The relationship between urinary incontinence and abdominal muscle thickness in community-dwelling older women undergoing comprehensive geriatric assessment.

PURPOSE: Urinary incontinence (UI) is one of the most common geriatric syndromes in older adults, especially in women. The aim of this study is to show the relationship between urinary incontinence and abdominal muscle thickness measured by muscle ultrasonography (US) in community-dwelling older women adults. METHODS: Eighty-seven community-dwelling older women participated in our study. The presence and the type of UI were recorded. Clinical and demographic characteristics were collected, and a comprehensive geriatric assessment was performed on all participants. Abdominal muscle layer thicknesses were evaluated with muscle US. RESULTS: The prevalence of UI was 55.2% (n = 48) of the study population. The median [IQR] age of the patients in the UI group was 73.0 [69.0-77.5] years and it was 69.0 [67.0-73.0] years in patients without UI (p = 0.007). Abdominal muscle thicknesses were measured smaller in patients with UI than those without UI except for internal oblique muscle thickness. The median [IQR] rectus abdominis muscle thickness was lower in patients with UI than in patients without UI, and the difference was statistically significant (p < 0.003). RA muscle was associated with UI regardless of age, polypharmacy, malnutrition, and frailty (OR: 0.58; 95% CI 0.38-0.89; p = 0.01). CONCLUSIONS: We have shown that UI was independently related to the rectus abdominis muscle thickness, which may reflect the function and mass of the pelvic floor muscles.

Dysphagia is closely related to frailty in mild-to-moderate Alzheimer's disease.

INTRODUCTION: Physical phenotype and the cumulative deficit model are two well-known concepts of frailty. One of the main components of frailty is loss of muscle mass and function, which may also include swallowing muscles, therefore is a risk factor for dysphagia. Since dysphagia is seen starting from the early stages of Alzheimer's Disease (AD), in this study we aimed to reveal the relationship between frailty and dysphagia and dysphagia-related quality of life through Swallow Quality of Life (SwalQoL) tool in patients with AD and compare them with cognitively intact older adults. METHODS: Comprehensive geriatric assessment, dysphagia evaluation by Eating-Assessment Tool (EAT-10) and SwalQoL questionnaire, and frailty assessment via FRAIL and Clinical Frailty Scale (CFS) were performed on all 101 participants of the study. Thirty-five patients were cognitively intact, 36 patients were diagnosed with mild AD, and 30 patients were diagnosed with moderate AD. RESULTS: Sex distribution was similar between the groups, however, there was a statistically significant age difference. The prevalence of frailty increased according to both frailty indexes as the cognitive status deteriorated. All parameters of SwalQoL except fear and sleep parameters deteriorated as cognitive status impaired. In quantile regression of the total score of the SwalQoL questionnaire and multivariable logistic regression of EAT-10, frailty, as defined by CFS and FRAIL, was associated with dysphagia and poor quality of life regardless of age, presence of dementia, as well as nutritional status. CONCLUSION: Swallowing difficulties in AD negatively affects the quality of life, and it is closely related to frailty in mild-to-moderate AD.

Prevalence of nutrition disorders and nutrition-related conditions in older patients with Alzheimer's disease.

BACKGROUNDS: Alzheimer's disease is frequently encountered with nutrition-related conditions such as malnutrition, sarcopenia, frailty, overnutrition, and micronutrient abnormalities in older patients. In this study, we aimed to evaluate the prevalence of nutrition disorders and nutrition-related conditions in the same patient group. METHODS: A total of 253 older patients with Alzheimer's disease underwent comprehensive geriatric assessment, which included nutrition-related disorders, malnutrition via the Mini Nutritional Assessment-Short Form (MNA-SF), frailty via the Clinical Frailty Scale (CFS), and sarcopenia was diagnosed according to European Working Group on Sarcopenia in Older People-2 criteria. RESULTS: The patients' mean age was 79.8 ± 6.5 years, and 58.1% were women. In our patients, 64.8% had malnutrition or were at risk of malnutrition; 38.3% had sarcopenia; 19.8% were prefrail; and 80.2% were frail. Malnutrition, frailty, and sarcopenia prevalence increased as the Alzheimer's disease stage progressed. Malnutrition was found to be significantly related with frailty scores via CFS (odds ratio [OR], 1.397; P = 0.0049) and muscle mass via fat-free mass index (FFMI) (OR, 0.793; P = 0.001). In logistic regression analysis, age, MNA-SF, and CFS were included in the model to detect the independent correlates of probable and confirmed sarcopenia. CFS was independently associated with probable and confirmed sarcopenia (OR, 1.822; P = 0.013; OR, 2.671; P = 0.001, respectively). Frailty was similarly related with FFMI (OR, 0.836; P = 0.031). Obesity was independently related with FFMI (OR, 0.688; P < 0.001). CONCLUSION: In conclusion, nutrition disorders and nutrition-related conditions can present concurrently in patients with all stages of Alzheimer's disease; therefore, these frequent problems should be screened and diagnosed accordingly.

Closure of pressure injury and mortality in internal medicine wards.

PURPOSE: The prevalence of pressure injury (PI) in hospitalized patients ranges from 5 to 15%, and is significantly greater in critical care and palliative care units. Prevalence of PI is considered an indicator of health care quality and is associated with increased morbidity and mortality. The study aims to determine the features of PI and its association with mortality among hospitalized patients in the inpatient service of a university hospital. METHODS: The present study comprised 89 patients hospitalized on the internal medicine inpatient service who had PI at the time of hospitalization and or who developed PI during hospitalization. Patients were categorized based on the state of PI closure (complete/incomplete). Mortality rates for 1 month, 3 months, 6 months, and 1 year were computed. RESULTS: The median age was 74. (IQR: 62-82). Forty-eight patients were female, and 15.7% of hospitalized patients had PI. A third of patients died during their index hospitalization. Patients with completely closed PI had decreased one-month, three-month, six-month, and one-year mortality rates. Complete closure of PI influenced all four mortality rates independently of other parameters, as determined by Cox regression analysis of the factors impacting mortality. CONCLUSION: As life expectancy rises, the frequency of PI increases, resulting in a rise in health care expenses. To reduce these expenses, prevention, early identification, and treatment of PI are essential. The primary finding of the study is that complete closure of PI in hospitalized patients reduces the risk of death.

Relationships of Fall Risk With Frailty, Sarcopenia, and Balance Disturbances in Mild-to-Moderate Alzheimer's Disease.

BACKGROUND AND PURPOSE: Cognitive impairment is one of the main risk factors for falls, and hence it commonly coexists with balance issues. Frailty and sarcopenia are intertwined and prevalent in dementia, and are closely related to falls. We aimed to determine the relationships of the fall risk with balance disturbances, sarcopenia, and frailty in mild-to-moderate Alzheimer's disease (AD). METHODS: The study enrolled 56 patients with probable AD. A comprehensive geriatric assessment was performed, and muscle strength and mass, performance status, gait, and balance were evaluated. All parameters were compared between fallers and nonfallers with AD. RESULTS: Fallers comprised 53.6% of the study population. The demographic features and AD stages did not differ between fallers and nonfallers. Fallers were more frail than nonfallers (p<0.05). Frailty was found to be independently associated with fall history (odds ratio=2.15, 95% confidence interval=1.20-3.82, p=0.031). We found that falls were not associated with AD stage, muscle mass and function, balance and geriatric syndromes except urinary incontinence in patients with AD (p>0.05). CONCLUSIONS: We found that falls were not influenced by AD stage. Both physical and cumulative frailty were strongly associated with falls in patients with mild-to-moderate AD.

The role of muscle ultrasound to predict sarcopenia.

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

Gender distribution among geriatricians: perspective from an ageing and developing country.

PURPOSE: Geriatrician numbers are increasing year by year in Turkey. We aimed to obtain information on licensed geriatricians, trainees, and board of directors of the societies in Turkey and compare this information with other countries' data. METHODS: The study was conducted as a cross-sectional study. The gender, institution, and title of licensed geriatricians and trainees were documented by scanning websites of university, training and research, state hospitals, and the website of Academic Geriatrics Association. Information about the board of directors of the societies was obtained from the websites of the societies. The last day for data inclusion was August 31, 2021. RESULTS: There were 90 licensed geriatricians and 77 trainees in Turkey as of 31 August 2021. While 52.2% (n = 47) of licensed geriatricians were female, the ratio of females among trainees was 76.6% (n = 59). The ratio of females among trainees was statistically higher than licensed geriatricians (p = 0.001). Females constitute 88.9% of the board of directors of the Academic Geriatrics Association and this ratio was higher than the ratio of females on the board of directors of local and international journals. CONCLUSION: Best of our knowledge, our study is the first to examine the gender distribution in geriatrics. The dominance of females in geriatrics is very important in countries where geriatrics is relatively newly established as even countries with a deep-rooted history and structure in geriatrics are trying to increase the number of female geriatricians under their new administrations.

Memory T cell responses in seronegative older adults following SARS-CoV-2 vaccination.

Generating memory T cell responses besides humoral immune responses is essential when it comes to the efficacy of a vaccine. In this study, the presence of memory T cell responses after aluminum-adjuvanted inactivated whole-virion SARS-CoV-2 vaccine (CoronaVac) in seronegative and seropositive elderly individuals were examined. CD4+ and CD8+ memory T cell proliferation and IFN-γ production capacities were evaluated. Additionally, clinical frailty scale (CFS) and FRAIL scales of the individuals were scored. CD4+ memory T cell responses more prominent than CD8+ memory T cells. In seronegative individuals, 80% of them had memory CD4+ and IFN-γ, whereas 50% of them had memory CD4+ and all of them had IFN-γ responses. Additionally, 40% of seronegative patients and 50% of seropositive patients had memory CD8+ responses. To sum up, humoral immune responses are not associated with memory T cell responses, and in seronegative individuals, memory T cell responses can be detected.

Frailty in community-dwelling older adults: reliability and validity of the Turkish version of the Gérontopôle frailty screening tool.

BACKGROUND: Recognizing frailty had a great importance in countries with an increasing geriatric population. The study aims to evaluate the reliability and validation of the Gérontopôle frailty screening tool (GFST), which was developed to screen frailty in the community-dwelling older adults, for the Turkish population. METHODS: In this crosssectional study, participants who applied to the geriatrics outpatient clinic of a university hospital were included. Comprehensive geriatric assessments of all patients were performed. The validity of the GFST was tested by its concordance with the FRAIL scale. Test-retest and interrater reliability analyses were made. RESULTS: Ninety-six patients were included in the study. Sixty-one and five-tenths percent (n = 59) of them are females. The median age was 72.0 (IQR: 10.0). There was a moderate concordance between the GFST and the FRAIL scale (Cohen's kappa: 0.566, p < 0.001). The Gérontopôle frailty screening tool interrater and retest reliabilities were excellent (Cohen's kappa: 0.814, p < 0.001 and 1.0, p < 0.001; respectively). The sensitivity of the GFST determined according to the FRAIL scale is 69.39%, the specificity is 86.36%, the positive predictive value is 85.00%, and the negative predictive value is 71.70%. DISCUSSION: The Gérontopôle frailty screening tool, which can be used by all healthcare professionals, is a valid and reliable tool for the Turkish geriatric population.

Letter to editor: is laboratory index really a practical and valid tool to predict mortality?

We carefully studied the article titled "A practical laboratory index to predict institutionalization and mortality - an 18-year population-based follow-up study" written by Heikkilä et al. and published in BMC Geriatrics on 25 February 2021 with great interest. We would like to make some comments regarding this article and tool. Laboratory Index (LI) has been executed with the data of 728 patients who had followed-up in our center, however the LI score was not able to predict the 10-year and 18-year mortality. Therefore, a question mark has been aroused in our minds at some points. Neither frailty nor comorbidities were considered in this index. For a geriatric patient, it would be inadequate to evaluate laboratory results regardless of the clinical status. Similarly, it would not be appropriate to predict mortality only on the basis of laboratory results without considering the clinical status of the patient.We think that although the recent study has a great impact, it can be improved by incorporating data on the comorbidities and frailty status of the patients into the analysis.