Undernutrition in obese older adults by fat percentage.

OBJECTIVE: The prevalence of obesity by fat percentage has seen a steady increase in older adults in recent years, secondary to increases in fat mass in body composition, even in healthy aging. Malnutrition is a common geriatric syndrome with serious clinical outcomes. Increases in fat mass and waist circumference with healthy aging should not prevent the risk of malnutrition from being masked. Malnutrition is often ignored in obese older people due to low BMI cut-off values in many screening tests. The present study seeks to raise awareness of the need to assess the frequency of undernutrition and related factors in obese older adults. METHODS: The data of 2013 community-dwelling patients aged ≥ 60 years who applied to a university geriatrics outpatient clinic between April 2012 and November 2022 were analyzed retrospectively, of which 296 were found to be obese based on fat percentage and were included in the study. Demographic data and the presence of any geriatric syndromes were obtained retrospectively from the patient files, functional status was assessed using the KATZ Activities of Daily Living (ADL) Scale and the LAWTON-BRODY Instrumental Activities of Daily Living Scale (IADL); frailty was screened using FRAIL-scale; and the sample was assessed for malnutrition using the Mini Nutritional Assessment-Short Form (MNA-SF), with undernutrition defined as an MNA-SF score of [Formula: see text] The patients' fat percentage and weight were measured using a bioimpedance analyzer. Fatty obesity was defined using the Zoico methodology (fat percentage [Formula: see text] 27.3% for males, [Formula: see text] 40.7% for females)[Formula: see text] handgrip strength (HGS) was measured using a hand dynamometer, and probable sarcopenia was defined as low HGS based on regional cut-off values (35 kg for males, 20 kg for females). RESULTS: The mean age of the 296 fatty obese older adults (102 males/194 females) was 74.4 + 6.5 years, and the median fat was 42.2% (27.4-59.5). Undernutrition was detected in 19.6% of the patients based on MNA-SF screening. A univariate analysis revealed age, sex, educational status, daily physical activity status, depression, difficulty in swallowing, chewing difficulty, probable sarcopenia, number of chronic diseases, and IADL to be associated with undernutrition, while a multivariate logistic regression analysis revealed depression [OR = 3.662, 95% CI (1.448-9.013), p = 0.005] and daily physical activity status [OR:0.601, 95% CI (0.417-0.867), p = 0.006] to be independently associated with malnutrition in obese older adults based on fat percentage. CONCLUSION:  The present study clarifies the significance of undernutrition in obese older adults also in our country, and recommends undernutrition screening to be carried out, by fat percentage, on obese older adults, especially with depression and low daily physical activity.

Cultural adaptation and clinical validation of Rapid Cognitive Screening Test in Turkish.

BACKGROUND: The Rapid Cognitive Screen (RCS) is a brief, easy to administer score screening tool for cognitive dysfunction which can be very useful for cognitive screening in busy clinical settings. We aimed to cross-culturally adapt and validate RCS in Turkish. METHODS: A total of 172 community-dwelling older participants from geriatric and neurology clinics, aged 60 and older were included. The translation and cultural adaptation process was carried out in five stages: (i) two initial translations from English to Turkish; (ii) combination of these two translations; (iii) backward translations; (iv) an expert committee that consisted of three geriatricians and two neurologists, one Turkish lecturer reviewed to compare backward translations with the English test; and (v) pretest. The inter-rater reliability and test-retest reliability were performed. To diagnose each type of dementia, gold standard diagnostic criteria specifically defined for each dementia were used. Performances of RCS test for dementia and mild cognitive impairment (MCI) were analyzed by using sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). The receiver operating characteristic analysis was performed to determine the area under the curve (AUC) with 95% confidence intervals (CI). RESULTS: Among participants, 37.2% were considered as cognitively normal, 25.6% with MCI and 37.2% with dementia. The sensitivity, specificity, PPV, and NPV of RCS (cut-off point of 4) for dementia were 89.06%, 92.56%, 87.7%, and 93.5%, respectively whereas the values were 77.27%, 51.56%, 52.3%, and 76.7% for MCI with a cut-off point of 8. The RCS predicted dementia (AUC = 0.972, 95% CI: 0.935-0.991) and MCI (AUC = 0.720%, 95% CI: 0.626-0.802). CONCLUSION: The cross-cultural adaptation was successfully achieved. The Turkish-RCS was found to be a reliable and valid test for screening of cognitive dysfunction.

The longitudinal associations of sarcopenia definitions with functional deterioration: a comparative study.

OBJECTIVE: Probable sarcopenia is a predictor of functional limitation in older adults. However, whether standard thresholds recommended by guides, or population-specific thresholds better predict impairment in functionality is an issue that needs to be enlightened. We aimed to study the associations of probable sarcopenia identified by the use of EWGSOP2 and population-specific thresholds with deterioration in functionality at follow-up and give prevalences of probable sarcopenia with different thresholds in older outpatients admitted to a tertiary health center. METHODS: In this retrospective, longitudinal follow-up study, we assessed handgrip strength (HGS) at the admission with a Jamar hand-dynamometer and diagnosed probable sarcopenia with standard and population-specific thresholds, i.e., 27 kg/16 kg, and 35 kg/20 kg in males/females, respectively. We evaluated activities of daily living (ADL) and instrumental ADL (IADL), with Katz and Lawton scales, at the admission and follow-up. To study whether probable sarcopenia was a predictor of impaired functionality, we defined two models for Cox regression analysis. We performed adjustments for age, sex, and nutritional status (assessed by Mini-Nutritional Assessment-Short Form) in Model 1 and defined Model 2 by adding low gait speed and frailty to the variables in Model 1. RESULTS: Among a total of 1970 patients, 195 had follow-up of median 560 days. The mean age was 75.5 ± 5.5, and 142 (72.8%) were female. In the basal evaluation, the prevalences of probable sarcopenia defined by the standard cut-offs and by population-specific cut-offs were 8.7% and 35.4%, respectively. In univariate analyses (Kaplan-Meier log-rank test), probable sarcopenia by population-specific cut-offs, but not EWGSOP2-cut-offs, was associated with deteriorations in both ADL (p = 0.04) and IADL (p < 0.001). In multivariate analyses, only the probable sarcopenia identified by population-specific cut-offs was independently associated with impairment in IADL in both models [HR (95%CI) = 1.88 (1.07-3.30), and 1.9 (1.04-3.6); for Model 1 and Model 2, respectively)]. CONCLUSION: Our findings suggested that the definition of probable sarcopenia identified by not standard, but population-specific thresholds more reliably predicted longitudinal deterioration of functionality in older outpatients. This finding might be considered as evidence supporting the use of population-specific cut-offs when the concern is sarcopenia diagnosis.

The effect of vitamin D on neurocognitive functions in older vitamin D deficient adults: a pilot longitudinal interventional study.

BACKGROUND: The relationship between vitamin D and cognitive status remains controversial. We aimed to evaluate the effect of vitamin D replacement on cognitive functions in healthy and cognitively intact vitamin D deficient older females. METHODS: This study was designed as a prospective interventional study. A total of 30 female adults aged ≥60 with a serum 25 (OH) vitamin D level of <10 ng/ml were included. Participants were administered 50 000 IU vitamin D3 weekly for 8 weeks followed by a maintenance therapy of 1000 U/day. Detailed neuropsychological assessment was performed prior to vitamin D replacement and repeated at 6 months by the same psychologist. RESULTS: Mean age was 63 ± 6.7 years and baseline vitamin D level was 7.8 ± 2.0 (range: 3.5-10.3) ng/ml. At 6 months, vitamin D level was 32.5 ± 3.4 (32.2-55) ng/ml. The Judgement of Line Orientation Test (P = 0.04), inaccurate word memorizing of the Verbal Memory Processes Test (P = 0.02), perseveration scores of the Verbal Memory Processes Test (P = 0.005), topographical accuracy of the Warrington Recognition Memory Test (P = 0.002), and the spontaneous self-correction of an error in the Boston Naming Test (P = 0.003) scores increased significantly, while the delayed recall score in the Verbal Memory Processes Test (P = 0.03), incorrect naming of words in the Boston Naming Test (P = 0.04), interference time of the Stroop Test (P = 0.05), and spontaneous corrections of the Stroop Test (P = 0.02) scores decreased significantly from baseline. CONCLUSION: Vitamin D replacement has a positive effect on cognitive domains related to visuospatial, executive, and memory processing functions.

Ishii test for screening sarcopenia: performance in community-dwelling older adults.

BACKGROUND: Sarcopenia is associated with an increased likelihood of major adverse health outcomes. Therefore, screening and early and timely identification of sarcopenia are essential. EWGSOP2 (European Working Group on Sarcopenia in Older People2) suggests Ishii screening test for formal-case findings. We aimed to define the diagnostic value of the Ishii screening test, which estimates the probability of sarcopenia using an equation-derived score based on three variables (age, grip strength, and calf circumference) in Turkish older adults. METHODS: Older adults aged > = 60 who applied to a geriatric outpatient clinic were included in the study. The recommendation of the EWGSOP2 for the definition of sarcopenia was followed. The probability of sarcopenia was estimated by using a score chart of Ishii. Performance of Ishii screening test was analyzed by using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). The receiver-operating characteristic (ROC) analysis was performed to determine the area under the curve (AUC). RESULTS: We included 1635 patients with the mean age of 74.7 ± 7.0. The prevalence of probable sarcopenia was 11.9%. The prevalence of confirmed sarcopenia according to height2 was 0.7%. The prevalence of severe sarcopenia was 0.3% in total. Against diagnoses of probable sarcopenia, confirmed sarcopenia, and severe sarcopenia, the sensitivity values of the Ishii screening test were 84%, 100%, and 100%; the specificity values were 86.1%, 83.9%, and 84.6%, respectively. PPV values were 44.9%, 4.2%, 2.1%; NPV were 97.6%, 100%, 100%, and the AUC values were 0.933, 0.961, and 0.959, respectively. CONCLUSION: Our results suggest that the Ishii screening test is a successful screening and maybe a candidate diagnostic test for sarcopenia.

Is there a relationship between ACTN3 R577X gene polymorphism and sarcopenia?

BACKGROUND AND AIMS: The alpha-actinin (ACTN) genes are important structural components of the sarcomere. Sarcopenia is a common geriatric syndrome characterized by morbidity and mortality. Our study aimed to examine the relationship between the ACTN3 R577X gene and sarcopenia in community-dwelling Turkish adults. METHODS: We designed a cross-sectional study among the patients aged ≥ 65 years admitted to the geriatric outpatient clinic. We recorded the general characteristics of the patients. We used the Jamar hand dynamometer to evaluate handgrip strength. Body composition was estimated using bioimpedance analysis. Sarcopenia was diagnosed according to the European Working Group on Sarcopenia in Older People2 criteria with population-specific cutoffs. We performed analyses of low muscle mass (LMM) with skeletal muscle mass index adjusted for body mass index [SMMI(BMI)]. We further categorized the SMMI(BMI) cutoffs into tenths. The analyzes were performed according to the 90th percentile SMMI(BMI) cutoffs. Peripheral blood samples were collected to determine the ACTN3 genotypes. RESULTS: 197 participants were included [mean age: 76.3 ± 6.1 years, 151 (76.6%) women]. The proportions of the ACTN3 genotypes were as follows: RX (45.1%) > RR (31%) > XX (23.9%). The significant difference between genotypes was found only for low SMMI(BMI) according to the 90th percentile (p = 0.025). In multivariate analysis, only gender (female) was independently associated with LMM. CONCLUSION: We did not find any association between ACTN3 R577X gene polymorphism and probable sarcopenia, confirmed sarcopenia and LMM. Besides, much more research is needed to reveal how ethnicity affects the muscles of older adults with ACTN3 R577X gene polymorphism.

Rational drug use habits of patients with chronic diseases: A cross-sectional examination focusing on the use of technological devices.

OBJECTIVE: The aim of this study was to investigate the factors affecting rational drug use habits and the use of technological devices in patients with chronic diseases. METHODS: Adults who applied to the internal medicine outpatient clinics of a university hospital between March and December 2019, who used medications for chronic disease were included in the study. Using a questionnaire, data on demographic characteristics, technology use, smoking and alcohol use, knowledge and behaviour on rational drug use were collected. RESULTS: Of the patients, 73.3% (n = 220) had smartphones, 28.0% (n = 84) tablets, 8.7% (n = 26) smartwatches, 6.0% (n = 18) were using smart bracelets, 52.3% (n = 157) knew the e-pulse application of the Ministry of Health, 53.3% (n = 160) forgot on occasions the time to take their medications, 51.7% (n = 155) threw away some drugs because the expiration date has passed, 64.0% (n = 192) had at home never-used or unfinished medications, 21.3% (n = 64) had medications to be used 'in case', 19.0% (n = 57) recommend drugs to others and 34.3% (n = 103) were getting advice from their environment on drug use. Women were 2.35 times more likely to use technology than men (95% CI: 1.19-4.64). Decreasing age was associated with an increased likelihood of using technology. Those with an income of more than twice the minimum wage compared with those with an income of minimum wage and below had 3.41 times (95% CI: 1.06-10.94) higher possibility of using technological devices, while compared with the illiterate, those with secondary education or university education had 14.96 times (95% GA: 3.67-60.93) higher possibility of using technological devices. CONCLUSION: The patients with chronic diseases demonstrate crucial deficiencies regarding rational drug use. The widespread use of technological devices may be an opportunity for preventive and remedial projects to be developed through these devices. Smartphone-based self-management tools should be developed and introduced to chronic patients.

Muscle strength cutoff values calculated from the young reference population to evaluate sarcopenia in Turkish population.

Sarcopenia is defined as a progressive and generalized skeletal muscle disorder that is associated with an increased likelihood of adverse outcomes, including mobility problems and mortality. To reach a global consensus for its standard definition and diagnosis, more recently, a revised EWGSOP consensus (EWGSOP2) has been published. In EWGSOP2 definition, sarcopenia has been regarded as skeletal muscle failure and low muscle strength has been put forward as its key defining characteristics. EWGSOP2 suggested the use of handgrip strength cutoff values calculated by mean minus 2.5 standard deviations of the young healthy population. In this report, following EWGSOP2's suggestion, we aimed to outline the handgrip strength cutoffs derived from a young Turkish reference population, and compare them with the other population-specific reports.

Sarcopenia quality-of-life questionnaire (SarQoL)®: translation, cross-cultural adaptation and validation in Turkish.

BACKGROUND: The sarcopenia quality-of-life (SarQoL)® questionnaire is a multidimensional sarcopenia specific tool designed for community dwelling older adults. AIMS: The aim of this study was to translate, to cross-culturally adapt and validate the SarQoL® questionnaire to assess sarcopenia-related quality of life in Turkish older adults. METHODS: The validation process was performed in two sections: the first section constituted the translation with cross-cultural adaptation of SarQoL® into Turkish. Second section constituted the clinical validation study. To validate the Turkish version of the SarQoL®, we assessed its validity (discriminative power, construct validity), reliability (internal consistency, test-retest reliability) and floor/ceiling effects. RESULTS: One hundred community-dwelling subjects (mean age: 74.7 ± 6.1 years) were evaluated. The EWGSOP2 consensus diagnostic criteria were used to diagnose probable sarcopenia. A database including 1437 older adults, with complete evaluation of sarcopenia parameters, served to define low global muscle function. Results revealed a good discriminative power: subjects with probable sarcopenia had higher total scores compared to non-sarcopenic subjects (50 ± 16 vs. 68.9 ± 16.9, p < 0.001) a high internal consistency (Cronbach's alpha: 0.88), consistent construct validity and excellent test-retest reliability (intraclass correlation coefficient: 0.97, 95% confidence interval: 0.94-0.98). There was no floor/ceiling effect. CONCLUSION: The Turkish version of the SaQoL® questionnaire was found to be reliable and valid for the measurement of quality of life of sarcopenic patients and is, therefore, available for use in clinical research and practice. This validation could enable use of the SarQoL® tool in the eastern populations more confidently.

Fat percentage cutoff values to define obesity and prevalence of sarcopenic obesity in community-dwelling older adults in Turkey.

PURPOSE: Sarcopenic-obesity (SO) is associated with low-functional-status and mortality. Few studies evaluated the definition and prevalence of SO. We aimed to investigate the fat-percentage cut-off values for obesity and prevalences of obesity, SO in community-dwelling older adults in Turkey. METHODS: Body-composition was measured using bioimpedance-analysis. Sarcopenia was defined by European-Working-Group-on-Sarcopenia-in-Older-People criteria. Obesity was defined by two different methods, a fat-percentile above 60th percentile (Zoico-method) or a BMI of ≥30 kg/m2 (WHO-definition). RESULTS: We enrolled 992 subjects (308 men, 684 women). Body fat-percentage thresholds for obesity were 27.3% for men and 40.7% for women according to Zoico-method. The rates of obesity were about 40% in both genders by Zoico-method; 29.2% versus 53.7% for men and women by WHO definition. Prevalences-of-sarcopenia was 3.1% versus 0.4%; SO was 0.3% versus 0.1% when obesity was assessed with Zoico-method in men and women, respectively. No case of SO was defined when obesity was assessed using WHO-definition. CONCLUSION: The threshold for obesity definition according to Zoico-method was similar to other European-populations. While obesity-prevalences were considerably high, SO prevalences were low but comparable to other populations. This low-prevalence seems to be due to underestimation of sarcopenia in obese subjects when skeletal-muscle-mass was adjusted by height2 to recognize low-muscle-mass.

Explicit versus implicit evaluation to detect inappropriate medication use in geriatric outpatients.

Aim: The rates and reasons why clinicians decide not to follow recommendations from explicit-criteria have been studied scarce. We aimed to compare STOPP version 2 representing one of the most commonly used excplicit tool with the implicit comprehensive geriatric assessment mediated clinical evaluation considered as gold standard.Methods: Two hundred and six (n = 206) outpatients ≥65 years old were included. The study was designed as retrospective, cross-sectional, and randomised. STOPP version 2 criteria were systematically used to assess pre-admission treatments followed by implicit clinical evaluation regarding two questions: Were the STOPP criteria recommendations valid for the individual patient and were there any potentially inappropriate-prescription other than depicted by STOPP version 2 criteria? The underlying reason(s) and associated clinical-features were noted.Results: About 62.6% potentially inappropriate-prescriptions were identified (0.6 per-subject) according to systematic application of STOPP v2 while it was 53.4% (0.5 potentially inappropriate-prescriptions per subject) by clinician's application of STOPP v2. Prevalence of non-compliance was 14.7% in 18 (21.7%) of 83 patients identified by systematic application. Suggestion to stop a drug was not accepted because of need of treatment despite likelihood of anticipated side-effects in about 2/3 and with no-anticipated side-effects in about 1/3 of non-compliances. Not following STOPP v2 was significantly associated with lower functional level. According to clinician's implicit-evaluation, there were an extra 59.2% potentially inappropriate-prescriptions (0.6 per subject) in 80 (38.8%) patients yielding a total of 112.6% potentially inappropriate-prescription.Conclusions: Most of the STOPP v2 directed drug cessations are decided valid by the clinicians. In patients with higher functional dependency, it is likely that they are not followed due to palliation focussed care/patient-family preferences. There may be as much as STOPP v2 identified potentially inappropriate-prescriptions by implicit evaluation in a significant percent of geriatric patients signifying need for comprehensive geriatric evaluation in practice.

A new screening tool for self-neglect in community-dwelling older adults: IMSelf-neglect questionnaire.

OBJECTIVE: We aimed to develop a new screening tool for self-neglect in community-dwelling self-sufficient older adults. METHODS: Istanbul Medical School Elder Self-Neglect questionnaire (IMSelf-neglect) was developed as a screening tool. Community-dwelling, self-sufficient older adults were recruited in a geriatric outpatient clinic (n = 226, 142 female, 84 male). Construct validity was based on social-worker's interview as a gold-standard method. The cut-off threshold for IMSelf-neglect questionnaire was calculated from ROC-analysis using cut-off values that predicted social-worker's opinion whether the older adult has self-neglect. RESULTS: Mean age was 74 ± 6.5 years. The inter-rater and test-retest reliability were excellent (r = 0.887, p < .05; r = 0.942, p < .05, respectively). The internal consistency was good (Cronbach's alpha: 0.708). Cut-off threshold for IM Self-neglect questionnaire was calculated as 7 with 92.1% sensitivity and 70.7% specificity. Positive predictive value and negative predictive value of IMSelf-neglect questionnaire were 38.9% and 97.8%, respectively. There was significant moderate agreement between social worker's assessment and results of IMSelf-neglect questionnaire (κ = 0.407, p < .001). The social worker confirmed 16.8% of the participants have self-neglect by the gold-standard clinical interview. Participants with self-neglect had decreased functionality, worse quality of life and tended to have more depression compared with participants without self-neglect. DISCUSSION/CONCLUSION: We developed the IMSelf-neglect questionnaire as a valid and reliable tool to screen self-neglect in outpatient clinics complementary to comprehensive geriatric assessment.

Prevalence of sarcopenia and its components in community-dwelling outpatient older adults and their relation with functionality.

AIM: Sarcopenia is recognized with its adverse functional outcomes. We aimed to report the prevalence of European Working Group on Sarcopenia in Older People (EWGSOP) defined sarcopenia and its individual components in community dwelling outpatient older adults and study the correlations of EWGSOP defined sarcopenia, muscle mass, muscle strength, and physical performance with functional status. MATERIAL AND METHODS: The subjects were prospectively recruited from the geriatrics outpatient clinics of our university hospital. Body composition was assessed with bioimpedance analysis. Muscle strength was assessed by measurement of hand grip strength with hydraulic hand dynamometer, physical performance was assessed by 4 meter usual gait speed (UGS). Impaired muscle function was defined as presence of low muscle strength and or slow gait speed. As a measure of functionality, modified version of Katz activities of daily living (ADL) and Lawton instrumental activities of daily living (IADL) were assessed. RESULTS: A total of 242 community dwelling outpatients with mean age of 79.4 ± 5.7 years were enrolled. 31.8% were male. Prevalence of low muscle mass was 2.1% and impaired muscle function was 71.1%. Prevalence of EWGSOP defined sarcopenia was 0.8% (1.3% in men and 0.6% in women). Most correlated parameter with ADL and IADL was the usual gait speed (r = 0.49, r = 0.63; p < .001, respectively). Grip strength was also correlated with ADL and IADL (r = 0.28, r = 0.35; p < .001). However, the skeletal muscle mass index (SMMI) was not correlated with ADL, IADL (p = .22, p = .22, respectively). In regression analysis, both ADL score and IADL scores were most related to UGS (beta = 0.5 and 0.6, p < .001), age (beta = -0.25 and -0.2, p < .001) and then sarcopenia (beta = 0.1 and 0.1, p < .05) but was not related to hand grip strength or SMMI. CONCLUSIONS: The prevalence of sarcopenia was low as 0.8% albeit the presence of impaired muscle function in more than 2/3 of the cases. We have found that EWGSOP defined sarcopenia had association with ADL and IADL. The gait speed component of sarcopenia had the strongest associations with functional measures but SMMI component did not have any relation. We suggest that although low muscle mass may be a parameter related to worse functionality, it should not be regarded prerequisite for presence of sarcopenia analogous to low bone mineral density for osteoporosis.

Cut-off points for height, weight and body mass index adjusted bioimpedance analysis measurements of muscle mass with use of different threshold definitions.

AIM: Low muscle mass (LMM) is a prerequisite to define sarcopenia. We aimed to report muscle-mass reference cut-off points adjusted for height and weight as muscle-mass threshold best discriminating muscle-weakness and adjusted for body mass index (BMI) significantly lower than that of healthy young population. MATERIAL AND METHOD: We included young adults between 18 and 39 years and community dwelling older adults 60-99 years of age. Bioimpedance analysis (BIA) was used to assess skeletal muscle mass. Skeletal muscle mass index (SMMI) adjusted for height, weight, BMI were calculated [SMMI (height), SMMI (weight), SMMI (BMI)]. Handgrip strength was evaluated with Jamar hydraulic dynamometer for muscle-strength. SMMI (height) and SMMI (weight) cut-offs that predict low muscle-strength were calculated with receiver operator characteristic (ROC) analysis. Low muscle-strength was evaluated by three different thresholds, i.e. 32 kg/22 kg, 30 kg/20 kg, 26 kg/16 kg in males/females. SMMI (BMI) cut-offs were calculated as "mean young SMMI (BMI)-two standard deviation." RESULTS: The young and older reference groups included 301 and 992 individuals, respectively. LMM cut-points for SMMI (height) were (i) 10.8 vs. 8.9 kg/m2 for 32/22 kg; 10.8 vs. 9.4 kg/m2 for 30/20 kg and 11.1 vs. 8.9 kg/m2 for the 26/16 kg thresholds, in males and females, respectively. LMM cut-points for the SMMI (weight) were 40.6% and 33.2% for the all three studied muscle-strength thresholds for males and females, respectively. For all the analyses sensitivity, specificity and likelihood ratios were not sufficiently high in both genders. The SMMI (BMI) cut-points were 1.049 vs. 0.823 kg/BMI for males and females, respectively. CONCLUSIONS: We presented the very first cut-off thresholds for muscle-mass adjusted by height and weight that best discriminate muscle-weakness in the older adults and by BMI that is significantly lower than that of healthy young population. This study suggests that correlation between total skeletal muscle mass measured by BIA (either adjusted for height or weight) and muscle strength is low.

The relationship between common geriatric syndromes and potentially inappropriate medication use among older adults.

BACKGROUND/AIM: Polypharmacy and inappropriate medication use in older adults is a major public health problem associated with morbidity and mortality. Aging is associated with metabolic changes and decreased drug clearance, increased drug-drug interactions, prescribing cascades, and potentially inappropriate medication (PIM) use. The purpose of this study was to evaluate the association between a common geriatric syndromes and PIM use among older adults. METHODS: Study participants were recruited among patients admitted to Istanbul Medical School Geriatrics outpatient clinic between June 2000 and June 2014 and were evaluated retrospectively by a geriatrician using the patients' records according to Beers 2012 criteria. RESULTS: Among the 667 enrolled patients, 421 (63.1%) were women and 246 (36.9%) were men. The use of PIM was not associated with age or sex. Polypharmacy (OR 4.86, 95% CI 3.25-7.27, p < 0.001), malnutrition (OR 2.69, 95% CI 1.52-4.76, p = 0.001), depression (OR 2.61, 95% CI 1.7-3.95, p < 0.001), presence of fall in the previous year (OR 2.24, 95% CI 1.51-3.32, p < 0.001), and dementia (OR 1.69, 95% CI 1.08-2.65, p = 0.021) were independently associated with the use of PIM. DISCUSSION/CONCLUSIONS: The results of our study suggest that PIM use is independently associated with presence of polypharmacy, malnutrition, depression, falls and dementia in older outpatients. Identifying the association of inappropriate medication use with common geriatric syndromes in older people can help to prevent, delay, and reduce PIM use and related adverse health outcomes.

Cut-off points for weight and body mass index adjusted bioimpedance analysis measurements of muscle mass.

AIM: Low skeletal muscle mass (LMM) is a criterion to define both sarcopenia and malnutrition. Muscle mass varies with gender, height, weight or fat mass, and many indices of adjusted-muscle mass have been proposed. We aimed to find reference cut-off points of the skeletal muscle mass index (SMMI) adjusted for weight and body mass index (BMI) in Turkish population. MATERIALS AND METHODS: Adults between 18 and 39 years of age and community-dwelling older adults of 60-99 years of age were included. Body composition was assessed with bioimpedance analysis (BIA). SMMI adjusted for weight and BMI were calculated [SMMI (weight) and SMMI (BMI)]. Muscle strength was assessed by hand-grip-strength with hand dynamometer. SMMI (weight) cut points were calculated from the healthy young adults' data as "mean SMMI-2 standard deviation (SD)". SMMI (BMI) cut points that predict low muscle strength were calculated with ROC analysis. To define low muscle strength, we used three currently suggested low muscle-strength thresholds, i.e., 32 kg/22 kg, 30 kg/20 kg, 26 kg/16 kg in males/females, respectively. RESULTS: 301 healthy young adults (187 male, 114 female) and 992 older people (308 male, 684 female) were included. LMM cut points for SMMI (weight) were 37.4% and 33.6% for males and females, respectively. SMMI (BMI) cut points that best predict the low grip-strength for 32 kg/22 kg; 30 kg/20 kg; 26 kg/16 kg thresholds were1.017 kg/BMI and 0.677 kg/BMI; 1.014 kg/BMI and 0.710 kg/BMI; 1.036 kg/BMI and 0.770 kg/BMI for males and females, respectively. CONCLUSIONS: Muscle-mass adjustment methods and techniques show diversity among the studies and have impact on the LMM cut-off points. This study presents population specific LMM thresholds for skeletal muscle mass adjusted for weight and BMI aiming to increase and improve the general applicability of the leading sarcopenia consensus definitions.

Low glomerular filtration rate as an associated risk factor for sarcopenic muscle strength: is creatinine or cystatin C-based estimation more relevant?

INTRODUCTION: We aimed to evaluate the association of a decreased glomerular-filtration-rate (GFR <60 ml/min/1.73 m2), estimated using Modification of Diet in Renal Disease (MDRD), creatinine- and cystatin C-based (CKDEPI-CR and CKDEPI-CC) Chronic Kidney Disease Epidemiology Collaboration equations with handgrip strength (HGS). METHODS: Community-dwelling males aged ≥60 years admitted to outpatient clinic were included. We used MDRD, CKDEPI-CR, and CKDEPI-CC formulas for GFR estimation and corrected these for body surface area. Muscle strength was assessed by HGS. RESULTS: 209 men (mean age 67.8 ± 6.4) were enrolled. Sixty-two patients (29.7%) had sarcopenic HGS. Subjects with sarcopenic HGS were older, had higher rate of a GFR < 60 ml/min/1.73 m2, had lower mid-upper arm circumference; tended to have lower creatine kinase, albumin, CKDEPI-CC-GFR levels; and higher BUN/creatinine ratio and cystatin C. Multivariate logistic regression analysis revealed a CKDEPI-CC lower than 60 ml/min/1.73 m2 as the only independent factor underlying sarcopenic HGS. Higher age tended to have an independent association. Only higher age was independently associated with low HGS when other estimations were used (p = 0.013 and p = 0.021 when MDRD and CKDEPI-CR were used, respectively). CONCLUSIONS: There is a strong association of a GFR level of <60 ml/min/1.73 m2 with sarcopenic HGS, when CKDEPI-CC formula is used.

Low skeletal muscle mass index is associated with function and nutritional status in residents in a Turkish nursing home.

INTRODUCTION: To determine the prevalence of low muscle mass (LMM) and the relationship between LMM with functional and nutritional status as defined using the LMM evaluation method of European Working Group on Sarcopenia in Older People (EWGSOP) criteria among male residents in a nursing home. METHODS: Male residents aged >60 years of a nursing home located in Turkey were included in our study. Their body mass index (BMI) kg/m2, skeletal muscle mass (SMM-kg) and skeletal muscle mass index (SMMI-kg/m2) were calculated. The participants were regarded as having low SMMI if they had SMMI <9.2 kg/m2 according to our population specific cut-off point. Functional status was evaluated with Katz activities of daily living (ADL) and Lawton Instrumental Activities of Daily Living (IADL). Nutritional assessment was performed using the Mini Nutritional Assessment (MNA). The number of drugs taken and chronic diseases were recorded. RESULTS: One hundred fifty-seven male residents were enrolled into the study. Their mean age was 73.1 ± 6.7 years with mean ADL score of 8.9 ± 2.0 and IADL score of 8.7 ± 4.6. One hundred twelve (71%) residents were aged >70 years. Thirty-five men (23%) had low SMMI in group aged >60 years, and twenty-eight subjects (25%) in the group aged >70 years. MNA scores were significantly lower in residents with low SMMI compared with having normal SMMI (17.1 ± 3.4 versus 19.6 ± 2.5, p = 0.005). BMI was significantly lower in the residents with low SMMI compared with normal SMMI (19.6 ± 2.7 versus 27.1 ± 4.1, p< 0.001). ADL scores were significantly different between residents with low SMMI and normal SMMI in those aged >70 years (8.1 ± 2.6 versus 9.1 ± 1.6, p = 0.014). In regression analyses, the only factor associated with better functional status was the lower age (p = 0.04) while the only factor associated with better nutrition was higher SMMI (p = 0.01). CONCLUSIONS: Low SMMI detected by LMM evaluation method of EWGSOP criteria is prevalent among male nursing home residents. There is association of low SMMI with nutritional status and probably with functional status within the nursing home setting using the EWGSOP criteria with Turkish normative reference cut-off value.

Body mass index and functional status in community dwelling older Turkish males.

Disability is utmost important on an aging population's health. Obesity is associated with increased risk for disability. On-the-other-hand, higher-BMI is reported as associated with better functionality in older people in some reports defined as "obesity paradox". There is some evidence on differential relationship between body weight status and functionality by living setting gender, and different populations. We studied the relation between body mass index and functionality in Turkish community dwelling older males accounting for the most confounding factors: age, multimorbidity, polypharmacy and nutritional status. This is a cross-sectional study in a geriatric outpatient clinic of a university hospital. Functionality was assessed with evaluation of activities of daily living (ADL) and instrumental activities of daily living (IADL) scales. Nutrition was assessed by mini-nutritional assessment test. Two hundred seventy-four subjects comprised our study cohort. Mean age was 74.4 ± 7.1 years, BMI was 25.8 ± 4.4 kg/m(2). Linear regression analysis revealed significant and independent association of lower BMI with higher ADL and IADL scores (B = 0.047 and B = 0.128, respectively) (p < 0.05) and better nutritional status (B = 1.94 and B = 3.05, respectively) (p < 0.001) but not with the total number of medications. Higher IADL score was associated with younger age and lower total number of diseases (B = 0.121, B = 0.595, respectively) (p < 0.05) while ADL was not. We suggest that lower BMI is associated with better functional status in Turkish community-dwelling male older people. Our study recommends longitudinal studies with higher participants from different populations, genders and living settings are needed to comment more.