Hypomagnesemia may be related to frailty, gait and balance problems, and basic activities of daily living in older adults.

OBJECTIVES: The study aims to investigate the relationship between hypomagnesemia, preclinical hypomagnesemia, and normomagnesemia as along with geriatric syndrome and comprehensive geriatric parameters(CGA). METHODS: 217 patients who applied to the geriatric clinic between November 2022 and December 2023 were included in the study. All patients underwent CGA. Patients were categorized into three groups: Magnesium (Mg) level ≤ 1.5 mg/dL, Mg level 1.5-1.8 mg/dL, and Mg level > 1.8 mg/dL. These three groups were compared in terms of demographic characteristics, comorbidities, CGA parameters, and geriatric syndromes. Regression analyses was conducted for significant parameters, adjusting for confounders. RESULTS: 74.9% of all participants were female, with an average age of 76.5 ± 6.6 years. The frequency of hypomagnesemia was 14.2%. Demographic characteristics and medication use, including proton pump inhibitors and diuretics, were similar in these three groups. While the FRIED frailty scale and the duration of the timed-up-and-go test were higher in the hypomagnesemia group, the Basic Activities Daily of Living (ADLs) and the Tinetti-POMA(performance-oriented mobility assessment) scores were lower in the hypomagnesemia group. When normomagnesemia was accepted as the reference category, FRIED frailty scale, Basic ADLs, and POMA score were more significant in the hypomagnesemia group (p = 0.025, p = 0.013 and p = 0.011,respectively), but there was no significance in the preclinical hypomagnesemia group regardless of the covariates. CONCLUSION: Hypomagnesemia, particularly serum Mg levels below 1.5 mg/dL, may be associated with frailty, basic ADLs, gait, and balance tests. In geriatric practice, patients with hypomagnesemia should be evaluated in terms of the risk of the mentioned disorders.

The effect of the anticholinergic burden on mortality following elective cardiac surgery.

OBJECTIVE: The cumulative effect of drugs with anticholinergic properties may pose a significant risk in the post-discharge period of patients who have undergone elective cardiac surgery. The aim of this study was to investigate the association between anticholinergic burden and 6-month postdischarge mortality in older cardiac surgery patients. METHODS: This study performed a retrospective longitudinal analysis of patients undergoing elective cardiac surgery at a tertiary care centre from January 2021 to January 2022. The Deyo-Charlson comorbidity index (D-CCI) was used to estimate the burden of comorbidities. The anticholinergic burden was assessed using the Anticholinergic Cognitive Burden scale (ACB) and Drug Burden Index (DBI) scale. All-cause postdischarge mortality was determined from electronic medical records. RESULTS: A total of 255 older adults who had undergone elective cardiac surgery and had been followed up for at least 6 months were included in this study. Approximately 12.5% (n = 32) of older patients died within 6 months of discharge. In multivariate Cox regression analysis, ACB (HR:1.31, 95%CI:1.10-1.56 p = 0.01) and DBI (HR:2.08, 95%CI:1.27-3.39 p = 0.01) showed significantly increased risk of 6-month postdischarge mortality after adjusting for several possible confounders (age, gender, D-CCl, and American Society of Anaesthesiologists (ASA) score). Overall event-free survival differed significantly between patients undergoing cardiac surgery based on anticholinergic burden according to the group-stratified ACB and DBI scales (χ2: 5.907, log-rank test, p = 0.015 and χ2: 15.389, log-rank test, p < 0.001 respectively). CONCLUSION: The anticholinergic burden is associated with 6-month all-cause post-discharge mortality in older cardiac surgery patients. A deprescribing approach should be considered, especially for older adults in the perioperative period. TRIAL REGISTRATION: The trial was retrospectively registered at ClinicalTrials.gov. Identifier: NCT05312684 Registered on 5 April 2022.

A new hematologic predictor of major adverse events after cardiac surgery: red cell distribution width to lymphocyte ratio.

BACKGROUND: The perioperative risk factors that cause severe morbidity and prolongation of postoperative hospital stay after cardiac surgery should be determined. Various scores have been used to predict morbidity and mortality. Preoperative blood counts are considered potential biomarkers of inflammation and oxidative stress. Inflammatory and immune imbalances may have a significant impact on postoperative adverse events. The present study aimed to investigate the association and potential predictive properties of red cell distribution width/ lymphocyte ratio (RLR) for major adverse events in adult patients who underwent coronary surgery with cardiopulmonary bypass. METHODS: After approval from the ethics committee, pre- and post-operative data of 700 patients were obtained from the electronic database of the hospital, intra- and post-operative anesthesia, and intensive care unit follow-up charts. We performed a stepwise multiple logistic regression analysis to investigate the association of RLR with major adverse events in adult patients who underwent coronary surgery with cardiopulmonary bypass. RESULTS: Among 700 patients, 47 (6.7%) had major adverse events after surgery. Multivariate logistic regression analysis showed that age (odds ratio [OR], 1.08; 95% confidence interval [CI], 1.03-1.12; P < 0.001), mean platelet volume (OR, 1.49; 95% CI, 1.07-2.06; P = 0.017), and RLR (OR, 1.21; 95% CI, 1.02-1.43; P = 0.026) were significantly associated with major adverse events. CONCLUSIONS: RLR indicates the balance between inflammatory and immune responses. Therefore, it can be used to predict adverse events following coronary surgery.

Is eGFR ≥60 mL/min/1.73 m2 in Patients Undergoing Coronary Angiography Really Safe for Contrast Nephropathy?

The aim of the present study was to define the risk factors associated with contrast-induced acute kidney injury (CI-AKI) in patients who underwent coronary artery angiography (CAG). In this retrospective cohort study, patients who underwent CAG between March 2014 and January 2022 were evaluated. A total of 2923 eligible patients were included in the study. Univariate and multivariate logistic regression analysis was used to identify the predictive factors. CI-AKI developed in 77 (2.6%) of 2923 patients. In multivariate analysis, diabetes mellitus (DM), chronic kidney disease (CKD), and estimated glomerular filtration rate (eGFR) were found to be independent factors associated with CI-AKI. In the subgroup analysis of patients with eGFR ≥60 mL/min/1.73 m2, eGFR remained a predictor of CI-AKI (Odds ratio (OR): .89, 95% CI: .84-.93; that is, a lower eGFR remains a risk factor for CI-AKI). In the receiving operating characteristic (ROC) analysis of patients with eGFR ≥60 mL/min/1.73 m2, the area under the curve of the eGFR was .826. Using the ROC curve based on Youden's index, the eGFR cut-off was found to be 70 mL/min/1.73 m2 for patients with eGFR ≥60 mL/min/1.73 m2. eGFR is also an important risk factor in patients with eGFR 60-70 mL/min/1.73 m2.

Association of drug burden index with delirium in community-dwelling older adults with dementia: a longitudinal observational study.

BACKGROUND: The Drug Burden Index (DBI) is a validated tool for assessing the dose-dependent cumulative exposure to sedative and anticholinergic medications. However, the increased risk of delirium superimposed dementia (DSD) with high DBI levels has not yet been investigated. AIM: This study aimed to examine the potential association between DBI scores and delirium in community-dwelling older adults with dementia. METHOD: A total of 1105 participants with cognitive impairment underwent a comprehensive geriatric assessment. Experienced geriatricians made the final diagnosis of delirium based on DSM-IV-TR and DSM-V. We calculated the DBI as the sum of all sedatives and anticholinergics taken continuously for at least four weeks before admission. Polypharmacy was defined as regular use of five or more medications. We classified the participants as having no exposure (DBI = 0), low exposure (0 < DBI < 1), and high exposure (DBI ≥ 1). RESULTS: Of the 721 patients with dementia, the mean age was 78.3 ± 6.7 years, and the majority were female (64.4%). In the whole sample, low and high exposures to anticholinergic and sedative medications at admission were 34.1% (n = 246) and 38.1% (n = 275), respectively. Patients in the high-exposure group had higher physical impairment (p = 0.01), higher polypharmacy (p = 0.01), and higher DBI scores (p = 0.01). In the multivariate Cox regression analysis, high exposure to anticholinergic and sedative medications increased the risk of delirium 4.09-fold compared to the no exposure group (HR = 4.09, CI: 1.63-10.27, p = 0.01). CONCLUSION: High exposure to drugs with sedative and anticholinergic properties was common in community-dwelling older adults. A high DBI was associated with DSD, highlighting the need for an optimal prescription in this vulnerable population. TRIAL REGISTRATION: The trial was retrospectively registered at ClinicalTrials.gov. Identifier: NCT04973709 Registered on 22 July 2021.

Preoperative red cell distribution width to lymphocyte ratio as biomarkers for prolonged intensive care unit stay among older patients undergoing cardiac surgery: a retrospective longitudinal study.

Introduction: Our aim was to use the red cell distribution width-lymphocyte ratio (RLR) as a novel biomarker to predict prolonged intensive care unit (ICU) length of stay (LOS) among older patients undergoing cardiovascular surgery. Methods: This longitudinal study included older patients admitted to a tertiary cardiovascular surgery hospital between January 2017 and January 2022. Results: A total of 574 patients were studied, including 83 patients (14.5%) who had prolonged ICU LOS and 471 (85.5%) control subjects. After adjustment for the European System for Cardiac Operative Risk Evaluation 2, the RLR score showed a 10% increased risk of prolonged ICU LOS (odds ratio: 1.10; CI: 1.05-1.16; p = 0.01). Conclusion: Preoperative RLR can be used to predict the risk of long-term intensive care stay in older cardiac surgery patients.

Risk factors predicting hospital length of stay in older patients with type 2 diabetes with Covid-19.

Background: Patients with Covid-19 disease could present with flu-like symptoms. However, nearly half of the subjects with positive test results for Covid-19 remain asymptomatic. Data on factors related to the duration of hospital stay in Covid-19 patients with diabetes mellitus remain limited. Objective: We aimed to identify risk factors predicting prolonged hospital length of stay (LOS) among diabetic patients hospitalized with Covid-19. Methods: This cohort study involved patients with type 2 diabetes (T2D) admitted to a tertiary hospital with mild or moderate Covid-19 between August 1 and November 31, 2020. Data on demographics, laboratory parameters, and clinical treatments were extracted from the medical records. Prolonged LOS was defined as equal to or greater than the median hospitable stay time. We used univariate and multivariate logistic regression analyses to explore risk factors associated with LOS. Results: We included 87 hospitalized T2D patients with mild or moderate Covid-19. The mean age was 69.5 ± 6.9 years, and 59.8% were female. In the unadjusted analysis, factors influencing the length of hospitalization were as follows: undertreatment of diabetes, high procalcitonin level, glycated hemoglobin, and low lymphocyte count. After adjustment for all covariates, subjects with a low lymphocyte had a 3.9 fold increased risk of prolonged LOS (OR:3.925 CI:1.044-14.755 p = 0.043). Conclusions: A lower lymphocyte count on admission was associated with prolonged hospital LOS in older T2D patients with Covid-19, suggesting this marker could help clinicians predict complications for an adverse outcome.

Could neutrophil-to-lymphocyte ratio predict mortality in community-dwelling older people with delirium superimposed on dementia?

BACKGROUND: Delirium superimposed on dementia (DSD) is associated with adverse outcomes in older adults. Nonetheless, little is known about the association between inflammatory markers and clinical outcomes of DSD. AIMS: This research investigated the predictive value of the neutrophil-to-lymphocyte ratio (NLR) for short- and long-term mortality among community-dwelling older adults with DSD. METHODS: This retrospective cohort study included 9755 older outpatients who were referred to a tertiary hospital between January 2010 and June 2021. All patients underwent a comprehensive geriatric assessment and routine laboratory tests. Delirium and dementia was diagnosed with the DSM-4 or DSM-5 criteria. We recorded information on mortality during 1 year following the delirium episode. RESULTS: Among 615 patients with dementia, 170 (26.3%) had delirium. Patients with delirium were predominantly older, with higher Deyo-Charlson comorbidity index scores, lower general cognitive performance, lower functional capability, and higher anticholinergic burden compared to those without delirium. At the 1-year follow-up, the mortality rate of DSD was 29.3%. Multivariate analysis showed that NLR at admission was an independent predictor of 1-month mortality (HR = 1.03; 95% CI 1.00-1.05; p = 0.04) and 1-year mortality (HR = 1.02; 95% CI 1.01-1.05; p = 0.01) of DSD patients. DISCUSSION: NLR can predict prognosis in various diseases including cardiovascular disease, malignancies, and cerebrovascular disease, but as yet there is no similar prognostic measure in delirium. Moreover, recent previous studies demonstrated NLR is a potential marker for the prediction of delirium in older adults with different clinical settings. In the current study, we demonstrated that NLR is also a prognostic marker for DSD. CONCLUSIONS: NLR could be useful marker for predicting short- and long-term mortality in patients with DSD. However, further studies are needed to validate these findings.

Association of anticholinergic burden with undernutrition in older adults: A cross-sectional study.

BACKGROUND: Limited data are available concerning the contribution of drugs with anticholinergic properties (DAPs) to undernutrition among older adults. This study aimed to determine the potential association of anticholinergic burden (ACB) to nutrition status in older people. METHODS: We prospectively enrolled participants aged over 65 who underwent a comprehensive geriatric assessment between January 2017 and June 2020. Nutrition status was assessed by the Mini Nutritional Assessment-Short Form (MNA-SF). The ACB was assessed using the ACB scale. RESULTS: A total of 615 participants were included in the analysis (mean age ± SD, 78.5 ± 6.6 years; male, 55.3%). The prevalence of undernutrition (MNA-SF score <12) was 22.6% (n = 139). Participants with undernutrition were predominantly older (P < 0.001), had lower mean body mass index scores (undernutrition, 27.3 ± 5.4 vs healthy, 29.5 ± 8.0; P = 0.007), had a lower educational level (P = 0.016), had higher cardiovascular disease morbidity (P < 0.001), and had a higher ACB (P < 0.001) when compared with those with normal nutrition status. In adjusted analysis, the odds of having undernutrition were higher among participants with an ACB score >1 (odds ratio, 1.20; 95% CI, 1.01-1.43; P = 0.044). The weighted multivariate linear regression analysis showed a significant inverse association between the total ACB score and MNA-SF score controlling for multiple confounders. CONCLUSION: ACB appears to be inversely correlated with nutrition status among older adults. Undernutrition may be considered an additional reason to consider deprescribing DAPs in this population.

Gait Speed is independently associated with Depression Symptoms in Mild Cognitive Impairment.

Depression symptoms are known to influence gait speed in cognitively healthy adults. In this study, we aimed to examine the relationship between gait speed and depression symptoms in older patients with mild cognitive impairment. The participants were classified as slow and normal gait speed based on the Fried criteria. A total of 152 subjects with mild cognitive impairment were included. Of these, 39.5% (n=60) had slow gait speed. Compared to normal speed group (n=92), patients with slow speed had more clinically significant depression (geriatric depression scale score ≥ 6) (p=0.004), cardiovascular disease (p=0.007), recent falls (p<0.001), and anticholinergic burden (p=0.005). Multivariable logistic regression analysis yielded statistically significant associations between slow gait speed and depression in age and gender adjusted [OR:3.30 (1.46-7.46), p=0.004] and fully adjusted [OR: 2.80 (1.10-7.08), p=0.030] models. This study showed an independent association between slow gait speed and depression symptoms in older people with mild cognitive impairment.

Psychological Burden among Community-dwelling Older Adults with and without a History of a Recent Covid-19 Infection.

OBJECTIVES: The outbreak of Covid-19's psychological burden to recovered vs. non-infected older individuals has not been compared yet. We aimed to perform a comparative analysis of psychological symptoms in community-dwelling older adults with and without a history of a Covid-19 infection. METHODS: In this study, we utilized a geriatric care unit's outpatient registry to prospectively enroll older adults with and without a history of Covid-19. An interviewer administered generalized anxiety disorder-2 (GAD-2), patient health questionnaire-2 (PHQ-2), six-item cognitive impairment (6-CIT), and post-traumatic stress disorder-5 (PTSD-5) tests over the phone. Correlation and multivariate logistic regression analyses were used to examine associations. RESULTS: The study included 120 older subjects, 46 (38.3%) reported past Covid-19 infection. Anxiety and depression were both significantly more prevalent among subjects without a history of Covid-19. Having no history of Covid-19, female gender, and psychoactive medication use showed independent associations with the risk of depression symptoms among all subjects, and female gender was additionally associated with anxiety symptoms. CONCLUSIONS: This study showed that the risk of depression symptoms was higher in a sample of older adults who were not infected with Covid-19 compared to those recovering from the disease. CLINICAL IMPLICATIONS: The impact of "fear of transmission" on the mental health of the elderly may be a significant issue to deal with. Older women are more prone to mental health risks by Covid-19.

Relationship between blood pressure index and cognition in older adults.

OBJECTIVE: We aimed to examine the contributions of blood pressure index (BPI) and other measurements to cognitive function in older adults. METHOD: Four hundred sixty-six subjects aged over 65 who applied to the outpatient Geriatric Clinics of Gulhane Training and Research Hospital were enrolled in the study. Demographics and clinical conditions were collected from their files. Pulse pressure index (PP) (SBP - DBP), mean arterial pressure index (MAP) [(SBP + DBP x 2)/3] and BPI (SBP/DBP) were recorded. We used the Mini-mental state examination (MMSE) test for evaluating global cognition. We classified participants into two groups based on MMSE score: normal with a score of 27 or more and lower cognitive function with a 26 or lower cognitive function. RESULTS: 31% of subjects (n = 143) had lower and 69% (n = 323) had normal cognitive function. When compared blood pressure measurements between groups, BPI and PP were higher in the subjects with lower cognitive function [BPI: 1.78 ± 0.25 vs. 1.71 ± 0.23, p = .007 and PP: 58.97 ± 17.59 vs. 54.05 ± 15.38, p = .009]. After adjustment for confounders, a 2.545 fold increased risk of cognitive decline was observed among subjects with higher BPI when compared to those with normal (OR: 2.545, 95%CI: 1.024-6.325, p = .044). CONCLUSION: The findings suggest that BPI is an associated with cognition in older adults and may a novel alternative marker for identifying the subjects at the risk of dementia.

May C-peptide index be a new marker to predict proteinuria in anemic patients with type 2 diabetes mellitus?

OBJECTIVE: C-peptide is a reliable marker of beta cell reserve and is associated with diabetic complications. Furthermore, HbA1c level is associated with micro- and macro-vascular complications in diabetic patients. HbA1c measurement of diabetic patients with anemia may be misleading because HbA1c is calculated in percent by taking reference to hemoglobin measurements. We hypothesized that there may be a relationship between C-peptide index (CPI) and proteinuria in anemic patients with type 2 diabetes mellitus (T2DM). Therefore, the aim of the present study was to investigate the association between C-peptide levels and CPI in anemic patients with T2DM and proteinuria. METHODS: The patients over 18 years of age with T2DM whose C-peptide levels were analyzed in Endocrinology and Internal medicine clinics between 2014 and 2018 with normal kidney functions (GFR>60 ml/min) and who do not use any insulin secretagogue oral antidiabetic agent (i.e. sulfonylurea) were enrolled into the study. RESULTS: Hemoglobin levels were present in 342 patients with T2DM. Among these 342 cases, 258 (75.4%) were non-anemic whereas 84 (24.6%) were anemic. The median DM duration of the anemic group was statistically significantly higher in T2DM (p=0.003). There was no statistically significant difference found in proteinuria prevalence between non-anemic and anemic patient groups (p=0.690 and p=0.748, respectively). Anemic T2DM cases were corrected according to the age, gender, and duration of DM. C-peptide and CPI levels were not statistically significant to predict proteinuria (p=0.449 and p=0.465, respectively). CONCLUSION: The present study sheds light to the association between C-peptide, CPI, and anemic diabetic nephropathy in T2DM patients and indicates that further prospective studies are needed to clarify this issue.

May Monocyte/HDL Cholesterol Ratio (MHR) and Neutrophil/Lymphocyte Ratio (NLR) Be an Indicator of Inflammation and Oxidative Stress in Patients with Keratoconus?

OBJECTIVE: To evaluate monocyte/high-density lipoprotein cholesterol ratio (MHR) and neutrophil/lymphocyte ratio (NLR) in patients with keratoconus (KC). METHODS: Thirty-one patients with KC (group 1) and 31 healthy control subjects (group 2) were included in the study. All participants' ocular examination findings, clinical and laboratory parameters were obtained from file records and laboratory archives. RESULTS: When group 1 was compared with group 2, MHR (13.7 ± 5.0 vs. 9.1 ± 3.7; p < .001) and NLR (2.3 ± 0.8 vs. 1.7 ± 0.6; p < .001) were statistically significantly higher in group 1. Optimal MHR cutoff value for KC was calculated as 10.2 with 77.4% sensitivity and 64.5% specificity, and optimal NLR cut-off value for KC was found as 1.9 with 71.4% sensitivity and 55% specificity. CONCLUSION: MHR and NLR values recognized as indicators of oxidative stress and systemic inflammation were significantly higher in patients with KC compared to the control group.