A Quality Improvement Study on Delirium Awareness Day: In Pursuit of Missed Delirium Diagnoses.

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

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.

Cutoff values for appendicular skeletal muscle mass using dual-energy x-ray absorptiometry in a reference group of Turkish adults.

BACKGROUND: The aim of this study is to determine cutoff values for different appendicular skeletal muscle mass index (ASMI) methods measured by dual-energy x-ray absorptiometry (DXA) in a reference group of the Turkish population. METHODS: Body composition analyses were performed with DXA, and appendicular skeletal muscle mass (ASM) was adjusted to body size as ASMI using height squared (ASM/ht2 ), weight (ASM/wt), and body mass index (BMI) (ASM/BMI). Sex-specific cutoff values were obtained as 1 and 2 standard deviations (SDs) below the mean values of ASM/ht2 , ASM/wt, and ASM/BMI. RESULTS: A total of 207 (106 women and 101 men) healthy adults were enrolled. Sex-specific cutoff values based on 1 SD below the mean values of ASM, ASM/ht2 , ASM/BMI, and ASM/wt were 14.44, 5.45, 0.61, and 24.07 in women and 22.63, 7.22, 0.90, and 29.04 in men, respectively; 2 SDs below the mean values of ASM, ASM/ht2 , ASM/BMI, and ASM/wt were 11.96, 4.65, 0.51, and 21.75 in women and 19.26, 6.40, 0.78, and 26.55 in men, respectively. ASM, ASM/BMI, ASM/ht2 , and ASM/wt were statistically significant positively correlated with handgrip strength (r = 0.81, r = 0.78, r = 0.73, and r = 0.67, respectively; P < 0.001). CONCLUSION: In this study, ASM/BMI was found to be the most suitable ASM adjustment method to predict muscle strength.

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.

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.

The role of muscle ultrasound to predict sarcopenia.

OBJECTIVES: This study aimed to provide data about the role of muscle ultrasound (US) to predict sarcopenia. METHODS: A total of 313 geriatric outpatients (age ≥65 y) were enrolled in the study. After a comprehensive geriatric assessment, anthropometric measurement and handgrip strength (HGS) data were obtained and a bioelectrical impedance analysis was performed. Sarcopenia was diagnosed using HGS and bioelectrical impedance analysis data. Gastrocnemius medialis (GC), rectus femoris (RF), and rectus abdominis (RA) muscle thickness as well as the RF cross-sectional area (CSA) were measured with US. The role of muscle US to predict sarcopenia was defined with a receiver operating characteristics analysis. RESULTS: The prevalence of probable and confirmed sarcopenia were 43.8% (n = 137) and 13.4% (n = 42), respectively. All muscle US parameters had positive correlations with both HGS and the fat-free mass index. There were inverse correlations between all muscle US parameters and the five-item sarcopenia questionnaire. The RF CSA had stronger correlations with the five-item sarcopenia questionnaire, HGS, and the fat-free mass index than others. The values of GC, RF, and RA muscle thickness and the RF CSA to predict sarcopenia for women/men were 13.9/13.8 mm (area under the curve [AUC]: 0.817/0.707 mm), 13/15.5 mm (AUC: 0.760/0.736 mm), 4.3/5.2 cm2 (AUC: 0.766/0.773 cm2), and 6.6/7.0 mm (AUC: 0.740/0.688 mm), respectively. CONCLUSIONS: GC, RF, and RA muscle thickness and the RF CSA all may predict sarcopenia accurately in geriatric outpatients.

Role of Ultrasonography in Estimating Muscle Mass in Sarcopenic Obesity.

BACKGROUND: Sarcopenic obesity (SO) is the coexistence of sarcopenia and obesity in an individual. The present study is designed to define the usefulness of skeletal muscle ultrasonography (US) in the definition of SO. METHODS: Eighty-nine participants aged ≥65 whose body mass index (BMI, kg/m2 ) was ≥30 were consecutively enrolled in an outpatient clinic of geriatric medicine. All underwent comprehensive geriatric assessment. US measurements were obtained in 6 different muscles consisting of core and limb muscles. We defined SO as the presence of low muscle function (defined by a handgrip strength < 27 kg in males and <16 kg in females) and high BMI (≥30). RESULTS: The median age of the participants was 72 (65-85) years; 81% were female, and 35% (n = 31) had SO. Anthropometric parameters that estimate muscle mass were lower in the sarcopenic group, but estimations of muscle mass with bioelectrical impedance analysis (BIA) did not differ between groups. All US estimations of muscle mass were lower in sarcopenic obese participants, albeit not all significantly. RF muscle cross-sectional area (RF CSA) and abdominal subcutaneous fat thickness were most strongly correlated with grip strength (r = 0.477 and r = -508, respectively). Receiver operating characteristic analysis suggested that the optimum cutoff point of RF CSA for SO was ≤5.22 cm2 , with 95.8% sensitivity and 46.7% specificity (area under the curve: 0.686). CONCLUSIONS: US evaluation of muscle mass may be more accurate than BIA-derived skeletal muscle index assessment for the diagnosis of SO.