Colistin treatment in older adults: why should we know more?

OBJECTIVES: We aimed to investigate the risk factors of colistin-associated nephrotoxicity in patients older than 65 years treated in the palliative care unit. METHODS: 119 palliative care patients who received intravenous colistimethate for at least 7 days were included in the study. The estimated glomerular filtration rate (GFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 2021 equation. Data were obtained from the hospital information system. RESULTS: The mean age of the participants was 76.7 ± 9.9 years and 49.4% were female. Of the 119 patients, 57 had colistin-induced nephropathy (CIN) according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria. The rate of CIN was higher in women than in men. The baseline phosphate level was higher in the CIN (+) group than in the CIN (-) group. The lower GFR values in patients with pneumonia persisted at days 14 and 30, whereas the lower GFR in patients without pneumonia did not. According to multivariate logistic regression, female gender and baseline phosphate level ≥ 4.5 mg/dl were found as independent variables for the development of nephropathy. CONCLUSIONS: The creatinine levels of the patients with pneumonia and CIN did not improve after nephrotoxicity, whereas the creatinine levels of the other patients without pneumonia and CIN did. Female gender and baseline phosphate were independent risk factors for CIN. Prolonged kidney failure may lead to a more difficult clinical follow-up process for clinicians. Therefore, clinicians should be aware of persistent renal insufficiency in older patients with pneumonia receiving colistimethate.

A different outlook to consequences of anemia in older adults.

OBJECTIVES: Anemia is a common health issue in older adults with crucial consequences. We aimed to investigate the relationship of anemia with various components of geriatric syndromes. METHODS: A total of 486 older individuals aged 65 and over admitted to a university hospital were included in this cross-sectional study. According to WHO criteria, we defined anemia as hemoglobin concentration lower than 13 g/dL in men and 12 g/dL in women. The Working Group on Sarcopenia in Older People (EWGSOP2) criteria were used to diagnose sarcopenia. Handgrip strength (HGS) was measured by a hand dynamometer. Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) questionnaires were used to evaluate functionality. Geriatric Depression Scale (GDS), Mini Nutritional Assessment (MNA), Mini-Mental State Examination (MMSE), and European Quality of Life-5 Dimensions (EQ-5D) questionnaires were also used. RESULTS: Participants' mean age was 72.2 ± 6.4 years and 58.8% of them were female. Ninety-two of 486 patients were anemic and 64.1% of anemic patients were female. Anemic group had lower IADL, EQ-5D, HGS scores, and higher GDS scores. According to multivariate logistic regression analysis, age, and anemia were found to be independent risk factors for dependency in IADL in both genders. Anemia, age, and depression were found to be independent risk factors for low HGS in women. CONCLUSION: Anemia and depression are independent factors for low HGS in women, and anemia and age are independent factors for dependency on instrumental daily activities in older persons. Treating depression and raising Hb to optimal levels may be critical interventions to improve the health and life quality of people aged 65 and over, particularly in the female gender.

Risk factors of poor sleep quality in older adults: an analysis based on comprehensive geriatric assessment.

OBJECTIVES: Sleep quality is associated with many diseases and conditions that affect individuals' health in various ways. We aimed to investigate the association between sleep quality and common geriatric conditions in older adults. METHODS: The study included 237 older adults admitted to the geriatric outpatient clinic of a university hospital. All patients underwent comprehensive geriatric assessment (CGA). The Geriatric Depression Scale (GDS), Beck Anxiety Inventory (BAI), European Quality of Life (EQ-5D), Pittsburgh Sleep Quality Index (PSQI), Katz Index of Independence in Activities of Daily Living (ADL) and Lawton and Brody Instrumental Activities of Daily Living (IADL) questionnaires, Tinetti Balance and Gait Assessment (TBGA), and Mini Nutritional Assessment (MNA) were performed on the participants. RESULTS: Participants had a mean age of 72.2 ± 6.3 years, and 146 (61.6%) of them had poor sleep quality. Of the participants, 61.2% were female. In the poor sleep quality group, GDS and BAI scores were higher while ADL, IADL, MNA, and EQ-5D index scores were lower. PSQI score had a negative correlation with ADL (r = -.207, p = .01), EQ-5D index (r = -.372, p = .00), MNA (r = -.277, p = .00), and TBGA (r = -.263, p = .41) scores and a positive correlation with GDS (r = .426, p = .00) and BAI (r = .450, p = .00) scores according to the results of correlation analysis. Multivariate logistic regression analysis showed that the presence of diabetes mellitus (DM) and higher GDS and BAI scores were independent variables for poor sleep quality [(p = .48, OR = 1.92; p = .20, OR = 1.11; and p <.01, OR = 1.11, respectively)]. CONCLUSIONS: We found that DM and depressive and anxiety symptoms were the risks of poor sleep quality. In addition, participants with poor sleep quality had a worse quality-of-life and nutritional status. Improving sleep quality may be helpful in the management of geriatric syndromes and that sleep quality assessment should be part of CGA.

Bone mineral density response to antiosteoporotic drugs in older depressed adults.

Until now, studies did not evaluate the efficacy of antiosteoporotic agents in depressed patients. We demonstrate that the presence of depression and/or serotonergic antidepressant use was associated with non-response to osteoporosis treatment in older adults. PURPOSE: This study aimed to evaluate the effects of depression and antidepressants on bone mineral density (BMD) and response to antiosteoporotic agents in older adults. METHODS: A total of 198 participants with osteoporosis, aged 65 and over, were included in this retrospective study. BMD was measured by dual-energy x-ray absorptiometry scanning at baseline and month 24. RESULTS: Eighty-three of the 198 patients had a diagnosis of depression, and all were serotonergic antidepressant users. Baseline BMD was similar in depressed and non-depressed patients. Lumbar spine BMD change was significantly lower in depressed patients than non-depressed patients (2.89% and 4.85%, respectively, p < 0.001). In addition, of those receiving denosumab treatment, depressed ones had lower lumbar spine BMD changes. Depression and/or antidepressant use was an independent variable for non-response to osteoporosis treatment in both the femoral neck (p = 0.008, OR = 2.61) and lumbar spine (p = 0.015, OR = 6.87), while alendronate and zoledronic acid were independent variables for non-response in the femoral neck and total femur compared to denosumab. CONCLUSIONS: Our study has shown that the presence of depression and/or serotonergic antidepressant use was associated with non-response to osteoporosis treatment in older adults. The results of our study may guide physicians to make treatment decisions in older individuals with depression.

Recurrent lower urinary tract infections: more than an infection for older women.

Background/aim: Older adults tend to have more urinary tract infections (UTIs). The frequency of recurrent lower urinary tract infections (rLUTIs) increases with age. rLUTIs are associated with long-term chronic effects on geriatric syndromes in older adults. We aimed to investigate possible risk factors that influence rLUTIs in older adults based on comprehensive geriatric assessment (CGA). Materials and methods: This cross-sectional study included 235 older adults admitted to Gaziantep University's Geriatric Outpatient Clinic between June 1 and November 30, 2022. All patients underwent CGA. The Geriatric Depression Scale (GDS), the European Quality of Life-Five Dimension (EQ-5D) questionnaire, the Pittsburgh Sleep Quality Index (PSQI), the Katz Index of Activities of Daily Living (ADL), the Lawton and Brody Index of Instrumental Activities of Daily Living (IADL), and the Mini Nutritional Assessment (MNA) tool were,administered. Handgrip strength (HGS) and gait speed were also measured, and the number of falls in the last year was recorded. Results: The mean age of the participants was 72.8 ± 6.8 years and 61.3% were female. Sixty-four patients had rLUTIs. The rLUTI group had higher frequencies of sarcopenia, hypertension, and diabetes; higher numbers of comorbidities and medications; higher GDS and PSQI scores; and more reported falls. They had lower ADL, MNA, EQ-5D, and gait speed scores. HGS was found to be lower in women with rLUTIs. Higher numbers of comorbidities and GDS scores and lower HGS were independent predictors of rLUTIs in women (p = 0.011, OR: 1.75; p = 0.018, OR: 1.14; and p = 0.042, OR: 0.91, respectively). Conclusion: We revealed that decreased HGS, higher GDS, and the number of comorbidities in older women were independent risk factors for rLUTIs. Our findings offer a new perspective on the importance of CGA in diagnosing and preventing rLUTIs.

An inconvenient status in anti-osteoporotic treatment process: corticosteroid use.

OBJECTIVE: There are limited studies investigating the comparison of the efficacy of anti-osteoporotic drugs in different conditions resulting in osteoporosis in older adults. This study aimed to compare the effectiveness of anti-osteoporotic agents in older adults with or without glucocorticoid-induced osteoporosis. METHODS: This retrospective study included 364 patients with osteoporosis, aged 65 years and older. Bone mineral density measurement was performed, and the percent change from baseline was calculated at month 24. RESULTS: Of the 364 patients, 80 were glucocorticoid users. Similar changes in the bone mineral density of the lumbar spine and femoral neck and fracture risk were found in patients with or without glucocorticoid-induced osteoporosis. There was no significant difference in bone mineral density changes between the groups in terms of anti-osteoporotic agents used. CONCLUSIONS: This study demonstrated that the response to anti-osteoporotic agents was similar in older adults with glucocorticoid-induced osteoporosis and those without glucocorticoid-induced osteoporosis. The results of our study may guide osteoporosis treatment in older individuals with glucocorticoid-induced osteoporosis.

An inconvenient status in anti-osteoporotic treatment process: corticosteroid use

SUMMARY OBJECTIVE: There are limited studies investigating the comparison of the efficacy of anti-osteoporotic drugs in different conditions resulting in osteoporosis in older adults. This study aimed to compare the effectiveness of anti-osteoporotic agents in older adults with or without glucocorticoid-induced osteoporosis. METHODS: This retrospective study included 364 patients with osteoporosis, aged 65 years and older. Bone mineral density measurement was performed, and the percent change from baseline was calculated at month 24. RESULTS: Of the 364 patients, 80 were glucocorticoid users. Similar changes in the bone mineral density of the lumbar spine and femoral neck and fracture risk were found in patients with or without glucocorticoid-induced osteoporosis. There was no significant difference in bone mineral density changes between the groups in terms of anti-osteoporotic agents used. CONCLUSIONS: This study demonstrated that the response to anti-osteoporotic agents was similar in older adults with glucocorticoid-induced osteoporosis and those without glucocorticoid-induced osteoporosis. The results of our study may guide osteoporosis treatment in older individuals with glucocorticoid-induced osteoporosis.

Different reflections of the face mask: sleepiness, headache and psychological symptoms.

Objectives. The COVID-19 pandemic has had significant physical and mental effects on healthcare workers. This study aims to evaluate the relationship between wearing face masks and headache, sleepiness, mood and anxiety symptoms in healthcare workers. Methods. A survey was administered to 365 healthcare workers working during the pandemic. The Beck depression inventory, the Beck anxiety inventory and the Epworth sleepiness scale were used to assess depressive symptoms, anxiety symptoms and daytime sleepiness, respectively. Participants were also asked about new-onset headaches. Results. Almost half of the participants (47.6%) reported new-onset headaches, and 23.2% reported excessive daytime sleepiness. The frequencies of depressive and anxiety symptoms were 43.7 and 59.2%, respectively. Sleepiness scores and new-onset headache frequency were higher in women and those using filtering facepiece respirators. A statistically significant positive correlation was found between mask-wearing duration, depressive and anxiety symptom scores, and sleepiness score. Conclusions. The present study has shown that many healthcare workers wearing face masks suffered from sleepiness, headaches and psychological symptoms during the COVID-19 pandemic. These findings indicate the importance of improving working conditions and planning psychological interventions for healthcare workers.

Do Long-Term Complications of Type 2 Diabetes Increase Susceptibility to Geriatric Syndromes in Older Adults?

Background and Objectives: Type 2 diabetes is one of the common chronic diseases in the elderly. It is thought that long-term complications of type 2 diabetes will negatively affect the quality of life in elderly individuals. It is possible that geriatric syndromes, especially frailty syndrome, are associated with diabetic complications, too. In this study, we aimed to evaluate the effect of macrovascular and microvascular complications of type 2 diabetes on frailty and other geriatric syndromes. In addition, the effect of these complications on quality of life was also reviewed. Materials and Methods: We conducted a cross-sectional study for four months. Comprehensive geriatric assessment tests were done on all patients. The Fried frailty index (FFI) was used for the evaluation of frailty syndrome. We assessed malnutrition by mini nutritional assessment short-form (MNA-SF), and Global Leadership Initiative on Malnutrition criteria (GLIM). The EWGSOP 2 criteria were used for the diagnosis of sarcopenia. Quality of life (QoL) was evaluated using the short form-36 (SF-36) questionnaire. Data analysis was done by SPSS version 22. Results: 237 females and 142 males with a mean age of 71.7 ± 6.1 years were included in the study. The frequency of macrovascular and microvascular complications was 41.4% and 68.1%, respectively. Frailty was found to be associated with macrovascular complications (p = 0.003). Handgrip strength, skeletal muscle mass index, and gait speed were decreased in the presence of macrovascular complications (p = 0.043, p < 0.001, p < 0.001). QoL was also decreased in patients with macrovascular complications (p = 0.003). Nutritional status and handgrip strength were negatively affected in patients with diabetic neuropathy (p = 0.019, p = 0.014). Polypharmacy was also found to be associated with macrovascular complications (p < 0.001, p < 0.001). Macrovascular complications were 2.5 times more common in malnourished patients according to GLIM and 3.2 times more common in patients with decreased gait speed. Conclusion: In this study, we observed that both macrovascular and microvascular complications of diabetes increase susceptibility to geriatric syndromes in elderly individuals. It could be useful to conduct prospective studies in which we can compare the effectiveness of treatment methods on this subject.

An uncommon presentation of Sjögren's syndrome and brucellosis.

We describe herein a case of hypokalemia due to proximal renal tubular acidosis (RTA) and Fanconi's syndrome (FS) and nephrogenic diabetes insipidus with DIC - a rare complication of Sjögren's syndrome (SS) and brucellosis. The interesting feature of this case was the presentation with severe hypokalemia, causing acute flaccid quadriparesis with cardiac arrest which is extremely rare. The patient was a 48-year-old woman who suffered cardiopulmonary arrest an hour after hospitalization. Analysis of a blood sample obtained before her cardiopulmonary arrest yielded surprising results: laboratory investigations showed profound hypokalemia (1.1 mEq/L) with renal K wasting, hyperchloremic metabolic acidosis with normal anion gap, hypophosphatemia with hypouricemia, glucosuria, and proteinuria. A diagnosis of RTA and FS were made. On the seventh day, she looked acutely ill, temperature 38.8 °C and pale, and her physical examination revealed purpuric skin lesions on both legs. The serum antibrucella titration agglutination test was found to be 1 of 160 positive with a nosocomial infection. The clinical and laboratory findings were consistent with disseminated intravascular coagulation (DIC). She was unable to concentrate her urine and so a diagnosis of nephrogenic diabetes insipidus (NDI) was reached. A thorough survey for the cause of FS, RTA and NDI revealed that she had xerophthalmia and xerostomia accompanied by high anti-Ro antibody, positive Schirmer test, confirming the diagnosis of SS.

Letrozole induced hypercalcemia in a patient with breast cancer.

Hypersecretion of PTHrP is a relatively common cause of malignancy-related hypercalcemia. However, there is only one case report of letrozole induced hypercalcemia. A 52-year-old female patient was referred to our clinic because of the recent discovery of hypercalcemia (11.0 mg/dL). The patient had a history of left breast carcinoma. She had started a course of letrozole (aromatase inhibitor; 2.5 mg dose/day) ten months earlier. Patient's parathyroid hormone-related protein levels were normal and a bone scintigram revealed no evidence of skeletal metastasis. Other potential causes of high calcium levels were ruled out. We recognized that, when letrozole was taken at one dose daily (2.5 mg), she had recurrent hypercalcemia. Our experience suggests that letrozole may precipitate hypercalcemia in a patient with breast cancer.