The association between fear of falling and orthostatic hypotension in older adults.

The aim of this study was to determine the relationship between the fear of falling/the degree of fear of falling (FoF) and orthostatic hypotension (OH) in older adults. This cross-sectional study was conducted with 314 older outpatients. If the total score of the Falls Efficacy Scale-International scale was 16-19, 20-27 and ≥ 28, it was assumed that there was low FoF, moderate FoF and high FoF, respectively. OH was evaluated for the 1st (OH1) and 3rd (OH3) minutes, after transitioning from the supine position to standing. Participants were aged 65-93 years (mean age 74.2 ± 8.5 years) and 193 (61.5%) were female. Among the FoF groups, significant differences were found for age, gender, education, marital status, who the patient lived with, the history of falling and hypertension, Timed Up-Go test score and hemoglobin levels (p < 0.005). The prevalence of OH1 and OH3 was found to be significantly higher in those with an FoF score of 20 and above than those below 20 (p < 0.005). After adjustment for potential confounders, participants who reported a high FoF had higher risk for OH1 and OH3 (OR 2.14, 95% CI 1.14-4.0, p = 0.017; and OR 2.72, 95% CI 1.46-5.09, p = 0.002, respectively), but those with moderate FoF had no increased risk of having OH compared to low FoF (p > 0.05). There is a close relationship between high FoF and OH in older adults. Therefore, when evaluating an older patient with OH, FoF should be evaluated, or FoF should also be questioned in older patients with OH.

Inflammation, Frailty and Cardiovascular Disease.

Chronic inflammation, which is called "inflamm-aging" , is characterized by an increased level of inflammatory cytokines in response to physiological and environmental stressors, and causes the immune system to function consistently at a low level, even though it is not effective. Possible causes of inflammaging include genetic susceptibility, visceral obesity, changes in gut microbiota and permeability, chronic infections and cellular senescence. Inflammation has a role in the development of many age-related diseases, such as frailty. Low grade chronic inflammation can also increase the risk of atherosclerosis and insulin resistance which are the leading mechanisms in the development of cardiovascular diseases (CVD). As it is well known that the risk of CVD is higher in older people with frailty and the risk of frailty is higher in patients with CVD, there may be relationship between inflammation and the development of CVD and frailty. Therefore, this important issue will be discussed in this chapter.

Nutritional profiles of older adults according the Mini-Nutritional Assessment.

BACKGROUND: Malnutrition among older adults plays an important role in clinical and functional impairment. AIMS: The aim of our study was to evaluate all parameters of Mini-Nutritional Assessment (MNA), according to the nutritional status and to define the risk factors that may cause at risk of malnutrition and malnutrition in more detail. METHODS: One thousand outpatients aged 65 years or older who underwent the Comprehensive Geriatric Assessment (CGA) were included the study. RESULTS: A total of 1000 patients (men vs women; 27.1% vs 72.9%), of whom the mean age was 74.30 ± 8.28, were enrolled. We found that 6.6% of patients were malnourished, 31.6% of patients were at risk of malnutrition and 61.8% of patients were well-nourished. The mean MNA score was 23.71 ± 4.19. In patients with malnourished subgroup, the parameters that cause the most loss of points were self-perception of health (87.9%), protein intake (86.4%) and taking at least 3 medications per day (77.3%). At the risk of malnutrition subgroup, protein intake (86.7%), self-perception of health (74.7%) and taking at least 3 medications per day (65.2%) were the three parameters that cause the most loss of points. DISCUSSION: In the at-risk and malnourished subgroups, perception of health status, protein intake and taking at least three medications per day were the same MNA parameters that cause the most loss of points, but the rates were different. CONCLUSIONS: A nutritional intervention should be done as soon as possible in patients who are at risk of malnutrition.

Effectiveness of the haemonetics MCS cell separator in the collection of apheresis platelets.

Platelet (PLT) transfusions play an important role in patients with thrombocytopenia or severely impaired platelet function. Platelet concentrates are prepared from whole-blood donations or by plateletpheresis. In recent years, different instruments have been developed to perform plateletpheresis. We evaluated an apheresis instrument, the Haemonetics MCS(®) + with regard to PLT yield, collection efficiency (CE), and collection rate (CR) in a retrospective, randomized study in 526 donors. In this system, we used leukoreduction filters post collection to obtain leukoreduced products. The Haemonetics MCS(®) + cell separator efficiently collected apheresis platelets with median PLT yields of 3.7 × 10(11), mean CE of 66.69 ± 13.73% and mean CR of 0.063 ± 0.013 × 10(11)/min. The median blood volume processed was 3290 (2420-4370) ml, and the median volume of acid citrate dextrose-A (ACD-A) used in collections on the device was 385 (196-517) ml. Also, this device allowed the collection of white blood cell (WBC) reduced plateletpheresis with mean 0.07 ± 0.15 × 10(6) WBC content. No serious donor or recipient reactions occurred.

Validity of the Mini-Nutritional Assessment Scale for Evaluating Frailty Status in Older Adults.

OBJECTIVES: Comprehensive Geriatric Assessment (CGA) may not be performed in clinical practice as it takes too much time and requires special training. The Mini-Nutritional Assessment (MNA) is widely used to assess nutritional status in older adults. We aimed to determine whether or not the MNA can estimate frailty status defined by the Fried criteria. SETTING AND PARTICIPANTS: Six hundred two outpatients aged 65 years or older who underwent the CGA were included the study. MEASURES: Frailty status was defined by 5 dimensions including shrinking, exhaustion, low levels of activity, weakness, and slowness: 0 for robust, 1-2 for prefrail, and 3-5 for frail. MNA was performed in all participants even if their MNA-Short Form scores were ≥12. RESULTS: Of the 602 outpatients, of whom the mean age was 74.2 ± 8.2 years, 190 participants (31.6%) were considered frail and 218 (36.2%) prefrail. Internal consistency of the MNA had a Cronbach-alpha of 0.701. Interclass correlation coefficient for the test-retest reliability was found as 0.697. MNA with a cut-off point of 22.5 had a sensitivity of 72.1% and a specificity of 91.2% to detect frail participants. MNA with a cut-off point of 25.5 had a sensitivity of 66.9% and a specificity of 85.4% to detect prefrailty. For the estimation of frailty and prefrailty, the area under the receiver operating characteristics curve of MNA was 0.903 and 0.834, respectively. CONCLUSIONS: MNA can be a useful tool for frailty screening indicating that 2 common geriatric syndromes, malnutrition and frailty, can be identified by MNA simultaneously in clinical practice.

Vitamin B12 and folate deficiencies are not associated with nutritional or weight status in older adults.

It is not known whether undernutrition causes vitamin B12 and folate deficiencies. The present study aimed to determine whether nutritional status, measured using the Mini Nutritional Assessment (MNA) scale, and body mass index (BMI) are indicators of lower level serum vitamin B12 and folate in older adults. 1007 outpatients aged 65 years or over were included the study. MNA scores >23.5, 17-23.5, <17, were categorized as normal nutritional status, risk of malnutrition, and malnutrition, respectively. Weight status was assessed using BMI and categorized as under or normal weight (<25 kg/m2), overweight (25-30 kg/m2), class I obese (30.0-35 kg/m2), class II obese (35-40 kg/m2), and class III obese (≥40 kg/m2). Vitamin B12 and folate deficiencies were defined as <200 pg/ml and <3 ng/ml, respectively. Among 1007 patients with an average age of 74.3 ±â€¯8.2 years, 6.9% were categorized as having malnutrition and 31.2% were categorized as at risk of malnutrition. While 45.7% of patients were categorized as having vitamin B12 deficiency and 0.9% folate deficiency. There were no differences between patients with malnutrition, at risk of malnutrition, and good nutrition in serum vitamin B12 or folate levels, or the presence of vitamin B12 or folate deficiency after adjustment for age, gender, and education (p > 0.05). The results were the same across BMI classifications (p > 0.05). Vitamin B12 and folate levels are not associated with nutritional or weight status and these should be evaluated independently of BMI and MNA values.

Mini Nutritional Assessment Scale-Short Form can be useful for frailty screening in older adults.

AIM: Mini Nutritional Assessment-Short Form (MNA-SF) is used to assess nutritional status in older adults, but it is not known whether it can be used to define frailty. This study was aimed to investigate whether or not MNA-SF can identify frailty status as defined by Fried's criteria. METHODS: A total of 1,003 outpatients (aged 65 years or older) were included in the study. All patients underwent comprehensive geriatric assessment. Frailty status was evaluated by Fried's criteria: unintentional weight loss, exhaustion, low levels of activity, weakness, and slowness. One point is assigned for each criterion, and frailty status is identified based on the number of points scored: 0 points, not frail; 1-2 points, pre-frail; ≥3 points, frail. A total score of MNA-SF <8, 8-11, and >11 indicates malnutrition, risk of malnutrition, and no malnutrition, respectively. RESULTS: Of the 1,003 outpatients (mean age 74.2±8.5 years), 313 participants (31.2%) were considered frail and 382 (38.1%) pre-frail. Among frail and pre-frail patients, 49.2% and 25.1% were at risk of malnutrition and 22.0% and 1.6% were malnourished, respectively. MNA-SF with a cut-off point of 11.0 had a sensitivity of 71.2% and a specificity of 92.8% for the detection of frail participants, and with a cut-off point of 13 had a sensitivity of 45.7% and a specificity of 78.3% for the detection of pre-frailty. The area under the curve for MNA-SF was estimated to be 0.906 and 0.687 for frailty and pre-frailty, respectively. CONCLUSION: MNA-SF can be useful for frailty screening in older adults.

Nocturia and its clinical implications in older women.

The aim of this study is to demonstrate the relationship between nocturia and geriatric syndromes, and comprehensive geriatric assessment parameters (CGA) in older women. 858 older outpatient women were included in this cross-sectional study. For the nocturia variable, the question, "Generally, during the past 30 days, how many times did you usually urinate after you have gone to sleep at night until the time you got up in the morning?'' was used. The relationships between nocturia status and common geriatric syndromes, and CGA parameters were determined. The mean age of patients was 74.1 ±â€¯8.0 years. The prevalence of patients who reported average of 0, ≥1, ≥2, ≥3, and ≥4 nocturnal episodes was 14.7%, 85.3%, 66.3%, 42.13%, and 24.1%, respectively. When all the covariates including age, education, Charlson Comorbidities Index score, glomerular filtration rate, antimuscarinic drugs and alpha-blockers use, diabetes mellitus, chronic obstructive pulmonary disease, and incontinence were adjusted, there were higher rates of insomnia, recurrent falls and higher scores of Timed Up-Go test in older women with ≥2 nocturia episodes (p < 0.05). There was a significant correlation between ≥3 nocturia episodes and lower Instrumental Activities of Daily Living scores and a significant correlation between ≥4 nocturnal episodes and frailty and polypharmacy (p < 0.05). Nocturia is quite common and associated with insomnia, frailty, polypharmacy, incontinence, falls, lower gait speed, and functionality in older women.Therefore, nocturia is very important for geriatric practice and ≥2 nocturia episodes can be a marker of poor health status in older women.

Comparison of Plateletpheresis on the Haemonetics and Trima Accel Cell Separators.

The use of apheresis equipment to collect platelets has rapidly increased in recent years. We compared two apheresis instruments (Haemonetics MCS + and Trima Accel) with regard to platelet (PLT) yield and efficiency, and collection rate (CR) in a retrospective study. Overall 120 data obtained by Haemonetics and Trima systems (N = 60 for each) were randomly selected among 400 plateletpheresis procedures performed at the Apheresis Unit of Kayseri Education and Research Hospital between July 2016 and January 2017. The CR was significantly higher with the Haemonetics compared to the Trima (0.076 ± 0.016 vs. 0.065 ± 0.015 (PLT × 1011 /min) respectively; P < 0.001). The PLT yield/unit was higher with the Haemonetics (4.4 ± 0.8 vs. 3.9 ± 0.8 × 1011 , P = 0.001). Haemonetics and Trima Accel instruments collected platelets efficiently. We hope that these data will be a guide in selecting equipment for apheresis units.