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.

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.

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.

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.

Changes in Place of Death of Older Adults during the COVID-19 Pandemic: A Retrospective Study from an Aging Country

In the COVID-19 pandemic, due to the difficulties in patients' applications to health centres, changes have occurred in the places of death of older adults. It is aimed to investigate the change in the places of death of older adults in Turkey, which is one of the countries most affected by the pandemic. Patients admitted to the geriatric outpatient clinic of a university hospital from 01.01.2013 to 29.02.2020 were included. Place and date of death were recorded as hospital or out-of-hospital death. According to results, while the median age of those who died during the pandemic was higher than before (p < 0.001) and during the pandemic, the hospital mortality ratio was higher than before. During the pandemic period, the hospital mortality ratio of older adults has increased in Turkey. This situation, which has occurred despite the increasing healthcare burden, can show the importance of the measures taken and robust health infrastructure.

Comparison of Mini Nutritional Assessment-Short and Long Form to predict all-cause mortality up to 7 years in geriatric outpatients

BACKGROUND

We aimed to find out whether the Mini Nutritional Assessment-Short Form (MNA-SF) can predict mortality up to 7 years when compared with the Mini Nutritional Assessment-Long Form (MNA-LF) in geriatric outpatients.

METHODS

This retrospective study was conducted in patients (≥65 years) who were admitted to the geriatric outpatient clinic of a university hospital. MNA-SF and MNA-LF results were available for all patients. Patients were grouped as normal nutrition status (score 12-14), at risk of malnutrition (score between 8 and 11), or malnourished (score ≤7) according to MNA-SF. Based on MNA-LF, patients had normal nutrition status (score ≥24), were at risk of malnutrition (score 17-23.5), or were malnourished (score <17). Survival of the patients was assessed retrospectively.

RESULTS

The study included 209 patients (62.2% female). During the 7-year follow-up, 77 (36.8%) patients died. After adjusting for age, sex, and Charlson comorbidity index, MNA-SF was significantly associated with all-cause mortality during 6-month, 1-year, 3-year, 5-year, and 7-year follow-up time. MNA-LF was superior to MNA-SF to estimate 6-month (P = 0.004) and 1-year mortality (P = 0.031). There was no difference between MNA-SF and MNA-LF regarding 3-year, 5-year, and 7-year mortality.

CONCLUSION

MNA-SF can predict short-term and long-term mortality in geriatric outpatients as well as MNA-LF. A cut-off value of 11, indicating risk of malnutrition according to MNA-SF, may be used for the risk estimation of 1-year, 3-year, and 5-year mortality. Therefore, this study highlights the importance of screening all geriatric outpatients for malnutrition and especially the risk of malnutrition for early intervention and treatment.

Global Leadership Initiative on Malnutrition criteria with different muscle assessments including muscle ultrasound with hospitalized internal medicine patients

BACKGROUND

The aim of this study is to identify cutoff values for muscle ultrasound (US) to be used in Global Leadership Initiative on Malnutrition (GLIM) criteria, and to define the effect of reduced muscle mass assessment on malnutrition prevalence at hospital admission.

METHODS

A total of 118 inpatients were enrolled in this cross-sectional study. Six different muscles were evaluated by US. Following defining thresholds for muscle US to predict low muscle mass measured by bioelectrical impedance analysis, malnutrition was diagnosed by GLIM criteria with seven approaches, including calf circumference, mid-upper arm circumference (MAC), handgrip strength (HGS), skeletal muscle index (SMI), rectus femoris (RF) muscle thickness, and cross-sectional area (CSA) in addition to without using the reduced muscle mass criterion.

RESULTS

The median age of patients was 64 (18-93) years, 55.9% were female. RF muscle thickness had moderate positive correlations with both HGS (r = 0.572) and SMI (r = 0.405). RF CSA had moderate correlation with HGS (r = 0.567) and low correlation with SMI (r = 0.389). The cutoff thresholds were 11.3 mm (area under the curve [AUC] = 0.835) and 17 mm (AUC = 0.737) for RF muscle thickness and 4 cm² (AUC = 0.937) and 7.2 cm² (AUC = 0.755) for RF CSA in females and males, respectively. Without using the reduced muscle mass criterion, malnutrition prevalence was 46.6%; otherwise, it ranged from 47.5% (using MAC) to 65.2% (using HGS).

CONCLUSIONS

Muscle US may be used in GLIM criteria. However, muscle US needs a standard measurement technique and specific cutoff values in future studies.

Insomnia and falls in older adults: are they linked to executive dysfunction?

BACKGROUND

Insomnia increases the incidence of falls and impairs executive function. Moreover, falls are associated with executive function impairment. The relationship between falls and executive function in patients with insomnia is not clear. The aim of this study was to evaluate relationship between falls and executive function in individuals with insomnia and a control group.

METHODS

This study involved 122 patients (47 insomnia, 75 controls). The Mini-Mental State Examination, Quick Mild Cognitive Impairment Screen, Trail Making Test A, clock-drawing test, and digit span test were used to measure executive function. Semantic and working memory dual task was also performed. Fall history was recorded and the Falls Efficacy Scale - International administered.

RESULTS

The median age of the patients was 71 years (range: 65-89 years), and 60.7% were women. The insomnia group scored lower on the three-word recall than the control group (P = 0.005), but there was no difference between the groups on cognitive tests. Fall history and fear of falling were more frequent in the insomnia group (P = 0.003, P < 0.001). Semantic and working memory dual tasks were correlated with clock-drawing test only in the insomnia group (r = -0.316, P = 0.031; r = -0.319, P = 0.029). Depression (odds ratio (OR) = 9.65, P = 0.001) and Trail Making Test A (OR = 1.025, P = 0.07) were independently associated with insomnia. Four-metre walking speed (OR = 2.342, P = 0.025), insomnia (OR = 3.453; P = 0.028), and the semantic memory dual task (OR = 1.589; P = 0.025) were also independently associated with falls.

CONCLUSION

Our study showed that dual tasking and executive function are related to falls in patients with insomnia. Managing insomnia and assessment of executive dysfunction may have beneficial effects on preventing falls.

Effect of clinical pharmacists' interventions on dementia treatment adherence and caregivers' knowledge

AIM

Poor adherence with dementia medications is common among patients and caregivers, owing to the absence of perceived effect, polypharmacy, and adverse effects. The aim of this study was to evaluate the effect of clinical pharmacists' interventions on the adherence to dementia treatment and the caregivers' knowledge of dementia.

METHODS

This study was conducted at a geriatric outpatient clinic of the university hospital between October 2018 and April 2019. The Morisky Green Levine Adherence Scale (MGLS) to patients or caregivers and the Dementia Knowledge Assessment Tool Version Two (DKAT2) to caregivers were applied at the beginning of the study and 4 months later by a clinical pharmacist. After the scales were applied in the first interview, verbal information about the importance of adherence to dementia treatment, and incorrect answers of caregivers in DKAT2 were provided by the clinical pharmacist.

RESULTS

A total of 94 patients and 91 caregivers were included in the study. High adherence to treatment was determined in 70.2% of the patients in the first interview and in 95.7% in the second interview (P < 0.001). The mean score of DKAT2 was 15.53 ± 2.44 in the first interview, while the median score of DKAT2 in the second interview was 19.11 ± 1.25 (P < 0.001).

CONCLUSION

The intervention of clinical pharmacists significantly increased the adherence to dementia treatment and the caregivers' knowledge of dementia. Close monitoring of dementia patients and caregivers by clinical pharmacists and collaboration with a multidisciplinary team play an important role in dementia care. Geriatr Gerontol Int 2021; 21: 506-511.

Older Adults With Coronavirus Disease 2019: A Nationwide Study in Turkey

Background

A novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) occurred in China in December 2019 and has spread globally. In this study we aimed to describe the clinical characteristics and outcomes of hospitalized older adults with coronavirus disease 2019 (COVID-19) in Turkey.

Methods

We retrospectively analyzed the clinical data of hospitalized patients aged ≥ 60 years with confirmed COVID-19 from March 11, 2020, to May 27, 2020 using nationwide health database.

Results

In this nationwide cohort, a total of 16942 hospitalized older adults with COVID-19 were enrolled, of whom 8635 (51%) were women. Mean age was 71.2 ± 8.5 years, ranging from 60 to 113 years. Mortality rate before and after curfew was statistically different (32.2% vs 17.9%; p & 0.001, respectively). Through multivariate analysis of the causes of death in older patients, we found that male gender, diabetes mellitus, heart failure, chronic kidney disease, dementia, cancer, admission to intensive care unit, computed tomography finding compatible with COVID-19 were all significantly associated with mortality in entire cohort. In addition to abovementioned risk factors, in patients aged between 60-79 years, coronary artery disease, oxygen support need, total number of drugs, and cerebrovascular disease during hospitalization, and in patients 80 years of age and older acute coronary syndrome during hospitalization were also associated with increased risk of mortality.

Conclusions

In addition to the results of previous studies with smaller sample size, our results confirmed the age-related relationship between specific comorbidities and COVID-19 related mortality.