCI) score significant on independent predictors of 9-month mortality (p = 0.01). Higher geriatric syndrome burden was linked to an approximately 10% lower risk for outpatient admissions (p = 0.01) and every point increase in the D-CCI score was associated with a 1.3-fold increased risk of utilizing outpatient services (p = 0.01). For multimorbidity, every point increase corresponded to a 2.6-fold higher risk of inpatient admissions (p = 0.01) and a 1.2-fold higher risk of emergency admissions (p = 0.01).

CONCLUSIONS

This study demonstrate that a geriatric syndrome burden and multimorbidity has a significant impact on healthcare utilization and mortality in adults aged 80 years and older. Integrated comprehensive, coordinated, and patient-centered care models for this population facing multiple geriatric syndromes could positively impact the healthcare system.

TRIAL REGISTRATION

The trial was prospectively registered at ClinicalTrials.gov. Identifier: NCT05993572 Registered on 15 July 2023.

A Rising Drug Burden Index Is Related With Malnutrition in Community-Dwelling Older Adults With Dementia

OBJECTIVES

Malnutrition is common in dementia patients and can lead to poor outcomes. Also, these patients are often prescribed medications with sedative and anticholinergic effects for various reasons. Thus, we aimed to explore the relationship between drug burden index (DBI), anticholinergic burden (ACB), and nutrition status in community-dwelling older adults with dementia.

METHOD

A total of 415 outpatients with dementia, evaluated by Mini Nutrition Assessment, and whose drug information is registered are included in study. DBI score was calculated by summing the scores of regularly used anticholinergic and/or sedative drugs taken for at least four weeks prior to admission.

RESULTS

The mean age of participants was 77.4 ± 6.3 years, and the majority were female (64.3%). The most prevalent type of dementia (71.6%) was Alzheimer's dementia. The prevalence of malnutrition is 23.6%. Polypharmacy was present in approximately half of the participants (47.5). In total, 57.0% of the participants were using anticholinergic drugs, and 77% of the participants had drug exposure. In the fully adjusted multivariate models, an increase in DBI score raised the risk of "malnutrition" by 2.12 times (OR, 2.12; 95% CI, 1.15-4.01; P = 0.02), whereas no relationship was determined between ACB score and "malnutrition" (OR, 1.21; 95% CI, 0.98-1.49; P = 0.07).

CONCLUSIONS

Older adults with dementia are frequently exposed to drugs with sedative and anticholinergic properties. Considering the relationship between DBI and malnutrition, these drugs and doses should be optimized to prevent malnutrition and its adverse outcomes in this vulnerable population.

A Community-Based Integrated Healthy Aging Program at a Tertiary Hospital (YASAM) for the Oldest Old Participants May have the Potential to Reduce Emergency Admission: Preliminary Evidence from a Pre-Post-Intervention Study

BACKGROUND

Frail, oldest old individuals living in the community frequently face obstacles when trying to access outpatient clinics, which results in a higher dependence on emergency departments. This trend highlights the need for improved accessibility and support services for this vulnerable population.

OBJECTIVES

This study aims to investigate the relationship between community-based integrated healthy aging program in tertiary hospital and healthcare utilization among the oldest old adults.

METHODS

A before-after pilot intervention prospective study was conducted between June 2023 and December 2023. The YASAM conducted a comprehensive assessment, including the Mini-Cog, Mini Mental Status Assessment, Mini Nutrition Assessment (short form), and Geriatric Depression (Yesavage) scale, as well as the Time-up and Go test and Stand-Chair tests. Health service utilization, including emergency visits, hospitalizations, and outpatient clinic visits, was documented after and before the index date for the participants.

RESULTS

The study included 312 participants, with a mean age of 85.8 ± 3.9 years. The proportion of individuals with mild cognitive impairment was 55.8 % (n = 159). The percentage of participants with possible sarcopenia was 43.3 % (n = 135), and the percentage of those with moderate or severe frailty was 53.8 % (n = 163). The average visits to the emergency department per month before the index date were lower than after the index date, and this difference was significant (p = 0.01).

CONCLUSIONS

Policymakers should consider expanding community-based integrated healthy aging programs in tertiary hospitals to meet the growing healthcare needs of older adults.

TRIAL REGISTRATION

The trial was prospectively registered at ClinicalTrials.gov. Identifier: NCT05993572 Registered on 15 July 2023.

Predictors of the Disability in Activities of Daily Living in Nursing Home Residents: A Descriptive Study

BACKGROUND

Disability in activities of daily living (ADL) is a common problem among nursing home residents. The purpose of this research was to evaluate the geriatric syndromes that contribute to disability in nursing home residents.

METHOD

The cross-sectional study included 124 older adults from two nursing homes. ADL disability was assessed with the Barthel Index. The sociodemographic characteristics and geriatric syndromes, including malnutrition, sarcopenia risk, frailty, immobility, urinary incontinence, cognitive impairment, and balance dysfunction were evaluated.

RESULTS

The 124 residents had a mean age of 80.12 ± 9.20 years and included 55.67% males. Age, malnutrition, sarcopenia risk, frailty, immobility, urinary incontinence, cognitive impairment, and balance dysfunction were all significantly correlated with the Barthel Index. However, only malnutrition, immobility, and urinary incontinence were found to account for 84.9% of the variance in disability of nursing home residents in regression analysis. These geriatric syndromes are the best predictors of ADL disability in all models (p < .05).

CONCLUSION

This study found that malnutrition, immobility, and urinary incontinence considerably contributed to the disability profile of nursing home residents. Health professionals need to develop multi-dimensional care and prevention strategies, especially for geriatric syndromes such as malnutrition, immobility, and urinary incontinence.

Muscle matters: The relationship between skeletal muscle and cardiac muscle in older people-A Cross-Sectional Prospective Observational Study

BACKGROUND

The term "cardiosarcopenia" has been proposed to describe the interrelated decline in both skeletal muscle mass and cardiovascular function. This study aimed to (1) compare cardiac structure and function between individuals with low and normal handgrip strength (HGS) and (2) examine the correlation between cardiac structure and function with HGS, gait speed, and muscle mass measured via muscle ultrasound (US).

METHODS

The study population comprised 93 older adults attending a geriatric outpatient clinic who reported no prior instances of atherosclerotic cardiovascular disease. Muscle strength was evaluated using HGS. Muscle mass was assessed using US to measure the thickness of the gastrocnemius medialis (GCM-thickness), rectus femoris (RF-thickness), and anterior thigh (AT-thickness) muscles, as well as the cross-sectional area of the RF (RF-CSA). Transthoracic echocardiography was performed, and left ventricular (LV) mass was calculated using the Devereux formula.

RESULTS

LV mass was significantly lower in the low HGS group compared with the normal HGS group (153.27 [32.31] g vs 175.02 [61.46] g, P = 0.029). Additionally, the low HGS group had lower LV posterior wall thickness compared with the normal HGS group (P = 0.017). LV mass was weakly correlated with GCM-thickness and gait speed, and LV end-diastolic diameter had weak/moderate correlations with HGS, RF-CSA, RF-thickness, and AT-thickness.

CONCLUSION

Ventricular mass in older adults significantly correlates with parameters of muscle mass, strength, and performance, which decline with age. To reveal the clinical effects of the reduced LV mass in patients with HGS further longitudinal studies are needed.

Distance from the Community to the City Center Is a Vital Determinant of Dietary Diversity Score for Rural Community-Dwelling Older Adults in Taiwan

Background: There was little knowledge of the dietary diversity of older adults in rural areas, with limited studies examining their nutritional status and related factors. This study aimed to assess the nutritional status of older adults in rural communities in Taiwan and explore the association between characteristics and the dietary diversity score (DDS). Methods: We collected data on sociodemographic, nutritional status, and DDS. The DDS was estimated based on nutritional intake using a 24 h dietary recall (24HR). Participants were grouped by distance from the city center into three categories (0-4 km, 4-8 km, and >8 km) to assess their correlation with food diversity. Results: A total of 567 participants were included, of whom 81.3% were women, and 65.5% were over 75 years of age. Of the participants, 154 lived within 4 km of the city center, 255 lived 4-8 km away, and 158 resided in remote communities (>8 km from the city center). Out of 538 participants who completed the dietary questionnaire, 274 (50.9%) were categorized as having low dietary diversity (DDS ≤ 4), while 264 (49.1%) were categorized as having high dietary diversity (DDS > 4). Conclusions: Our results showed the distance from the community to the city center significantly influences the DDS of the residents in rural communities. Nearly half of the rural population has a low DDS. The implementation of the research project aimed to determine the feasibility of daily nutrition evaluation and optimization programs for the elderly in rural areas is crucial in the future.

Dietary total antioxidant capacity and frailty in Turkish community-dwelling and nursing home: cross-sectional study

Background

This study examines the relationship between dietary total antioxidant capacity, frailty, and nutritional status in Turkish older adults living in the community and nursing homes.

Methods

This study included 160 older adults (50% female) living in the community (n = 80) and a nursing home (n = 80). Anthropometric measurements were taken, and BMI was calculated. Demographic characteristics, nutritional status (MNA-SF: Mini Nutritional Assessment Short Form), frailty (FRAIL Scale), activities of daily living (Katz ADL), and three-day food consumption records were assessed. Dietary total antioxidant capacity was determined based on the three-day food consumption record.

Results

The mean ages of the groups were similar (72.5 ± 6.0 and 72.2 ± 5.9 years). Nursing home residents had significantly higher rates of chronic disease (91.3%) and regular medication use (90.0%) (p < 0.05). Overweight was more prevalent among community dwellers (50.0%, p < 0.05), while obesity was more common in nursing home residents (26.2%, p > 0.05). Frail (32.5%) and pre-frail (40.0%) rates were higher in nursing home residents compared to elderly community dwellers (21.2 and 38.8%, respectively). Dependence ratios were similar between the groups (p > 0.05). Community-dwelling participants had a lower risk of malnutrition. While their daily carbohydrate intake was lower, nursing home residents had higher intakes of protein, fat, ω-3 fatty acids, fiber, vitamins (except vitamin E), and minerals. Frailty showed a strong negative correlation with Katz (r = -0.56, p < 0.001) and MNA-SF scores (r = -0.44, p < 0.001), while weak positive correlations were observed with TRAP, TEAC, and FRAP3 values. A negative correlation was observed between the residential setting and TORAC (r = -0.424, p < 0.001), TRAP (r = -0.190, p < 0.001), TEAC (r = -0.257, p < 0.001), and total VCEAC (r = -0.241, p = 0.002) values.

Conclusion

Residential setting may affect nutrient intake, frailty, dietary total antioxidant capacity, and overall health in older adults.

The Association of Sarcopenia and Body Composition With Benign Positional Paroxysmal Vertigo in Older Adults

OBJECTIVES

One-third of older adults suffer from dizziness and vertigo. Benign positional paroxysmal vertigo (BPPV), which occurs due to otoconia moving into the semicircular canal, is the most common vestibular disorder. We evaluated the connection between BPPV and geriatric symptoms.

METHODS

A comprehensive geriatric evaluation included daily living activities, Mini-Mental State Examination (MMSE), and Geriatric Depression Scale tests for all patients. Patients' nutritional status was assessed using the Mini-Nutritional Assessment. Body weight and fat free mass were determined from the bioimpedance analyzer. Hand grip strength was measured using an electronic hand dynamometer to determine muscle strength. Sarcopenia was assessed using the European Working Group on Sarcopenia in Older People-2 recommendations. The patients were divided into three groups as BPPV-positive, BPPV-negative, and healthy (control).

RESULTS

Obesity, low muscle mass, dynapenia, gait speed, low gait speed, and history of falling statistically significantly differed between the three groups, but age, gender, smoking, alcohol consumption, body mass index, MMSE, depression, number of falls, and comorbid diseases did not differ. The BPPV-positive group had greater rates of obesity, low muscle mass, dynapenia, and sarcopenia than the control group (p = 0.008, 0.007, 0.01, 0.03). In the unadjusted univariate analysis, low muscle mass, sarcopenia, and obesity were risk factors for "BPPV" (Odds Ratio [OR]: 3.43, Confidence Interval [Cl]: 1.25-9.37, p = 0.016; OR: 3.47, Cl: 1.32-9.13, p = 0.011; OR: 2.71, Cl: 1.09-6.70, p = 0.031).

CONCLUSIONS

Obesity, sarcopenia, and low muscle mass are risk factors for BPPV, and we urge the older population to adopt healthy diet and exercise regimens to reduce BPPV-related falls.

LEVEL OF EVIDENCE

3 Laryngoscope, 135:1486-1492, 2025.

Which screening tool performs best in identifying malnutrition risk among hospitalized older adults with cardiovascular disease? A diagnostic accuracy study comparing six different screening tools with GLIM criteria

PURPOSE

This study aimed to compare the performance of six different screening tools with the GLIM criteria in identifying malnutrition risk among older adults with cardiovascular diseases.

METHODS

In this diagnostic accuracy study, data from 669 patients aged 65 and older, hospitalized at Bandırma Training and Research Hospital diagnosed with cardiovascular disease, were evaluated. The data were obtained using a questionnaire that included a Demographic Information Form, Global Leadership Initiative on Malnutrition (GLIM) Criteria, Malnutrition Screening Tool (MST), Malnutrition Universal Screening Tool (MUST), Short Nutritional Assessment Questionnaire (SNAQ), Mini Nutritional Assessment-Short Form (MNA-SF), Nutritional Risk Screening-2002 (NRS-2002), and Graz Malnutrition Screening (GMS) tool. GLIM criteria were used as gold standard and six screening tools were used as index tests. Receiver Operating Characteristic (ROC) curve analysis was conducted to calculate the Area Under the Curve (AUC), and the sensitivity, specificity, accuracy, and Cohen's Kappa (κ) coefficient of the index tests were assessed.

RESULTS

The mean age of the patients was 75.5 ± 7.7 years, 55.2% were female. According to the GLIM criteria, the prevalence of malnutrition was calculated as 22.0%. The AUC calculated by ROC indicated that MST (AUC: 0.905) had excellent predictive value, while MUST (AUC: 0.874), SNAQ (AUC: 0.851), MNA-SF (AUC: 0.842), and GMS (AUC: 0.820) demonstrated good predictive value. Among the screening tools, GMS had the highest sensitivity (92.5%), whereas MNA-SF exhibited the highest specificity (91.6%). MNA-SF also demonstrated the highest agreement with the GLIM criteria (Cohen's κ: 66.8) and the highest accuracy (88.3%).

CONCLUSION

This study found that the MNA-SF tool outperformed other comprehensive screening tools when evaluating malnutrition risk in light of the GLIM criteria.

The prevalence and related factors of social frailty in older adults: A low- and middle-income country perspective

OBJECTIVES

There are no studies examining the prevalence of social frailty and associated factors in low- and middle-income countries. This study aimed to assess the prevalence of social frailty and identify the contributing factors among older adults in Türkiye.

METHODS

This cross-sectional study included 570 participants aged 65 and older, all outpatients at a geriatric clinic. Data for demographics and co-morbidities were collected. Anthropometric measurements and comprehensive geriatric assessments were conducted. Social frailty was assessed using the 5-item Social Frailty Index (SFI), and physical frailty was evaluated with the Fried Frailty Phenotype. Sarcopenia was diagnosed based on low handgrip strength and reduced calf circumference.

RESULTS

Participants' mean age was 75.2 ± 6.3 years. Social frailty, depression, physical frailty and sarcopenia prevalence were 24%, 25%, 14% and 26%, respectively. Social frailty was reported to be statistically higher in women and those living alone, while significantly lower in married individuals. Depression, physical frailty and sarcopenia were more commonly observed in participants with social frailty (p < .01). Furthermore, participants with heart failure and Parkinson's disease were more socially vulnerable than those with other co-morbid conditions. Multivariate logistic regression analysis revealed that age, physical frailty and depressive mood significantly increased social frailty, whereas being married decreased it even after adjusting for potential confounding factors.

CONCLUSIONS

Social frailty was more prevalent than physical frailty among Turkish older adults, reaching 24%. Advanced age, depression, physical frailty and being unmarried were strongly related factors to social frailty.

Clinical implication of anemia in older patients with dementia with lewy bodies

AIM

This research sought to investigate the possible connection between anemia and various parameters of comprehensive geriatric assessment in elderly individuals diagnosed with Dementia with Lewy Bodies (DLB). To our knowledge, this investigation represents the first attempt to examine how anemia impacts patients suffering from DLB.

METHODS

This cross-sectional study encompassed 147 DLB patients from a single geriatric outpatient clinic. The study defined anemia as hemoglobin levels under 12 g/dL for women and 13 g/dL for men. Patients' demographic information, coexisting medical conditions, and results from comprehensive geriatric evaluations were also recorded.

RESULTS

Participants in the study had an average age of 85.4 ± 7.1 years. Anemia was present in 46.9% of the patients. Significant disparities were noted between individuals with and without anemia regarding the occurrence of congestive heart failure (CHF), polypharmacy, geriatric depression, and insomnia (all p < 0.05). After controlling for age, gender, and CHF in the multivariate analysis, the association between anemia and both the quantity of medications used [OR: 1.15 (95% CI:1.01-1,31)] and Geriatric Depression Scale-15 scores [OR: 0.88, 95% CI: 0.78-0.98] remained statistically significant (p < 0.05) when comparing anemic patients to non-anemic individuals.

CONCLUSION

In the present study almost one in two older patients with DLB were anemic. Anemia is associated with presence of CHF, higher number of drugs and depressive mood in DLB. It is recommended that healthcare providers should recognize the importance of anemia and its associated effects when treating older adults with DLB. This approach may lead to more effective management and treatment of this complex condition.

Comparing nutritional status, quality of life and physical fitness: aging in place versus nursing home residents

BACKGROUND

Quality of life (QoL) is a key indicator of well-being in older adults (OAs) and several factors, including nutrition, physical fitness, and dwelling place, can influence QoL. OA residing in institutional settings, such as nursing homes (NH), often can exhibit different QoL outcomes, nutrition status and physical fitness compared to those living independently in age-in-place (AIP) environments. This study seeks to compare the QoL, and physical activity levels of OA residing in NH with those AIP and to evaluate their dietary quality.

METHODS

This cross-sectional study included a total of 400 voluntary OAs, residing either in Narlıdere Nursing Home and Aged Care Rehabilitation Centre (n = 200) or aging in place (n = 200) in İzmir, Turkey. Participants were recruited between May 2023 and December 2023. Data collection involved face-to-face interviews using a questionnaire that covered demographic and anthropometric measurements, Mini Nutritional Assessment (MNA), Older People's Quality of Life (OPQOL-brief), Physical Fitness and Exercise Activity Levels of Older Adults Scale (PFES), and a 24-hour dietary recall. Nutritional status was further assessed using the Healthy Eating Index for Older Adults (HEI-OA).

RESULTS

Mean age of OAs was 77.8 ± 6.5 years and BMI was 25.8 ± 3.9 kg/m². HEI scores were not differed between groups (NH: 42.8 ± 8.1, AIP: 42.2 ± 11.0, p < 0.542), but AIP residents had lower poor diet quality (NH: 40.4 ± 5.9, AIP: 37.5 ± 7.9, p < 0.001). NH residence had higher OPQOL scores (NH: 54.8 ± 7.8, AIP: 47.6 ± 10.4, p < 0.001), and higher MNA scores (NH: 25.6 ± 2.7, AIP: 22.4 ± 5.5, p < 0.001). NH group had lower PFES scores, indicating reduced physical fitness compared to AIP participants (NH: 67.3 ± 6.3, AIP: 74.7 ± 7.7, p < 0.001). Nutrient intake analysis revealed that NH residents consumed more daily water, protein, and micronutrients than AIP participants, with statistically significant differences in protein, MUFA, and SFA intake (p < 0.001). A significant relationship between MNA and QoL total score in NH (r = 0.157, p = 0.027) and AIP (r = 0.619, p < 0.001) was found.

CONCLUSION

The findings of this study revealed the potential influence of nutritional status on QoL, in enhancing QoL outcomes.

The impact of undernutrition on the association between hypomagnesemia and dynapenia in older women

OBJECTIVES

To determine the association between hypomagnesemia and dynapenia in older women with different nutritional status.

METHODS

This cross-sectional study included older women who attended one outpatient geriatric clinic. Undernutrition was defined according to the Mini Nutritional Assessment score (MNA) (< 23,5), and handgrip strength of < 16 kg on dynamometer was defined as dynapenia. The association between hypomagnesemia (serum magnesium < 1.7 mg/dL) and dynapenia was determined by logistic regression analysis.

RESULTS

Among the 933 older women (mean age 81 ± 8), the prevalences of undernutrition and hypomagnesemia were 61% and 15%, respectively. The risk of hypomagnesemia increased with each step of decline in nutritional status, and undernutrition was associated with hypomagnesemia (OR 1.64, 95% CI 1.11-2.43, p = 0.013) In the entire cohort, hypomagnesemia was associated with dynapenia (OR 2.01, 95% CI 1.35-3.00, p = 0.001). In well-nourished patients, hypomagnesemia was not associated with dynapenia, even when unadjusted. However, in the undernourished group, hypomagnesemia was associated with dynapenia after adjusting for age, diabetes mellitus, hypertension, coronary heart disease, Barthel and Lawton scores, polypharmacy, glomerular filtration rate, serum albumin, hemoglobin, and MNA score (OR 2.95, 95% CI 1.04-8.32, p = 0.040). The coexistence of hypomagnesemia and undernutrition (versus neither of them) was significantly associated with dynapenia (OR 4.44, 95% CI 2.67-7.41, p < 0.001).

CONCLUSION

The prevalence of hypomagnesemia increases with worsening nutritional status. Hypomagnesemia is associated with dynapenia in older women who are undernourished, even after adjusting for nutritional status, but not in those who are well nourished. The coexistence of undernutrition and hypomagnesemia increase the risk of dynapenia substantially.

The association between sarcopenic obesity and malnutrition in community-dwelling older adults

BACKGROUND

The increase in fat tissue and the decrease in muscle mass with advancing age have prompted researchers to explore the coexistence of sarcopenia and obesity, i.e. sarcopenic obesity (SO). SO may lead to malnutrition due to poor diet quality, while malnutrition may contribute to SO by causing further muscle loss and metabolic imbalances.

OBJECTIVES

The aims were to investigate: (i) the prevalence of SO in community-dwelling older adults, (ii) the diagnostic ability of two different malnutrition methods, and (iii) the association between SO and malnutrition.

METHODS

Community-dwelling older adults (≥65 years) were invited to participate. SO assessment was conducted based on the ESPEN/EASO consensus criteria. Malnutrition was evaluated based on both the Global Leadership Initiative on Malnutrition (GLIM) criteria and the Mini-Nutritional Assessment (MNA).

RESULTS

Five hundred and ninety older adults (69.3% women, mean age: 74.31 ± 6.55 years) were included in the study. The overall prevalence of SO was 5.9% (n = 35). The prevalence of malnutrition was 23.9% according to the GLIM criteria, while it was 3.1% according to MNA. The agreement between the two measurements was ĸ = 0.32. There was no association between SO and malnutrition based on either GLIM (P: .06, OR: 1.971, 95% CI: 0.966-4.024) or MNA (P: .948, OR: 1.934, 95% CI: 0.119-7.306).

CONCLUSIONS

Even though the agreement for diagnosing malnutrition between GLIM criteria and MNA was fair, the number of participants diagnosed with malnutrition by GLIM criteria was almost eight times higher than MNA. No association was established between SO and malnutrition defined by GLIM or MNA.

CLINICAL TRIAL NUMBER

NCT05122104.

Comparison of rectus femoris muscle shear wave elastography and thickness on evaluation of frailty

PURPOSE

The objective of this study is to evaluate the potential of rectus femoris shear wave elastography (RF-SWE) in assessing its impact on frailty and physical performance parameters, using a comparative analysis with rectus femoris muscle thickness (RF-MT).

METHODS

A total of 149 participants aged 60 and above were included in this research. All participants underwent a comprehensive geriatric assessment, frailty status assessment (using the frailty phenotype [FFP]), and evaluation of physical performance parameters (utilizing the short physical performance battery score [SPPB] and handgrip strength measurement). RF-MT and RF-SWE were measured by a radiologist with participants in a prone and relaxed position.

RESULTS

The mean age of participants was 73.8 ± 6.5, with 61.7% (n = 92) being female. Participants were divided into 2 groups based on their frailty status, with 40 (26.8%) identified as frail and 109 (73.2%) as non-frail. RF-MT exhibited a significant correlation with frailty and the SPPB, while RF-SWE did not exhibit significant associations except for handgrip strength. In regression analyses, RF-MT was found to be significantly and independently associated with physical frailty. The optimal cutoff value for RF-MT was determined to be ≤ 17.74 (area under the ROC curve [AUC], 0.752; 95% CI 0.675-0.819; p < 0.001). In contrast, RF-SWE did not show a significant relationship.

CONCLUSION

RF-MT is more strongly associated with physical performance and physical frailty than the muscle quality assessed by RF-SWE. Measuring RF-MT, rather than RF-SWE, proves to be an effective tool for predicting frailty in the geriatric population.

The Paradoxical Relationship Among Diabetes Mellitus, Osteoporosis and Sarcopenia: The PARADOS Study

INTRODUCTION

Type 2 diabetes mellitus (DM), osteoporosis (OP) and sarcopenia are major public health problems related with higher fall/fracture risks, morbidity and mortality. Due to the lack of a comprehensive analysis among OP, sarcopenia and DM; we aimed to explore the relationships between DM and the aforementioned conditions in postmenopausal women.

METHODS

This cross-sectional study included postmenopausal women who consecutively admitted to the Departments of Physical & Rehabilitation Medicine, and Endocrinology and Metabolism. Demographic data, nutrition/cognition status and frailty scores of the participants were recorded. Sarcopenia-related parameters including, anterior thigh muscle thickness, handgrip strength, chair stand test, gait speed, and one-leg stand test (OLST) were measured. ISarcoPRM algorithm was used for the diagnosis of sarcopenia.

RESULTS

A total of 444 postmenopausal women were consecutively enrolled. DM patients (N = 158) had higher frequency of sarcopenia (23.4 % vs. 12.9 %), but lower frequency of OP (33.5 % vs. 50.7 %) than controls (both p < 0.01). As regards regression analyses; menopause duration was positively (OR: 1.054, 95 % CI 1.030-1.077), but weight (OR: 0.957, 95 % CI 0.940-0.975) and DM (OR: 0.477, 95 % CI 0.310-0.733) were negatively related with OP (all p < 0.001). On the other hand, age (OR: 1.094, 95 % CI 1.056-1.133), body mass index (OR: 1.131, 95 % CI 1.067-1.198), and DM (OR: 1.887, 95 % CI 1.107-3.218) were positively related with sarcopenia (all p < 0.05). In addition, age (β = -0.355, p < 0.001), body mass index (β = -0.108, p = 0.021) and DM (β = -0.209, p < 0.001) were negatively related with OLST values.

CONCLUSION

DM has paradoxical associations with bone mass and muscle mass/function. Although it has negative relationship with OP (about two times lower odds), it has positive relationship with sarcopenia (about two times higher odds).

Associations between serum sodium level ranges with geriatric syndromes

PURPOSE

To determine prevalences of common geriatric syndromes in the setting of different normal ranges of serum sodium.

METHODS

In this cross-sectional study, 2048 older adults (aged ≥ 60) who underwent comprehesive geriatric assessment between 2016 and 2023 in one geriatric outpatient clinic were evaluated. Patient groups included moderate hyponatremia (< 130 mEq/L, n = 28, 1.6%), mild hyponatremia (130-134 mEq/L, n = 130, 7.3%), lower-normal range (135-140 mEq/L, n = 904, 50.4%), upper normal range (141-145 mEq/L, n = 702, 39.2%), and hypernatremia (> 145 mEq/L, n = 29, 1.6%). A separate analysis was also performed according to the following classification: borderline hyponatremia (133-137 mEq/L), normal (138-142 mEq/L), and borderline hypernatremia (143-147 mEq/L). Logistic regression analysis was performed to determine associations between serum sodium groups and geriatric syndromes.

RESULTS

After applying the inclusion/ exclusion criteria a total of 1792 patients were included, with a mean age of 81 ± 8 years and 71% were female. With the exception of geriatric depression, all other syndromes were more prevalent in the lower-normal range than the upper normal range. After adjustments for age, sex, comorbidities, functional status, and drug exposures, upper normal range of serum sodium was associated with lower risks of dependency (OR 0.72, 95% CI 0.53-0.99, p = 0.043) and malnutrition (OR 0.69, 95% CI 0.51-0.94, p = 0.018). Compared to borderline hyponatremia, borderline hypernatremia was associated with lower risks of polypharmacy (OR 0.58, 95% CI 0.37-0.89, p = 0.014), dependency based on basic activities of daily living (OR 0.55, 95% CI 0.31-0.98, p = 0.042), malnutrition (OR 0.55 95% CI 0.33-0.91, p = 0.020), and frailty (OR 0.65, 95% CI 0.44-0.96, p = 0.031).

CONCLUSIONS

Compared to a lower normal level of sodium, an upper normal level of sodium was associated with a lower risks of dependency and malnutrition. Borderline hypernatremia was associated with lower prevalences of polypharmacy, dependency, frailty, and malnutrition compared to borderline hyponatremia among geriatric outpatients in this single-center study.

Sleep hygiene education in older adults: effectiveness and association with comprehensive geriatric assessment

OBJECTIVES

This study aimed to evaluate the results of sleep hygiene education via a comprehensive geriatric assessment.

METHOD

A cross-sectional research was conducted on insomnia outpatients at a tertiary hospital, and all participants received sleep hygiene education as well as a comprehensive geriatric assessment. Sleep parameters were assessed before and four weeks after education.

RESULTS

The study included 141 participants. A significant improvement was obtained in all four scales' scores before and after education (PSQI score 11 [8-13] vs. 5 [3-9], p < .001; SHI score 12 [8-16] vs. 4 [1-8], p < .001; ESS score 6 [3-8] vs. 2 [0-6], p < .001; Jenkins SS score 15 [10-19] vs. 7 [5-11], p < .001). Female gender ratios, as well as the presence and risk of malnutrition, differed between groups with and without the PSQI score improvement. In the regression analyses, female gender and the presence of malnutrition or malnutrition risk were evaluated as possible factors affecting the PSQI responses (respectively, OR: 3.48, CI 95%: 1.21-10.00, p = .020; OR: 0.29, CI 95%: 0.09-0.949, p = .041).

CONCLUSION

Sleep hygiene education and interdisciplinary interventions are crucial in the management of sleep disorders in older adults.

Association between the systemic immune-inflammation index and sarcopenia in older adults: a cross-sectional study

BACKGROUND

Chronic inflammation is increasingly recognized as a crucial contributor to sarcopenia pathogenesis, but accurate diagnosis remains a challenge.

AIM

Our study aims to investigate the relationship between sarcopenia and the Systemic Immune-Inflammation Index (SII), a comprehensive indicator of inflammation.

METHODS

This cross-sectional study enrolled 632 patients. All participants underwent a comprehensive geriatric assessment. Sarcopenia was assessed through the evaluation of handgrip strength and calf circumference. To determine the SII, we used the formula: Platelet count (109/mm3)×Neutrophil count (109/mm3) / Lymphocyte count (109/mm3).

RESULTS

The average age of the participants was 74.8 ± 6.4, and 62.3% (n = 394) were female. Patients were grouped as non-sarcopenic and sarcopenic. The non-sarcopenic group had 536 patients (84.8%), while the sarcopenic group comprised 96 patients (15.2%). Sarcopenic patients showed a higher median SII score than the non-sarcopenic group (p < 0.001). Multivariate logistic regression analysis revealed that the SII score was significantly and independently associated with sarcopenia even after adjusting for potential confounding factors (β = 1.002, 95% CI = 1.001-1.003, p < 0.001). The ROC analysis identified the optimal cut-off for SII in predicting sarcopenia as > 765. At this threshold, the negative predictive values were determined to be 88.1%, with a specificity of 88%.

CONCLUSION

SII is significantly associated with sarcopenia in a geriatric outpatient population, and a population-specific SII cut-off may serve as a novel, simple, and practical biomarker for diagnosing sarcopenia.

Weight-Adjusted Waist Index: an anthropometric measure for frailty in older adults

PURPOSE

Current measures of frailty often rely on subjective assessments or complex scoring systems. This study aims to investigate the utility of a novel anthropometric measure, the Weight-Adjusted Waist Index (WWI), as a simple and objective predictive marker for frailty in older adults.

METHODS

This cross-sectional study included 847 patients aged 65 years and older. Comprehensive geriatric assessments and anthropometric measurements were conducted. Frailty was diagnosed using the Clinical Frailty Scale (CFS). The association between WWI and frailty was analyzed using multivariate logistic regression analysis.

RESULTS

The mean age of the participants was 74.9 ± 6 years, with 56.3% (n = 477) being women and 14.8% (n = 125) classified as frail. The frail group had a significantly higher WWI than the non-frail group (p < 0.001). In multivariate logistic regression analysis, WWI remained significantly associated with frailty, even after adjusting for other potential confounding factors (OR = 2.51, 95% CI 1.77-3.57, p < 0.001). The predictive ability of WWI for frailty was measured by the area under the receiver operating characteristic (ROC) curve, which was 0.705 (95% CI 0.67-0.73; p < 0.001). The optimal WWI threshold for predicting frailty was identified as > 12.

CONCLUSION

The Weight-Adjusted Waist Index shows significant potential as a simple and objective predictive marker for frailty in older adults.

A Neglected Point: Frailty in Older Adults with Differentiated Thyroid Cancer

BACKGRUOUND

This study investigated the risk of frailty in older adults with differentiated thyroid cancer (DTC) and the effect of thyroid- stimulating hormone (TSH) levels on frailty.

METHODS

This single-center, cross-sectional study included 70 DTC patients aged ≥60 years with stable TSH levels during the previous year while receiving levothyroxine. Frailty was assessed using the fried frailty phenotype (FFP). Anterior thigh muscle thickness was measured by ultrasound, and the sonographic thigh adjustment ratio (STAR) index was calculated. Muscle strength was measured using a hand dynamometer. Physical activity was determined by the physical activity scale for the elderly (PASE).

RESULTS

The median (interquartile range) age and follow-up time were 65 years (62 to 71) and 11 years (7.0 to 14.2), respectively. The median TSH level was 1.10 μIU/mL (0.49 to 1.62), and 58.6% of patients were prefrail/frail. Muscle mass and strength were reduced in 35.7% and 17.2% of patients, respectively. TSH levels were lower in those with prefrailty/frailty (P=0.002), low muscle mass (P=0.014), and low strength (P=0.037) than in their normal counterparts. TSH levels correlated negatively with FFP (P= 0.001) and positively with the STAR index (P=0.034). TSH below 1.325 μIU/mL was associated with an increased frailty risk (area under the curve=0.719; P=0.001). Low TSH, female sex, low handgrip strength, and low PASE leisure time scores emerged as independent predictors of frailty (P<0.05).

CONCLUSION

Older adults with lower TSH levels due to DTC are at high frailty risk and have low muscle mass and strength. Therefore, TSH targets should be set based on a comprehensive evaluation with consideration of the risk-benefit ratio.

Relationship between different muscle mass indices and physical performance measures in Turkish older adults

BACKGROUND

Sarcopenia, characterized by the loss of skeletal muscle, is assessed using appendicular skeletal muscle mass indices (ASMI). Various international groups propose different ASMI thresholds for assessing sarcopenia. However, the optimal ASMI that correlates best with physical performance measures in older Turkish adults remains unexplored. This study aims to determine which ASMI is most closely associated with physical performance measures, particularly low handgrip strength (dynapenia), in Turkish older adults.

METHODS

The study included 326 individuals aged 60 and above. Comprehensive geriatric assessments were conducted on all participants, along with anthropometric evaluations and body composition analyses. ASMI was calculated by adjusting height squared, weight, and body mass index (BMI). Physical performance was assessed through handgrip strength, gait speed, and the chair stand test.

RESULTS

The mean age of the participants was 74 ± 5.77 years, with 59.8% being women and 37.5% having dynapenia. Height-squared adjusted ASMI was not significantly associated with gait speed or the chair stand test. Weight-adjusted ASMI correlated with handgrip strength and gait speed but not with the chair stand test. Both height and weight-adjusted ASMI did not differ significantly between participants with and without dynapenia (p > 0.05). BMI-adjusted ASMI significantly correlated with all physical performance parameters (p < 0.05). Furthermore, in multivariate regression analysis, BMI-adjusted ASMI (OR = 0.028, 95% CI = 0.01-0.31, p = 0.006) was independently associated with dynapenia.

CONCLUSION

The study indicates that ASMI adjusted for BMI shows stronger correlations with all physical performance parameters and is independently associated with dynapenia. Utilizing ASMI adjusted for BMI may improve sarcopenia diagnosis in Turkish older adults.

Sarcopenia emerges as a risk factor for cardiac diastolic dysfunction: a new focus for research

OBJECTIVES

Cardiac diastolic dysfunction (left ventricular diastolic dysfunction [LVDD]) is a well-known predictor of heart failure. We hypothesized that sarcopenia is independently associated with diastolic dysfunction. We aimed to investigate the association of the most recent consensus definition of sarcopenia with LVDD.

METHODS

We included 121 older participants admitted to a cardiology outpatient clinic. We followed the European Working Group on Sarcopenia in Older People 2 definition of confirmed sarcopenia (presence of low muscle mass and low muscle strength). We estimated skeletal muscle mass with bioimpedance analysis and muscle strength by hand grip strength via a Jamar hydraulic hand dynamometer. Skeletal muscle mass was adjusted by body mass index. LVDD was determined by echocardiographic parameters measured per American Society of Echocardiography recommendations. We ran multivariate logistic regression analyses adjusted for well-known risk factors for diastolic dysfunction (i.e., age, sex, obesity, smoking, diabetes mellitus, hypertension, and ischemic heart disease) to detect whether sarcopenia was independently associated with diastolic dysfunction. We gave results in odds ratio (OR) and 95% confidence interval (CI).

RESULTS

Mean age was 69.9 ± 5.8 years, and 38.8% of participants were male. Confirmed sarcopenia was detected in 34.7%, and diastolic dysfunction was detected in 19.8%. In univariate analyses, sarcopenia was associated with diastolic dysfunction (OR, 6.7, 95% CI, 2.4-18.9). Regression analyses showed that two parameters, sarcopenia (OR, 7.4, 95% CI, 2.1-26.6, P = 0.002) and obesity (OR, 5.0, 95% CI, 1.03-24.6, P = 0.046), were associated with diastolic dysfunction.

CONCLUSIONS

This study revealed sarcopenia to be a new risk factor for diastolic dysfunction, adding to its known risk factors. Future longitudinal studies are needed to clarify the factors underlying their copresence.

C-reactive protein/albumin ratio as a novel predictor for nutritional status of geriatric patients

BACKGROUND AND AIMS

The C-reactive protein to albumin ratio (CAR) is a novel parameter that has been reported as a significant prognostic marker in some diseases. The purpose of the present research was to investigate the predictive value of this ratio with regard to nutritional status in geriatric patients.

METHODS AND RESULTS

A total of 154 geriatric patients (age ≥65 years) who consecutively presented to the internal medicine outpatient clinic were included in this cross-sectional study. The Mini Nutritional Assessment (MNA) was used as a reference to determine the nutritional status of the patients. Based on the MNA results, the patients were divided into two groups: normal nutrition and malnourished or at risk of malnutrition. The median CAR of malnourished patients or those at risk of malnutrition was significantly higher than that of patients with normal nutritional status (p = .012). A significant negative correlation was also observed between the MNA score and the CAR (r = -0.196, p = .015). The receiver operating characteristic curve analysis indicated that the CAR was a significant predictor of malnourishment or the risk of malnutrition (p = .012).

CONCLUSION

The CAR could predict which geriatric patients were malnourished or at risk of malnutrition. CAR may be used as a new tool in the nutritional screening of geriatric patients.

The predictive capacity of adductor pollicis muscle thickness for physical frailty in older adults

PURPOSE

There is a need for an easily measurable and reliable surrogate marker for physical frailty. This study aims to investigate the predictive capacity of adductor pollicis muscle thickness (AMPT), which can be easily measured externally and minimally influenced by subcutaneous adipose tissue, for physical frailty.

METHODS

A total of 589 patients (16.3% physically frail, 54.7% pre-frail, 29% robust) were included. Comprehensive geriatric assessments and anthropometric measurements of the patients were performed. APMT was assessed with a skinfold caliper. Physical frailty was diagnosed using the fried frailty phenotype. The predictive ability of APMT for the diagnosis of frailty was examined.

RESULTS

Of all the participants, 64.3% were women, and the average age was 74 ± 5.9 years. There was no significant difference in waist and hip circumference, or body mass index between the frail and non-frail groups. APMT, handgrip strength, gait speed, and calf circumference were significantly lower in frail patients than in non-frail ones (p < 0.01). The area under the curve (AUC) of APMT for physical frailty was determined to be 0.627 (95% confidence interval [CI] 0.58-0.66; p < 0.001). The best cut-off value for APMT was ≤ 18.5 mm for all individuals.

CONCLUSION

Adductor pollicis muscle thickness can be a useful anthropometric marker for evaluating the risk of physical frailty.

The relationship between dehydration and etiologic subtypes of major neurocognitive disorder in older patients

PURPOSE

Studies investigating associations between etiologic subtypes of major neurocognitive disorder (MND) and dehydration frequency are lacking. The aim of this study was to investigate the prevalence and risk factors of dehydration among older adults with and without MND (dementia), and across different etiologic subtypes of MND.

METHODS

This cross-sectional study included adults aged ≥ 65 years old from one geriatric outpatient clinic. Dehydration was defined as a calculated [1,86 × (Na + K) + 1,15 × glucose + urea + 14] plasma osmolarity of > 295 mOsm/L.Clinical characteristics and measures of comprehensive geriatric assessments of patients with dehydration and normohydration were compared. MND was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition criteria. The underlying etiologic subtypes were determined by specific diagnostic criteria.

RESULTS

Of the 1377 patients 72% were female, the mean age was 80 ± 8 years, and 575 had dementia. Dehydration was more common in patients with dementia than those without dementia (58% vs. 53%, p = 0.044). The prevelance of dehydration was 57%, 62%, 54%, 57% and 68% in Alzheimer's disease, Parkinson's disease dementia, fronto-temporal dementia, dementia with Lewy bodies, and vascular dementia, respectively (p ≥ 0.05). MND was associated with dehydration (OR 1.26, 95% CI 1.01-1.57; p = 0.037) after adjustment for age and sex. In multivariable analysis, among patients with dementia, hypertension, DM, CKD, and dysphagia were more common while mean Mini-Mental State Examination score was lower in those who had dehydration versus no dehydration in older patients with dementia (p < 0.05).

CONCLUSION

Dehydration is slightly associated with the presence of MND independent of age and sex. However, dehydration is also quite common in older patients without cognitive disorders. Therefore, hydration status should be monitored in older adults irrespective of neurocognitive status. Hypertension, DM, CKD, dysphagia and severity of cognitive dysfunction were associated with dehydration in patients with dementia. The prevalence of dehydration is highest in patients with vascular dementia.

Sarcopenia and Associated Factors in Adults Aged 40 and Above: A Study Conducted in Primary Healthcare

INTRODUCTION

Sarcopenia, characterized by progressive skeletal muscle loss, has emerged as a significant public health concern, with a global prevalence of 10-27%. While traditionally studied in geriatric populations, recent evidence indicates its impact on individuals aged 40 and above, with early manifestations of muscle decline. Primary care settings play a pivotal role in the early identification and management of sarcopenia, facilitating timely diagnosis and intervention. This study aims to evaluate the prevalence of sarcopenia and its associated factors among individuals aged 40 and above attending a family medicine outpatient clinic.

METHODS

A cross-sectional study was conducted in a family medicine outpatient clinic, including participants aged 40 and above. Participants underwent handgrip strength measurements, calf circumference measurements, and a 4-m walking test. Based on the criteria of the European Working Group on Sarcopenia in Older People 2 (EGSWOP2), individuals with sarcopenia and those at risk of sarcopenia were identified. The Mini Nutritional Assessment (MNA) was used to assess nutritional status. Sociodemographic characteristics, comorbidities, and laboratory values were recorded. A comparison was made between individuals with normal muscle strength and those at risk of sarcopenia.

RESULTS

Among 213 individuals, 33 (15.4%) were at risk of sarcopenia (probable sarcopenia), and 12 (5.6%) were diagnosed with sarcopenia. There was a negative correlation observed between age and muscle strength (r=-0,339, p<0,001), and positive correlation was found between muscle strength and MNA score (r=0.301, p<0.001). Individuals with higher education and income levels exhibited higher muscle strength. Participants at risk of sarcopenia had higher prevalence rates of comorbidities such as diabetes mellitus (DM), chronic kidney disease, and cardiovascular disease (p=0.20, p<0.01, p=0.015, respectively).

CONCLUSION

Our study highlights the prevalence and associated factors of sarcopenia in individuals aged 40 and above emphasizing the need for screening and intervention strategies in primary care settings. The study findings support the role of primary care in addressing sarcopenia and improving patient outcomes.

The role of thiol-disulfide homeostasis and ischemia-modified albumin in osteosarcopenia

BACKGROUND

Oxidative stress results from an imbalance between the induction of reactive oxygen species and the ability of cells to metabolize them. Numerous markers can be used to assess the level of oxidative stress. Thiol-disulfide homeostasis (TDH) and ischemia-modified albumin (IMA) are some of them. The aim of this study is to investigate the role of TDH and IMA, which are indicators of oxidative stress, in older patients with osteosarcopenia (OS).

METHODS

The study was conducted cross-sectionally in a geriatrics outpatient clinic. Patients who applied to the outpatient clinic for three months were included in the study. Patients with acute infection, delirium, malignancy, severe liver, heart or kidney dysfunction and who did not give their consent for the study were excluded from the study. The study was conducted with 136 patients. Sarcopenia was diagnosed according to muscle ultrasonography (USG) and handgrip strength (HGS) results. Osteopenia/osteoporosis was diagnosed according to bone mineral densitometry (BMD) results. The combination of osteopenia/osteoporosis and sarcopenia was accepted as OS.

RESULTS

Native thiol, total thiol value and nativethiol /totalthiol*100 values were significantly lower in the group with OS (respectively; value = 265 ± 53.8 standard deviation (SD) μmol/L, p =  ≤ 0.001; value = 295.33 ± 55.77 SD μmol/L, p = 0.001; value = 90.06 (2.8) interquartile ranges (IQR), p = 0.033). Disulfide/native thiol*100 and disulfide/total thiol*100 values were significantly higher in the group with OS (respectively; value = 5.5 (1.7) IQR, p = 0.033; value = 4.97 (1.4) IQR, p = 0.034).

CONCLUSION

In our study, the role of oxidative stress in OS was demonstrated by using TDH as an oxidative stress parameter.

Exploring the complex associations among risks of malnutrition, sarcopenia, and frailty in community-dwelling older adults

BACKGROUND

Malnutrition, sarcopenia, and frailty are age-related conditions that are associated with multiple health-related negative outcomes. However, the complex associations between them remain to be elucidated. The aims of the study were to explore: (1) whether the risk of sarcopenia has a mediator effect on the association between risks of malnutrition and frailty; and (2) whether physical activity (PA) level modulates this mediator effect in community-dwelling older adults.

METHODS

This cross-sectional study involved 593 older adults (62.73% female; mean age = 71.35 ± 5.86 years). The Mini Nutritional Assessment-Short Form (MNA-SF), the SARC-F Questionnaire, and the FRAIL Questionnaire were used to assess the risks of malnutrition, sarcopenia, and frailty, respectively. The International Physical Activity Questionnaire Short Form (IPAQ-SF) was employed to assess PA level. Using the Hayes PROCESS macro (Models 4 and 7), mediation and moderated mediation analyses were performed.

RESULTS

The mediation analysis demonstrated that the MNA-SF had a significant effect on the SARC-F (B=-0.325; p < 0.001) and the SARC-F, in turn, had a significant effect on the FRAIL (B = 0.341; p < 0.001). The total (B=-0.171; p < 0.001), direct (B=-0.061; p = 0.001), and indirect (B=-0.111; bootstrap CI did not include zero, which indicates a significant effect) effects of MNA-SF on FRAIL were significant, showing that 65% of the association between the MNA-SF and FRAIL was explained by the SARC-F acting as a mediator. The moderated mediation analysis demonstrated that the association between MNA and SARC-F was moderated by the PA level (B = 0.253; p = 0.016). The SARC-F mediated and relatively enhanced the association between MNA-SF and FRAIL only in older adults with a moderate PA level (B=-0.120; CI: -0.154 to -0.085).

CONCLUSIONS

The SARC-F partially mediates the association between the MNA-SF and the FRAIL, indicating that malnutrition affects frailty through an indirect path via sarcopenia. Furthermore, the PA level moderates this mediator effect, with sarcopenia serving as a mediator in older adults with moderate a PA level but not in those with a low PA level. These findings reveal that it may be beneficial to consider PA level in combination with malnutrition and sarcopenia in the management and prevention of frailty in community-dwelling older adults.

Assessment of phase angle as a novel indicator for sarcopenic obesity according to the ESPEN/EASO criteria in older adults with diabetes mellitus

BACKGROUND

Sarcopenic obesity (SO) is a clinical condition in which sarcopenia and obesity occur together, and is associated with more poor clinical outcomes, increased mortality, and morbidity than sarcopenia. Phase angle (PhA), a parameter derived from bioimpedance analysis (BIA), provides data on cellular health, membrane integrity, and cellular function. This study aimed to evaluate the relationship between SO and PhA among older adults with type 2 diabetes mellitus (DM).

METHODS

We performed a cross-sectional study in a tertiary hospital, and all participants underwent a comprehensive geriatric assessment, the hand-grip strength test (HGST), the chair stand test (CST) for muscle strength evaluation, the 4-meter walking test, and the timed up-and-go (TUG) test for physical performance assessment. The diagnosis of SO was made according to the ESPEN/EASO criteria. The PhA was determined automatically by the BIA using resistance and reactance at 50 kHz for each participant.

RESULTS

A total of 322 participants were included in the study. The mean age of the participants was 72.5 ±5.8, and 203 (63%) of them were female; 63 (19.6%) of them were sarcopenic obese. In multivariable logistic regression analyses, a significant relationship was found when the model was adjusted for age, female gender, MNA-sf scores, HbA1c level, and CCI scores (OR: 0.53, 95%CI: 0.29-0.98, P = 0.04). In ROC analyses, for PhA in predicting SO diagnosis, the AUC was 0.586 (95%CI: 0.505-0.678, P = 0.033). At the cut-off score 4.4, sensitivity was 57.1% and specificity was 61.4%; positive predictive value (PPV) was 26.5%; negative predictive value (NPV) was 85.5%.

CONCLUSIONS

The study identified a significant relationship between SO and PhA among older adults with type 2 DM. However, larger prospective studies are needed to confirm the potential utility of PhA as a biomarker for SO.

Prevention and Treatment of Malnutrition in Older Adults Living in Long-Term Care or the Community: An Evidence-Based Nutrition Practice Guideline

Malnutrition in older adults can decrease quality of life and increase risk of morbidities and mortality. Accurate and timely identification of malnutrition, as well as subsequent implementation of effective interventions, are essential to decrease poor outcomes associated with malnutrition in older adults. The Academy of Nutrition and Dietetics Evidence Analysis Center conducted a systematic review of the literature to develop an evidence-based nutrition practice guideline for the prevention and treatment of malnutrition in older adults. The objective of this guideline was to provide evidence-based recommendations to identify, prevent, or treat protein-energy malnutrition in older adults (mean age ≥65 years) living in long-term care and community settings. This guideline provides 11 nutrition recommendations to inform shared decision making among dietitians, members of the health care team, family members or caregivers, and older adults living in long-term care or the community to prevent or treat malnutrition. Topics include dietitian effectiveness, nutrition assessment tools, oral nutrition supplements, food fortification, and home-delivered and congregate meals. Guideline implementation should include consideration of the importance of comprehensive individualized nutrition care for older adults. Future research is needed to address gaps that were identified related to the validity, reliability, and feasibility of nutrition assessment tools, as well as the effectiveness of dietitian interventions on outcomes of interest in older adults living in long-term care and the community.

Predictive value of adductor pollicis muscle thickness for ultrasound-based sarcopenia in older adults

BACKGROUND

The adductor pollicis muscle thickness (APMT) is least affected by subcutaneous adipose tissue and can be measured externally. The aim of this study is to identify the predictive value of APMT for the diagnosis of ultrasonography-based sarcopenia.

METHODS

A total of 245 outpatients who were aged ≥65 years (49 with sarcopenia and 196 without sarcopenia) were included in this cross-sectional study. Patients with knee or hip replacement, advanced dementia, cerebrovascular disease, neurodegenerative disease, or decompensated heart failure and those using drugs that affect muscle functions, such as steroids, were excluded. Comprehensive geriatric assessments and anthropometric measurements of the patients were performed. APMT was assessed with a skinfold caliper. The diagnosis of sarcopenia was based on a low Sonographic Thigh Adjustment Ratio (STAR) index (anterior thigh muscle thickness by ultrasonography/body mass index [BMI] ratio, cutoff points are <1.4 for men and <1.0 for women) and low handgrip strength. The predictive ability of APMT for ultrasound-based sarcopenia diagnosis was examined.

RESULTS

There was no significant difference in terms of arm and calf circumference and BMI between the sarcopenic and nonsarcopenic groups. APMT, handgrip strength, anterior thigh muscle thickness, and gait speed were significantly lower in the patients with sarcopenia. The best cutoff points of APMT for sarcopenia were ≤16.5 for women and ≤21.5 for men with areas under the curve of 0.70 and 0.66, respectively, and negative predictive values of 91.2 and 94.3, respectively (P < 0.001).

CONCLUSION

APMT can be a useful anthropometric marker for ultrasound-based sarcopenia diagnosis.

Examining potentially inappropriate medication use among elderly individuals in palliative care: A comprehensive study

This study aimed to evaluate the prevalence of polypharmacy, the presence of potentially inappropriate medications and related factors in older adults receiving palliative care. This cross-sectional descriptive study was performed in 213 patients who were served from palliative care services. Mini Nutritional Assessment-Short Form, Katz Activities of Daily Living Scale and Charlson Comorbidity Index were applied. Polypharmacy was defined as the use of 5 or more medicines while the use of 10 or more medicines was considered as hyper-polypharmacy. PIM was assessed according to the TIME-to START and TIME-to STOP criteria. A total of 213 patients were included, mean age was 78.00 ± 9.08 years. Polypharmacy was present in 59.2 % of the patients and hyper-polypharmacy was present in 10.8 %. There was a statistically significant correlation between polypharmacy and marital status, history of falls, mid-upper arm, and calf circumference (p = 0.017, p = 0.022, p = 0.010, p = 0.003, respectively). The rate of inappropriate medication use of the cardiovascular system, gastrointestinal system, analgesics, musculoskeletal system, and nervous system drugs was high. There was at least one inappropriate medication use in 56.3 % of older adults. PIMs use was 18.3 % according to TIME-to-START criteria and was 48.4 % according to TIME-to-STOP criteria. There was a higher rate of PIMs use according to TIME criteria in the group with polypharmacy than non-polypharmacy (p < 0.001). The prevalence of polypharmacy and the presence of PIMs is high in older adults receiving palliative care. Polypharmacy could increase the PIMs use. The use of TIME criteria to evaluate palliative care patients may be helpful in reducing inappropriate medication use.

Role of muscle ultrasound in frailty assessment in older adults with type 2 diabetes mellitus

BACKGROUND

Frailty is a geriatric syndrome that is characterized by increased vulnerability to intrinsic and extrinsic stressors due to decreased biologic reserves. Muscle ultrasound (US) is a valid and reliable method for assessing muscle quantity in older adults. The study aims to examine the relationship between frailty definitions and US-derived muscle parameters.

METHODS

We conducted a cross-sectional study with type 2 diabetes mellitus outpatients in a tertiary hospital, and all participants underwent a comprehensive geriatric assessment. For frailty assessment, the Fried Frailty Phenotype (FFP), the Clinical Frailty Scale (CFS), and the Edmonton Frailty Scale (EFS) were performed. Muscle US measurements included Gastrocnemius Medialis (GM) muscle thickness, GM fascicle length, GM pennation angle, Rectus Femoris (RF) muscle thickness, Rectus Femoris cross-sectional area (RFCSA), Rectus Abdominis (RA) muscle thickness, External Oblique (EO) muscle thickness, Internal Oblique (IO) muscle thickness, and Transverse Abdominis (TA) muscle thickness.

RESULTS

In all, 373 participants were included in the study. The median age of participants was 72.7 ± 5.9 years, and 64.6% of them were female. According to the FFP, 18.2% of the participants were living with frailty, 56% of them were pre-frail; 57.4% of them were living with frailty according to the CFS; 25.2% of them were living with frailty, and 20.6% of them were pre-frail according to the EFS. The FFP, CFS, and EFS scores were related to muscle thickness of GM, RF, and RA, fascicle length of GM, and pennation angle of GM and RFCSA. Particularly, GM pennation angle, RF muscle thickness, and RFCSA were associated with an increased risk of frailty. Besides muscle thickness of GM, RF, and RA, fascicle length of GM, pennation angle of GM, and RFCSA were significant for predicting the presence of frailty.

CONCLUSIONS

US-derived regional muscle measurements are associated with frailty definitions (in both physical, cumulative deficit, and multidimensional models) in a diabetic geriatric population.

Physical frailty is related to oxidative stress through thiol/disulfide homeostasis parameters

AIM

To evaluate relationship between frailty and oxidative stress through thiol/disulfide homeostasis parameters [Native thiol (NT), total thiol (TT), and disulfide levels (D), disulfide-native thiol (D/NT), disulfide-total thiol (D/TT), native thiol-total thiol (NT/TT) ratios, and ischemia-modified albumin levels (IMA)].

MATERIALS AND METHODS

In total, 139 community-dwelling older adults were included. The frailty status, defined by the FRIED frailty index (FFI) and Clinical Frailty Scale (CFS), and comprehensive geriatric assessment results compared with thiol/disulfide homeostasis parameters and ischemia-modified albumin levels.

RESULTS

NT and TT levels were significantly lower in the frail group (respectively; p = 0.014, p = 0.020). The FFI scores were correlated with the levels of NT, TT, D/NT, D/TT, and NT/TT (respectively; r = - 0.25, r = - 0.24, r = 0.17, r = 0.17, r = - 0.17). The significant correlation could not be retained with the CFS scores. In ROC analysis, the AUC for NT was calculated as 0.639 in diagnosing frailty according to the FFI (95% CI 0.542-0.737), AUC was 0.638 for TT (95% CI 0.540-0.735), and AUC was 0.610 for NT/TT (95% CI 0.511-0.780). The AUC was calculated as 0.610 for both D/NT and D/TT in diagnosing physical frailty (95% CI 0.511-0.708).

CONCLUSION

Thiol/disulfide homeostasis parameters can be a potential biomarker in diagnosing physical frailty. However, further studies are needed for diagnosing frailty defined with cumulative deficit models.

The effect of social frailty on mental health and quality of life in older people: a cross-sectional study

PURPOSE

This study aims to evaluate anxiety, depression, loneliness, death anxiety, and quality of life and investigate their relationship with social frailty in the geriatric population. Additionally, it aimed to identify social frailty predictors.

METHODS

The study included 136 participants admitted to the geriatric outpatient clinic. The 15-item Geriatric Depression Scale (GDS-15), the Multidimensional Scale of Perceived Social Support (MSPSS), the Cumulative Illness Rating Scale for Geriatrics (CIRS-G), the Templer Death Anxiety Scale (T-DAS), the Loneliness Scale for the Elderly (LSE), the Quality of Life Scale (CASP-19), the Generalized Anxiety Disorder-7 Test (GAD-7), the Tilburg Frailty Indicator (TFI), the FRAIL Scale, and the Clinical Frailty Scale (CFS) were performed. The TFI was used to collect data about social frailty.

RESULTS

There were 61.8% females, and the median age (min-max) was 72.2 (65.3-90.3) years. The prevalence rate of social frailty was 26.7%. The rates of depression, loneliness, anxiety, death anxiety, the burden of chronic disease, and frailty were higher in the social frailty group. Furthermore, logistic regression analysis revealed a strong relationship between social frailty status and widowhood (odds ratio (OR) 6.86; 95% confidence interval (95% CI), 2.42-19.37; p < 0.001), moderate to severe anxiety symptoms (OR 4.37; 95% CI 1.08-17.68; p = 0.038), and a TFI-physical frailty score (OR 1.40; 95% CI 1.12-1.73; p = 0.002).

CONCLUSION

In older adults, the social dimension of frailty is associated with quality of life and psychological state. Physical frailty and sociodemographic characteristics may affect the development of social frailty.

Which comorbidity index is more appropriate for geriatric patients from the frailty perspective?

OBJECTIVES

This study examined the relationship between comorbidity indices and physical, psychologic and social frailty and 1-year mortality.

METHODS

A cross-sectional analysis was conducted with 136 community-dwelling older adults. The relationship of 4 comorbidity indices (CIRS-G, ACCI, GIC, ICED) with 3 different frailty scales (FRAIL, CFS, TFI) was examined.

RESULTS

The participants' median age was 72 years (65-90); 62% of the participants were female. Overall, 15.4% of the participants were living with frailty according to the FRAIL scale, 27.9% of them according to the CFS, 58.8% of them according to the TFI, 47.7% of them living with psychological frailty, and 28.6% of them living with social frailty. There were significant and moderate correlations between CIRS-G and FRAIL, CFS and TFI total scores, TFI-Psychological scores and TFI-Social scores (respectively; p < 0.001, r = 0.530; p < 0.001, r = 0.471; p < 0.001, r = 0.535; p < 0.001, r = 0.402; p = 0.016 r = 0.206). AUC for CIRS-G was calculated as 0.716 among comorbidity indices in predicting the presence of frailty according to the FRAIL scale (p = 0.002, 95%CI [0.60-0.82]), 0.765 according to the CFS (p < 0.001, 95%CI [0.66-0.86]), 0.746 according to the TFI (p < 0.001, 95%CI [0.66-0.82]).

CONCLUSION

The CIRS-G index was found to be superior to other indices in predicting the presence of frailty of comorbidity indices, and only GIC scores showed significant results in predicting mortality. However, it would not be the right approach to recommend a single comorbidity index when evaluating older adults.

Calf circumference predicts sarcopenia in maintenance hemodialysis

BACKGROUND

Early recognition of sarcopenia in hemodialysis (HD) patients will be of great importance in preventing adverse outcomes and improving the quality of life in these patients. The main goal of this study was to evaluate the diagnostic accuracy of calf circumference (CC) measurement in detecting sarcopenia among CKD patients undergoing maintenance HD.

METHODS

This cross-sectional study included 52 patients (53 ± 17 years) who were currently in a maintenance HD. Muscle strength was evaluated using handgrip strength, and smooth muscle mass index (SMI) was assessed through bioelectrical impedance analysis, and CC was measured at the widest part of the calf with the foot pressed against a hard surface.

RESULTS

Out of the total patient population, sarcopenia was identified in 32.7% (n = 17). The two groups were comparable in terms of age, weight, and height, but the median body mass index of sarcopenic group was statistically lower than nonsarcopenic group (21.6 kg/m2 [18.9-24.6] vs 24.7 kg/m2 [21.4-27.3]. The sarcopenic group had a substantially smaller CC than the nonsarcopenic group (30.0 cm [26.5-32.0] vs 31.5 cm [30.3-34.8], P = 0.013; respectively). In the regression analysis, CC was found to be independently associated with post-HD SMI (P < 0.001; odds ratio, 1.938; and 95% CI, 1.020-2.856). CC was positively but weakly correlated with handgrip strength, however strong and significant correlation was found between CC and SMI (r = 0.277, P = 0.047 and r = 0.733, P < 0.001; respectively). A CC of 31 cm or less predicted confirmed sarcopenia in HD patients (area under the curve = 0.709, P = 0.006, specificity = 0.556, sensitivity = 0.765).

CONCLUSIONS

Low muscle mass and potentially low muscle strength in HD patients can be accurately identified through the use of CC measurements. Specifically, a CC measurement below 31 cm has found to be a useful indicator to identify individuals on maintenance HD.

Cognitive Status is Better in Older Adults under Colchicine Treatment: A Case-Control Study

PURPOSE

We aimed to investigate the effects of colchicine, an important anti-inflammatory agent, on cognitive functions in a geriatric population diagnosed with gout or osteoarthritis by comparing it to non-colchicine users.

METHODS

138 geriatric patients (67 colchicine users and 71 non-users) were enrolled. Within comprehensive geriatric assessment (CGA), cognitive status assessment via Mini-Mental State Examination test (MMSE), Quick Mild Cognitive Impairment Screening test (Qmci), clock drowning test (CDT), and digit span tests were performed.

RESULTS

Median age was 68 (65-72), and there were 82 female (59.4%) patients. The scores of CDT, Backward Digit Span Test, MMSE-Total, MMSE-Attention, MMSE-Motor Function, Qmci-Total Score, Qmci-Clock drawing, and Qmci-Logical Memory were significantly higher in the colchicine user group (p < .005), showing better cognitive function. Adjusted model analysis showed that colchicine usage is independently correlated with higher Qmci-Total Score and Qmci-Logical Memory Score (For Qmci total score β = 7.87 95%CI = 5.48-10.27, p = <0.0001, and for Qmci Logical memory score β = 3.52, 95%CI = 2.12-4.91, p = <0.0001).

CONCLUSION

To the best of our knowledge, this is the first study revealing that colchicine usage is associated with better cognitive performance in older adults. Further investigations with a prospective, larger-sampled and randomized design are needed to show the causal relationship between colchicine and cognition.

The relationship between the quantity and type of macronutrients in diet and frailty in older outpatients

BACKGROUND AND AIM

The aim of this study is to determine the relationship between the quantity and type of macronutrients in the diet and frailty.

MATERIAL AND METHODS

A total of 106 patients were included in the study. Exclusion criteria included patients with pacemakers, edema, advanced dementia, acute infectious and inflammatory disease, and those using oral or enteral nutritional supplements. Frailty was assessed using the Fried Frailty Phenotype. Three-day dietary records were taken, 2 days on weekdays and 1 day on weekends. The Nutrition Information System (BeBis) 8.2 full version program was used to analyze the average energy and nutrient values of the consumed foods. Insufficient protein and energy intake were defined as taking less than 1 or 1.2 g/kg/day for protein and less than 30 kcal/kg/day for energy, respectively.

RESULTS

The mean age of the participants was 74.3 (± 6.75), and 68.9% (n = 73) of them were women. 26.4% (n = 28) of the patients were classified as frail. There was no difference between the energy consumption of < 30 kcal/kg/day in the frail and non-frail groups. Protein consumption of less than 1.2 g/kg/day had a significant relationship with frailty. There was no significant difference between the consumed plant/animal protein ratio and frailty, but plant protein, polyunsaturated fatty acids, and fiber intake were significantly lower in frail patients. Decreased consumption of polyunsaturated fatty acids (PUFAs), advanced age, and increased number of medications were identified as independently associated factors with frailty.

CONCLUSION

This study found that frailty was associated with less than 1.2 g/kg/day protein consumption, lower fiber, and PUFA consumption.

Phase angle is associated with frailty in community-dwelling older adults

OBJECTIVES

Frailty is a geriatric syndrome associated with adverse outcomes. Malnutrition and sarcopenia are conditions intertwined with frailty. Phase angle (PhA), used to evaluate nutritional status and sarcopenia, shows the cell membrane integrity and is closely related to clinical outcomes and mortality in many chronic conditions. The aim of this study was to evaluate the relationship between PhA and frailty in community-dwelling older adults.

METHODS

The study included 299 older adults admitted to a geriatric outpatient clinic. A comprehensive geriatric assessment was performed on all participants. Frailty was evaluated via the Clinical Frailty Scale, ≥4 levels were accepted as living with frailty. All participants underwent bioelectrical impedance analysis, and PhA was recorded for each participant.

RESULTS

The prevalence of frailty among the participants was 53%. The median PhA was lower in patients living with frailty than in those who were robust (5.10 [4.55-7.80] and 5.90 [3.90-6.90] degrees, respectively, and P = 0.014). Multivariable regression analysis showed that PhA was also associated with frailty in both sexes (odds ratio [OR], 0.920; P = 0.034 for men; OR, 0.81; P = 0.005 for women, respectively) independent of age, handgrip strength, nutritional status, body mass index, living alone, and burden of morbidities.

CONCLUSION

PhA calculated with bioelectrical impedance analysis was significantly associated with frailty. Further research with large samples is needed to determine whether PhA demonstrates potential utility as a biomarker for frailty.

The relationship between urinary incontinence and abdominal muscle thickness in community-dwelling older women undergoing comprehensive geriatric assessment

PURPOSE

Urinary incontinence (UI) is one of the most common geriatric syndromes in older adults, especially in women. The aim of this study is to show the relationship between urinary incontinence and abdominal muscle thickness measured by muscle ultrasonography (US) in community-dwelling older women adults.

METHODS

Eighty-seven community-dwelling older women participated in our study. The presence and the type of UI were recorded. Clinical and demographic characteristics were collected, and a comprehensive geriatric assessment was performed on all participants. Abdominal muscle layer thicknesses were evaluated with muscle US.

RESULTS

The prevalence of UI was 55.2% (n = 48) of the study population. The median [IQR] age of the patients in the UI group was 73.0 [69.0-77.5] years and it was 69.0 [67.0-73.0] years in patients without UI (p = 0.007). Abdominal muscle thicknesses were measured smaller in patients with UI than those without UI except for internal oblique muscle thickness. The median [IQR] rectus abdominis muscle thickness was lower in patients with UI than in patients without UI, and the difference was statistically significant (p < 0.003). RA muscle was associated with UI regardless of age, polypharmacy, malnutrition, and frailty (OR: 0.58; 95% CI 0.38-0.89; p = 0.01).

CONCLUSIONS

We have shown that UI was independently related to the rectus abdominis muscle thickness, which may reflect the function and mass of the pelvic floor muscles.

Associations of EWGSOP1 and EWGSOP2 probable sarcopenia definitions with mortality: A comparative study

BACKGROUND & AIMS

Sarcopenia is a well-defined geriatric syndrome and a major cause of disability and mortality. We investigate the associations of alternative sarcopenia definitions with mortality in community-dwelling older adults.

METHODS

Sarcopenia was defined based on the EWGSOP1 and EWGSOP2 probable sarcopenia criteria, with standard handgrip strength (HGS) cut-offs of 30/20 kg for an EWGSOP1 definition and 27/16 kg for an EWGSOP2 definition, or alternatively, population-specific cut-offs of 35/20 kg for a EWGSOP2 definition. The 5-year mortality rate was assessed in the accessible cases.

RESULTS

The prevalence of sarcopenia among 204 older adults [53.9% female; aged 74.5 ± 7.0] was 4.9% based on the EWGSOP1 criterion, 23.5% according to the EWGSOP2-suggested standard (British) HGS cut-offs and 50.0% based on the EWGSOP2 population-specific cut-offs. In the 103 accessible patients, the mortality rate was 30.1%. Cox-regression analyses adjusted for parameters determined through univariate analyses [age and sarcopenia definitions (in 3 different models)], showed that the EWGSOP1 definition (HR = 4.26, 95% CI = 1.45-12.42, p = 0.008) and EWGSOP2 probable sarcopenia definition with population-specific cut-offs (HR = 2.58, 95% CI = 1.12-5.93, p = 0.03) were associated with a greater mortality risk, while the EWGSOP2 probable sarcopenia definition with standard-cut offs was not (p = 0.09).

CONCLUSIONS

This is the first study to investigate the associations of EWGSOP2-defined probable sarcopenia with mortality based on standard vs. population-specific HGS cut-offs. The results suggest that population-specific cut-offs should be used when available. We suggest that conducted in community-dwelling older adults, our results have implications for most of older adults.

Prevalence of nutrition disorders and nutrition-related conditions in older patients with Alzheimer's disease

BACKGROUNDS

Alzheimer's disease is frequently encountered with nutrition-related conditions such as malnutrition, sarcopenia, frailty, overnutrition, and micronutrient abnormalities in older patients. In this study, we aimed to evaluate the prevalence of nutrition disorders and nutrition-related conditions in the same patient group.

METHODS

A total of 253 older patients with Alzheimer's disease underwent comprehensive geriatric assessment, which included nutrition-related disorders, malnutrition via the Mini Nutritional Assessment-Short Form (MNA-SF), frailty via the Clinical Frailty Scale (CFS), and sarcopenia was diagnosed according to European Working Group on Sarcopenia in Older People-2 criteria.

RESULTS

The patients' mean age was 79.8 ± 6.5 years, and 58.1% were women. In our patients, 64.8% had malnutrition or were at risk of malnutrition; 38.3% had sarcopenia; 19.8% were prefrail; and 80.2% were frail. Malnutrition, frailty, and sarcopenia prevalence increased as the Alzheimer's disease stage progressed. Malnutrition was found to be significantly related with frailty scores via CFS (odds ratio [OR], 1.397; P = 0.0049) and muscle mass via fat-free mass index (FFMI) (OR, 0.793; P = 0.001). In logistic regression analysis, age, MNA-SF, and CFS were included in the model to detect the independent correlates of probable and confirmed sarcopenia. CFS was independently associated with probable and confirmed sarcopenia (OR, 1.822; P = 0.013; OR, 2.671; P = 0.001, respectively). Frailty was similarly related with FFMI (OR, 0.836; P = 0.031). Obesity was independently related with FFMI (OR, 0.688; P < 0.001).

CONCLUSION

In conclusion, nutrition disorders and nutrition-related conditions can present concurrently in patients with all stages of Alzheimer's disease; therefore, these frequent problems should be screened and diagnosed accordingly.

Balance performance measured by posturography in mild-moderate Alzheimer's Disease: An undervalued assessment

PURPOSE

The aim of the study was to compare balance performance in mild-moderate stage Alzheimer's disease (AD) patients and healthy peers using clinical balance tests and computerized posturography.

METHODS

We recruited 95 patients and divided them into two groups; 51 patients (62 % (n=32) female) in AD group and 44 patients in healthy controls group (50 % (n=22) female). Berg Balance Scale (BBS) and Timed Up & Go (TUG) test were performed. Computerized posturography was performed.

RESULTS

The mean age was 77.2±5.5 years in the AD group and 73.8±4.4 years in the control group (p<0.001). Sensory organization test composite equilibrium score (60[30-81], p<0.001), step quick turn-sway velocity (69.2 [38.2-95.8], p<0.001) and step quick turn-time (3.8 [1.6-8.4], p<0.001) were significantly impaired in mild-moderate stage AD patients. Berg Balance Scale (50 [32-56], p<0.001) and TUG test (13.0 [7.0-25.7], p<0.001) results were worse in AD.

CONCLUSIONS

Computerized posturography measures were impaired in mild-moderate AD patients. The results highlight importance of early screening for balance and fall risk in AD patients. The study provides multi-dimensional and holistic assessment of balance performance in early-stage AD patients. Alzheimer's disease patients at earlier stages are prone to fall risk and should be evaluated accordingly.

Depression level, nutritional status, and dietary nutrient intake of the older adult at the community level in a selected area of Bangladesh

Malnutrition is associated with higher rates of morbidity and death in the older population. Depression or mental health is a major component of older adult malnutrition. The aim of the study was to measure the level of malnutrition and depression in older adults, as well as their correlated factors, such as dietary energy and nutrient consumption. A cross-sectional study was conducted among 108 older individuals living in two areas of Faridpur, Bangladesh. The Mini Nutritional Assessment-Short Form (MNA-SF), Geriatric Depression (GD) Scale, and 24-h dietary recall were used to measure the nutritional status, depression level, and dietary nutrients, respectively. A total of 20.4% and 55.6% were malnourished or at risk of malnutrition, respectively. Around 81.5% of the study subjects exhibited a different degree of depression and 9.3% were identified as having severe depression. There was a significant inverse association between the MNA-SF score and the GD score (r = -0.684, p=<0.001). The average energy and protein consumption was 1387 kcal and 45.52 g, respectively; and energy and protein intake were significantly lower in the depressed group (1353 Kcal, 43.8 g) than in the non-depressed group (1530 Kcal, 52.4 g). An extremely low energy consumption (<20 kcal/kg body weight/day) was noted in 27.1% of the older adults. None of the participants in this study were able to meet the requirements for dietary fiber, calcium, vitamin B6, folate, vitamin D, and vitamin E. Specific nutrition-related intervention programs as well as social and familial support are recommended to improve the nutritional status of older adults.

Comparison of Grip Strength Measurements by Widely Used Three Dynamometers in Outpatients Aged 60 Years and Over

Grip strength (GS) is widely used in various fields such as sports, rehabilitation, and geriatrics to assess muscle strength, and to diagnose sarcopenia and frailty in older adults. There is a potential for measurement differences among different dynamometers available, and studies comparing GS measurements by variable tools have conflicting results. The two most frequently used dynamometers are the Jamar hydraulic (Jamar) and spring-type hand grip dynamometers, and Jamar has not been compared to Jamar PLUS+ Digital (Jamar+) dynamometer in older adults. So, we aimed to assess GS measurements with the Jamar as the reference standard against Jamar+, and spring-type Takei T.KK. 5401 (Takei) digital dynamometers. One hundred and ten outpatients aged >60 years were included. Inter-instrumental reliability was determined. The differences between dynamometers were evaluated by Bland-Altman plots and measurement error. The measurements with Jamar+, and Takei dynamometers were reliable and valid regarding the Jamar dynamometer. Takei and Jamar+ dynamometers overestimated GS over the Jamar dynamometer. Though the differences in the measured values might be disregarded in clinical practice, individuals defined to have low GS varied by the use of different dynamometers. Grip strength better be measured by the same dynamometer in serial measurements of older individuals.

Evaluation of the relationship between GOHAI, MNA and the dental hygiene of using denture wearers for older patients

BACKGROUND

The use of removable dentures increase due to tooth loss that occurs with ageing. The relationship between age, use of removable dentures and nutrition is important.

OBJECTIVE

To evaluate the effectiveness of the GOHAI, the MNA, and the dental hygiene of older patients using dental prostheses.

METHODS

This was a cross-sectional study of people over 65 who used removable prostheses in at least one jaw (partial or complete denture) for a minimum of 6 months (n = 120). The data were collected using questionnaires of a qualified examiner and oral clinical tests with interviewers in person. The subjects' nutritional status was assessed by a Turkish version of the mini nutritional assessment (MNA). GOHAI questionnaire was used to evaluate those aspects considered to have an impact on the quality of life of the older population, such as functional limitation, aesthetic dissatisfaction, chewing discomfort, avoidance of particular food, out-of-social contacts and self-medication administered for dental pain.

RESULTS

There was no statistically significant correlation between the GOHAI score and sociodemographic and intraoral data (p > .050). A negative correlation was found between age and MNA. A statistically significant difference was found between the MNA score's median values according to the participant's education level, type of prosthesis, and marital status (p < .050). Good was determined as the highest GOHAI category with 54%.

CONCLUSION

There is a negative correlation between age and MNA. The risk of malnutrition increases with age. Since the oral condition also affects the patient's systemic condition, the team caring for geriatric patients must bring these people to the maximum level of life in a multidisciplinary manner.