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.

Frailty and its associates in community-dwelling older adults.

OBJECTIVE: While the literature contains several studies on the frailty assessed during hospitalization and/or outpatient settings and nursing homes, few studies have assessed frailty in community-dwelling older adults. We investigated the prevalence of frailty and associated factors among older adults in a sample of community-dwelling older adults. METHODS: We included community-dwelling older adults >60 years living in the Fatih District of the Istanbul Province. We conducted the study between November 2014 and May 2015. We collected the data such as age, sex, number of diseases and drugs, functional status, frailty, the presence of geriatric syndromes, common diseases, and quality-of-life assessment. Frailty was evaluated by the FRAIL scale. RESULTS: A total of 204 adults (mean age: 75.4±7.3 years) were included, of whom 30.4% were robust, 42.6% were pre-frail, and 27% were frail. In multivariate analyses, associated factors of frailty were the number of drugs [odds ratio (OR)=1.240, p=0.036], the presence of cognitive impairment (OR=0.300, p=0.016), and falls (OR=1.984, p=0.048). CONCLUSION: The present study established the prevalence of frailty in a large district in the largest metropolis in the country through a valid screening method. Our results suggest that clinicians should consider frailty evaluation in patients with multiple drug usage, cognitive impairment, and falls.

Associations of EWGSOP1 and EWGSOP2 probable sarcopenia definitions with mortality: A comparative study.

BACKGROUND & AIMS: Sarcopenia is a well-defined geriatric syndrome and a major cause of disability and mortality. We investigate the associations of alternative sarcopenia definitions with mortality in community-dwelling older adults. METHODS: Sarcopenia was defined based on the EWGSOP1 and EWGSOP2 probable sarcopenia criteria, with standard handgrip strength (HGS) cut-offs of 30/20 kg for an EWGSOP1 definition and 27/16 kg for an EWGSOP2 definition, or alternatively, population-specific cut-offs of 35/20 kg for a EWGSOP2 definition. The 5-year mortality rate was assessed in the accessible cases. RESULTS: The prevalence of sarcopenia among 204 older adults [53.9% female; aged 74.5 ± 7.0] was 4.9% based on the EWGSOP1 criterion, 23.5% according to the EWGSOP2-suggested standard (British) HGS cut-offs and 50.0% based on the EWGSOP2 population-specific cut-offs. In the 103 accessible patients, the mortality rate was 30.1%. Cox-regression analyses adjusted for parameters determined through univariate analyses [age and sarcopenia definitions (in 3 different models)], showed that the EWGSOP1 definition (HR = 4.26, 95% CI = 1.45-12.42, p = 0.008) and EWGSOP2 probable sarcopenia definition with population-specific cut-offs (HR = 2.58, 95% CI = 1.12-5.93, p = 0.03) were associated with a greater mortality risk, while the EWGSOP2 probable sarcopenia definition with standard-cut offs was not (p = 0.09). CONCLUSIONS: This is the first study to investigate the associations of EWGSOP2-defined probable sarcopenia with mortality based on standard vs. population-specific HGS cut-offs. The results suggest that population-specific cut-offs should be used when available. We suggest that conducted in community-dwelling older adults, our results have implications for most of older adults.

Clinical validation of SARC-F by proxy as a practical tool to evaluate sarcopenia in dependent older adults.

INTRODUCTION: Sarcopenia is a prevalent disorder in older adults with significant adverse outcomes and regular screening is recommended for those at risk. The SARC-F questionnaire is the most commonly recommended screening tool for sarcopenia. However, as a self-reported tool, it cannot be applied to dependent individuals with communication problems. We hypothesized that implementation of the proxy-reported SARC-F (SARC-F by proxy) would be non-inferior in screening sarcopenia when compared with the standard SARC-F. Thus, we aimed to investigate the clinical validity of the SARC-F by proxy in identifying sarcopenia in older adults and to compare its performance with the standard SARC-F. Additionally, we aimed to determine the ideal cut-off of SARC-F by proxy in screening sarcopenia. MATERIALS AND METHODS: This is a validation study including older adults aged ≥60 years without communication problems and their close proxies. The participants were recruited from a geriatric outpatient clinic of a tertiary health center and a nursing home. Standard SARC-F was transformed to SARC-F by proxy and administered to the proxies of older adults, and standard SARC-F was administered to the patients simultaneously in different rooms. We defined sarcopenia as probable and confirmed by the EWGSOP2 consensus report. We performed receiver operating characteristics (ROC) and sensitivity/specificity analyses of SARC-F by proxy for diagnosing sarcopenia and compared its performance with standard SARC-F by the DeLong test. RESULTS: We included 172 older adults (median age: 72; 44.8% female) and 107 proxies in close contact (median age: 55, 63.2% female). The prevalence of probable and confirmed sarcopenia was 18.9% and 12.9%, respectively. For both definitions, area under the curve (AUC) values of SARC-F by proxy and standard SARC-F were moderate and similar [probable sarcopenia: 0.619 and 0.624 (p = 0.9); confirmed sarcopenia 0.613 and 0.645 (p = 0.7), respectively]. The best balance between sensitivity and specificity was achieved with a SARC-F by proxy score of ≥2 for both sarcopenia definitions (sensitivity levels were 74.7% and 77.8%, and specificity levels were 50.0% and 49.6%, for probable and confirmed sarcopenia, respectively). DISCUSSION: SARC-F by proxy showed a similar, non-inferior performance compared to the standard SARC-F in the evaluation of sarcopenia. Our results suggest that it can be used instead of standard SARC-F to screen sarcopenia in older patients with communication problems. Further validation studies in different populations are warranted to support our findings.

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.

Prevalence and Determinants of Falls in Community-dwelling Older Adults in Türkiye: A Population-based Cross-sectional Study Conducted between 2014-2015.

PURPOSE: Falls are a common public health problem in older adults regarding increased morbidity, mortality, and healthcare costs. Determining the factors associated with falls is of utmost importance for detecting at risk people. We present here a field study conducted to examine the prevalence of falls and the associated factors among community-dwelling older adults. METHODS: In this population-based cross-sectional study, we included adults aged > 60 years living in the Fatih District of the Istanbul Province between November 2014-May 2015, through a simple random sampling method. We noted age, sex, falls, fear of falling, number of diseases and medications, the presence of diabetes, hypertension, dyslipidemia, urinary and fecal incontinence, and chronic pain. Frailty was assessed with the FRAIL questionnaire. Functional capacity was evaluated by Katz's 6-item ADL and Lawton Brody's 8-item IADL scales. The European quality-5 dimension (EQ-5D) questionnaire was used for the quality of life assessment. The cognitive status screening was conducted with a Mini-cog test. Depressive mood was evaluated with the Geriatric Depression scale short form (GDS-SF). Malnutrition screening was conducted by the mini-nutritional assessment short form. Handgrip strength (HGS) was measured with a hand dynamometer. Body composition was assessed through a bioimpedance analysis. The 4-meter usual gait speed was recorded. The European Working Group on Sarcopenia in Older People2 (EWSGOP2) criteria was used for the sarcopenia definition. The Romberg and the postural instability tests were evaluated for balance and gait. Continuous variables were expressed as mean ± standard deviation or median and interquartile range for descriptive statistics, while categorical variables were expressed as the number and percentages. The differences between groups were determined through an independent sample t-test or Mann-Whitney U test when required, and Chi-square and Fisher's exact tests were applied for categorical variables. A multivariate logistic regression analysis was used to determine the independent factors associated with falls among the factors identified as significant in univariate analyses. RESULTS: The prevalence of falls was 28.5% [mean age: 75.4 ± 7.3 (range: 61-101 years), 53.6% female], and a significant association was identified between falls and the number of diseases and medications, diabetes, chronic pain, frailty, ADL, IADL, and EQ-5D scores, dementia, GDS-SF score and level of ambulation in univariate analyses (p = 0.001, 0.030, 0.030, 0.010, 0.004, 0.040, 0.007, 0.003, 0.030 and 0.007, respectively). In the multivariate analysis, positive dementia (OR = 3.66, 95% CI = 1.40-9.53; p = 0.010) and frailty screenings (OR =1.47, 95% CI = 1.05-2.06; p = 0.020) were identified as associates of falls. CONCLUSION: Falls were independently associated with positive dementia and frailty screening. These results will help develop specific and tailored precautions for at-risk groups to prevent the negative outcomes of falls.

Frailty and its associates in community-dwelling older adults

SUMMARY OBJECTIVE: While the literature contains several studies on the frailty assessed during hospitalization and/or outpatient settings and nursing homes, few studies have assessed frailty in community-dwelling older adults. We investigated the prevalence of frailty and associated factors among older adults in a sample of community-dwelling older adults. METHODS: We included community-dwelling older adults >60 years living in the Fatih District of the Istanbul Province. We conducted the study between November 2014 and May 2015. We collected the data such as age, sex, number of diseases and drugs, functional status, frailty, the presence of geriatric syndromes, common diseases, and quality-of-life assessment. Frailty was evaluated by the FRAIL scale. RESULTS: A total of 204 adults (mean age: 75.4±7.3 years) were included, of whom 30.4% were robust, 42.6% were pre-frail, and 27% were frail. In multivariate analyses, associated factors of frailty were the number of drugs [odds ratio (OR)=1.240, p=0.036], the presence of cognitive impairment (OR=0.300, p=0.016), and falls (OR=1.984, p=0.048). CONCLUSION: The present study established the prevalence of frailty in a large district in the largest metropolis in the country through a valid screening method. Our results suggest that clinicians should consider frailty evaluation in patients with multiple drug usage, cognitive impairment, and falls.

Sarcopenic obesity versus sarcopenia alone with the use of probable sarcopenia definition for sarcopenia: Associations with frailty and physical performance.

BACKGROUND & AIMS: Ageing brings alterations in body composition, as skeletal muscle gradually declines and accumulation of adipose tissue accompanies it. Although sarcopenia (S) and obesity (O) were separately reported to be associated with frailty and poor physical performance, whether they bring more detrimental or favorable effect when they coexist (i.e. sarcopenic obesity; SO) is an issue needs clarification. We aimed to study the associations of SO and S alone with frailty and poor physical performance, by using probable S definition. METHODS: This was a retrospective, cross-sectional study including community dwelling older adults who were ≥60 years old and admitted to the outpatient clinic of a tertiary hospital between 2012 and 2020. We measured handgrip strength via hand dynamometer and defined decreased muscle strength as probable S. We performed bioimpedance analysis to evaluate body composition and used fat percentile method to define obesity. We assessed nutritional status via Mini-Nutritional Assessment-Short Form, frailty via FRAIL scale, and physical performance via Timed Up and Go (TUG) test. We examined the associations of four body phenotypes, i.e. non-S non-O, SO, S alone and O alone with frailty and impaired TUG in univariate and multivariate analyses (Model 1). We further performed a head to head analysis of SO vs S to see if one of them was associated more with frailty and impaired TUG (Model 2). RESULTS: There were 1366 older adults included in the study (mean age: 74.6 ± 6.9; 68.3% female). The prevalences of non-S non-O, S alone, SO and O alone were 53.5, 7.5, 2.8 and 36.2%, respectively. Multivariate analysis adjusted for age, gender and nutritional status revealed that both SO and S alone were independently associated with frailty and impaired TUG, with SO demonstrating lower odds than S alone (OR = 5.9 and 6.05 for frailty, and 3.9 and 4.4 for TUG, respectively). Head-to-head comparison between SO and S alone in Model 2 showed that two groups did not demonstrate significant difference in terms of the frailty and impaired TUG risk. CONCLUSION: Although SO and S groups demonstrated similar risks, obesity accompanying sarcopenia might show a favorable trend in terms of frailty and poor physical performance, compared to sarcopenia alone. Longitudinal studies are needed to reveal whether an obesity paradox exists for frailty and physical performance in older adults.

Probable sarcopenia: associations with common geriatric syndromes and comorbidities in Turkish geriatric patients from a university hospital.

PURPOSE: EWGSOP2 defines "probable sarcopenia" as the presence of low muscle strength without non-muscle causes. The associations of probable sarcopenia have been studied in few reports to date, and our intention in this study is to identify associations of probable sarcopenia with common geriatric syndromes in a sample of older adults who attended the geriatric outpatient clinic of Istanbul University Hospital. METHODS: The present study was designed as a retrospective cross-sectional study. We performed a comprehensive geriatric assessment to the participants. Univariate analyses were performed to determine relationship of probable sarcopenia with age, sex, common geriatric syndromes, i.e., frailty, falls, polypharmacy, malnutrition, and comorbidities, i.e., diabetes mellitus, hypertension, chronic kidney disease, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), depression, osteoporosis, and the variables found to be significant were included in logistic regression analyses. The results are presented as an odds ratio (OR), with a 95% confidence interval (CI). RESULTS: Included in the study were 456 participants with a mean age of 74.6 ± 6.6 years, of which 71.1% were female. Probable sarcopenia was identified in 12.7% (n = 58) of the sample. A multivariate analysis was carried out, the factors associated with probable sarcopenia were identified as male sex (OR 0.269, 95% CI 0.142-0.510), frailty (OR 4.265, 95% CI 2.200-8.267) and chronic kidney disease (OR 3.084, 95% CI 1.105-8.608). CONCLUSION: Probable sarcopenia was more significantly associated with frailty than with other geriatric syndromes, signifying its importance as a marker for frailty. The study further identified chronic renal failure as a factor significantly associated with probable sarcopenia among the variety of studied diseases that frequently accompany aging.

Hypotension Under Antihypertensive Treatment and Incident Hospitalizations of Nursing Home Residents.

BACKGROUND AND OBJECTIVE: Hypertension is the most prevalent chronic disease in older adults. Antihypertensive drug use increases with aging. In some studies, hypotension developing under antihypertensive medication use has been indicated as a potential risk factor for morbidity and mortality in older adults. Our objective was to assess the relationship between hypotension under antihypertensive treatment and incident hospitalization of nursing home residents. METHODS: We detailed blood pressure measurements of the previous 1-year period that were noted regularly at 2-week intervals and studied their mean values. The systolic blood pressure (SBP) and diastolic blood pressure (DBP) thresholds to define low SBP (≤ 110 mm Hg) and DBP (≤ 65 mm Hg) were derived from our previous study. We noted demographics, number of co-morbidities and regular medications, mobility status, and nutritional assessment via the Mini Nutritional Assessment Short Form. RESULTS: We included 253 participants (66% male, mean age 75.7 ± 8.7 years). The prevalence of low SBP (≤ 110 mmHg) and low DBP (≤ 65 mmHg) was 34.8% and 15.8%, respectively. Among residents, 4% were bedridden, 15.8% wheelchair bound, 14.5% needing assistance for reduced mobility, and 62.7% were ambulatory. At a median of 15 months of follow-up, hospitalization incidence from any cause was 50.8% (n = 134). Incident hospitalization was more common in the group that had low DBP (odds ratio = 3.06; 95% confidence interval 1.02-9.15; p = 0.04) after adjusting for age, number of comorbidities and medications, mobility status, and nutritional status. Low SBP was not associated with hospitalization. CONCLUSIONS: The low DBP (≤ 65 mm Hg) during the previous year was associated with incident hospitalization of nursing home residents after adjustment for several factors. These findings indicate that lower DBP may be a causative factor for incident hospitalization. We need further studies to explore whether a correction of diastolic hypotension may decrease the hospitalization risk in this vulnerable population.

Associations between polypharmacy and physical performance measures in older adults.

OBJECTIVES: A preserved ambulation is one of the keypoints for functionality and polypharmacy, a common problem in older adults, is associated with worse functional status. Our aim was to examine the associations of polypharmacy with certain physical performance measures used to evaluate ambulation. METHODS: This retrospective, cross-sectional study was conducted in a geriatric outpatient clinic. Using ≥5 medications was accepted as polypharmacy. Usual gait speed (UGS), chair sit-to-stand test (CSST), timed up and go test (TUG) and short physical performance battery (SPPB) were performed to assess physical performance status. We created two models for logistic regression analyses: Model 1 was adjusted for age, sex and body mass index (BMI). We added comorbidities to Model 1 and further created Model 2. RESULTS: There were 392 participants (69.1% were female, mean age: 73.9±6.2 years). Polypharmacy was seen in 62.5%. Participants with polypharmacy presented with a poor physical performance compared to the no-polypharmacy group (p<0.001, for each). In multivariate analyses, polypharmacy was independently associated with poor SPPB (Odds Ratio (OR)=2.5; 95% Confidence Interval (CI)=1.3-4.7 and OR=2.4; 95% CI=1.2-4.8 for Model 1 and 2, respectively) and long CSST (OR= 2.6; 95% CI=1.3-5.2 and OR=3.7; 95% CI=1.7-8.2 for Model 1 and 2, respectively). There was a significant association between polypharmacy and slow UGS in Model 1 (OR=1.9; 95% CI=1.0-3.5); but relationship did not persist after adding comorbidities into the first model (OR=1.6; 95% CI= 0.8-3.1). There was no significant association between long TUG and polypharmacy in any of the models. CONCLUSION: Polypharmacy is well-known with its association with falls and fractures in older adults and this might be explained by its association with poor physical performance. Whether polypharmacy causes a deterioration in physical performance is an issue needs to be enlightened by further longitudinal studies.

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.

Associations of sarcopenic obesity versus sarcopenia alone with functionality.

BACKGROUND & AIMS: There have been several attempts to come up with a global operational definition of sarcopenia (S), and consequently, a definition of S has been established, to some extent. That said, the definition of sarcopenic obesity (SO), which is defined as the presence of obesity + sarcopenia, remains obscure, hindering evaluations of the prevalence and relevance of SO. It has yet to be elucidated whether SO is associated with worse functionality when compared to S alone (S without obesity). In the present study, we compare SO and S alone in terms of their associations with functional measures through the application of alternative definitions of SO. As a secondary output, we document the prevalence of SO based on alternative definitions. METHODS: This retrospective cross-sectional study included community-dwelling adults over 60 years of age who presented as outpatients to a university hospital between 2012 and 2020. All were evaluated for body composition (bioimpedance analysis), handgrip strength (Jamar hand dynamometer) and functional health status [activities of daily living (ADL), instrumental activities of daily living (IADL)]. The fat percentile method was used to define the obesity component of SO. Low muscle mass (LMM) was defined using two different adjustment methods of skeletal muscle mass (LMM adjusted by height2 or LMM adjusted by BMI). S was defined based on the EWGSOP2 definition, as probable S (low muscle strength) or confirmed S (low muscle strength + LMM). Accordingly, three alternative definitions of SO were applied based on three alternative definitions of S, i.e., "obesity + sarcopenia (probable)", "obesity + sarcopenia (confirmed, LMM adjusted by height2)" and "obesity + sarcopenia (confirmed, LMM adjusted by BMI)". The associations of SO and S alone with functional measures were examined with univariate analyses and adjusted multivariate analyses. RESULTS: Included in the study were 1468 older adults (median age 75; 68.8% female). The prevalence of SO was very low (0.2%) based on the SO definition "obesity + sarcopenia (confirmed, LMM adjusted by height2), but it was present at a considerable and comparable rate based on SO definition "obesity + sarcopenia (probable)" and SO definition "obesity + sarcopenia (confirmed, LMM adjusted by BMI)" (4.1%, 4.0%; respectively). As SO by "obesity + sarcopenia (confirmed, LMM adjusted by height2)" had an ignorable prevalence, this definition of SO was excluded from further analyses. Multivariate analyses revealed that, when compared to the Non-S Non-Obese group, S alone definitions had odds ratio (OR) of 5.4 and 3.4 while SO definitions had an OR of 3.2 and 2.7 for impaired ADL, and an OR of 7.9 and 6.4, while SO definitions had an OR of 3.0 and 2.7 for impaired IADL. SO was thus found to be associated with a lower prevalence of impaired functional measures than that of S alone. CONCLUSIONS: Our results suggest that the SO definition confirmed, LMM adjusted by height2 has an ignorable prevalence in populations in which underweight or malnutrition is uncommon. Among sarcopenic older individuals, obesity may have a protective effect against the limitations of some functional measures, providing evidence of the possible protective effect of obesity in sarcopenic individuals.

Hypotension in Nursing Home Residents on Antihypertensive Treatment: Is it Associated with Mortality?

OBJECTIVE: To assess whether low systolic blood pressure (SBP) or diastolic blood pressure (DBP) due to antihypertensive medications might be related to mortality among nursing home (NH) residents. DESIGN: Observational, longitudinal. SETTING: Nursing home. PARTICIPANTS: Age ≥60 years, receiving antihypertensive medications. MEASUREMENTS: Demographic characteristics, mobility status, number of chronic diseases and drugs, nutritional status, and antihypertensive medications were noted. At the first visit, we recorded blood pressure (BP) measurements of last 1 year, which were measured regularly at 2-week intervals and considered their mean values. SBP and DBP thresholds were analyzed for mortality by ROC analysis. Multivariate Cox regression analyses were performed to determine factors related to mortality. RESULTS: The sample included 253 residents with a mean age of 75.7 ± 8.7 years, and 66% were male. Residents were evaluated at a mean follow-up time of 14.3 ± 5.2 months (median: 15) for short-term mortality and 31.6 ± 14.3 months (median: 40) for long-term mortality. The prevalence of low SBP (≤110 mm Hg) and low DBP (≤65 mm Hg) was 34.8% and 15.8%, respectively. In follow-up, the short-term mortality rate was 21.7% (n = 55) and the long-term mortality rate was 42.2% (n = 107). Low SBP (≤110 mm Hg) was related to mortality in short- and long-term follow-ups [short-term follow-up: hazard ratio (HR) 3.7, 95% confidence interval (CI) 1.5-8.6, P = .01; long-term follow-up: HR 1.8, 95% CI 1.1-3.0, P = .02], adjusted for age, mobility status, nutritional state, and total number of diseases and drugs. Low DBP (≤65 mm Hg) was related to mortality in short- and long-term follow-ups [short-term follow-up: HR 3.0, 95% CI 1.2-7.8, P = .02, long-term follow-up: HR 2.8, 95% CI 1.5-5.2, P = .001], adjusted for age, mobility status, nutritional state, and total number of diseases and drugs. CONCLUSIONS AND IMPLICATIONS: Systolic hypotension was found in more than one-third of the NH residents receiving antihypertensive treatment. Low SBP and DBP were significant factors associated with mortality. Particular attention should be paid to prevent low SBP and DBP in NH residents on antihypertensive treatment.

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.

Comparison of standard versus population-specific handgrip strength cut-off points in the detection of probable sarcopenia after launch of EWGSOP2.

OBJECTIVE: We aimed to compare European Working Group on Sarcopenia in Older People (EWGSOP2)-suggested and population-specific handgrip strength (HGS) thresholds to detect probable sarcopenia and their associations with physical-performance measures and frailty. METHODS: A retrospective cross-sectional observational-study included geriatrics outpatients applied to a university-hospital. HGS, timed up and go test (TUG), and usual gait speed (UGS) were assessed. Frailty was screened by FRAIL-scale. RESULTS: A total of 1825 older adults were included (mean age, 74.5 + 7.0 years; 68.8% female). Prevalence of low-HGS were 12.2% by the EWGSOP2-recommended (27/16 kg) cut-offs and 37.5% by population-specific cut-offs (35/20 kg) (p<.001). When low-HGS was defined by EWGSOP2 suggested cut-offs, low-HGS was associated with impaired UGS, (odds ratio [OR] = 3.8, 95% confidence interval [CI]: 2.0-6.9, p<.001); impaired TUG, (OR = 4.6, 95% CI: 2.4-8.8, p<.001); and frailty (OR = 20.9, 95% CI: 8.3-53.0, p<.001). Similarly, low HGS determined by population-specific cut-off points was associated with impaired UGS (OR = 3.1, 95% CI: 2.1-6.9, p<.001); impaired TUG (OR = 6.0, 95% CI: 3.0-11.8, p<.001); and frailty (OR = 7.3, 95% CI: 4.1-13.0, p<.001). CONCLUSIONS: Application of EWGSOP2-recommended standard HGS-cut-offs showed successful application in-practice. However, use of standard HGS cut-offs may result in underdiagnosis of probable sarcopenia. Therefore, we suggest that, whenever available, use of population-specific cut-offs for HGS may be better for correctly identifying older adults at risk.

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.

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.

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.