The Current Landscape of Pharmacotherapies for Sarcopenia.

Sarcopenia is a skeletal muscle disorder characterized by progressive and generalized decline in muscle mass and function. Although it is mostly known as an age-related disorder, it can also occur secondary to systemic diseases such as malignancy or organ failure. It has demonstrated a significant relationship with adverse outcomes, e.g., falls, disabilities, and even mortality. Several breakthroughs have been made to find a pharmaceutical therapy for sarcopenia over the years, and some have come up with promising findings. Yet still no drug has been approved for its treatment. The key factor that makes finding an effective pharmacotherapy so challenging is the general paradigm of standalone/single diseases, traditionally adopted in medicine. Today, it is well known that sarcopenia is a complex disorder caused by multiple factors, e.g., imbalance in protein turnover, satellite cell and mitochondrial dysfunction, hormonal changes, low-grade inflammation, senescence, anorexia of aging, and behavioral factors such as low physical activity. Therefore, pharmaceuticals, either alone or combined, that exhibit multiple actions on these factors simultaneously will likely be the drug of choice to manage sarcopenia. Among various drug options explored throughout the years, testosterone still has the most cumulated evidence regarding its effects on muscle health and its safety. A mas receptor agonist, BIO101, stands out as a recent promising pharmaceutical. In addition to the conventional strategies (i.e., nutritional support and physical exercise), therapeutics with multiple targets of action or combination of multiple therapeutics with different targets/modes of action appear to promise greater benefit for the prevention and treatment of sarcopenia.

Undernutrition in obese older adults by fat percentage.

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

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

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

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.

Which Treatment Strategy Is Preferred In The Octogenarians With Acute Coronary Syndrome?

Objectives: To compare the efficacy of invasive and conservative strategy in the management of octogenarians with acute coronary syndrome. METHODS: The retrospective study was conducted after approval from the ethics review committee of University of Health Sciences, Derince Training and Research Hospital, Turkey and comprised data from April 2020 to April 2021 related to octogenarian patients of either gender admitted to University of Health Sciences, Darica Farabi Training and Research Hospital, Turkey with acute coronary syndrome diagnosis. The data was divided into invasive group A and conservative group B. Data was analysed using SPSS 25. RESULTS: Of the 168 patients with median age 84(interquartile range: 81-86 years), there were 25(14.9%) in group A; 14(56%) males and 11(44%) females. There were 143(85.1%) patientsin group B; 70(49%) males and 73 (51%) females. Overall mortality was 111(66.1%); 11(44%) in group A, and 100(69.9%) in group B (p=0.012). Elevated alanine aminotransferase and invasive strategy were independent factors associated with mortality (p<0.05). CONCLUSIONS: The invasive strategy in the management of octogenarian patients presenting with acute coronary syndrome was found to be more efficient compared to the conservative strategy.

Optimizing pharmacotherapy and deprescribing strategies in older adults living with multimorbidity and polypharmacy: EuGMS SIG on pharmacology position paper.

Inappropriate polypharmacy is highly prevalent among older adults and presents a significant healthcare concern. Conducting medication reviews and implementing deprescribing strategies in multimorbid older adults with polypharmacy are an inherently complex and challenging task. Recognizing this, the Special Interest Group on Pharmacology of the European Geriatric Medicine Society has compiled evidence on medication review and deprescribing in older adults and has formulated recommendations to enhance appropriate prescribing practices. The current evidence supports the need for a comprehensive and widespread transformation in education, guidelines, research, advocacy, and policy to improve the management of polypharmacy in older individuals. Furthermore, incorporating deprescribing as a routine aspect of care for the ageing population is crucial. We emphasize the importance of involving geriatricians and experts in geriatric pharmacology in driving, and actively participating in this transformative process. By doing so, we can work towards achieving optimal medication use and enhancing the well-being of older adults in the generations to come.

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.

Management of Type 2 Diabetes in Frail Older Adults.

Aging is one of the most important factors associated with the dramatic increase in the prevalence of type 2 diabetes mellitus (T2DM) globally. In addition to traditional micro- and macrovascular complications, diabetes mellitus (DM) in older adults is of great importance due to its independent relationship with frailty, which is defined as a decline in functional reserves and vulnerability to stressors. Frailty assessment enables the determination of biological age, thus predicting potential complications in older adults and identifying tailored treatment strategies. Although the latest guidelines have acknowledged the frailty concept and provided recommendations specific to this subgroup of older adults, frail older adults are particularly considered only as anorexic, malnourished people for whom relaxed treatment targets should be set. However, this approach bypasses other metabolic phenotypes in the context of diabetes and frailty. Recently, a spectrum of metabolic phenotypes in the context of frailty in DM was suggested, and the two edges of this spectrum were defined as "anorexic malnourished (AM)" and "sarcopenic obese (SO)." These two edges were suggested to require different strategies: Opposite to the AM phenotype requiring less stringent targets and de-intensification of treatments, tight blood glucose control with agents promoting weight loss was recommended in the SO group. Our suggestion is that, regardless of their phenotype, weight loss should not be the primary goal in DM management in older adults who are overweight or obese, because of the increased malnutrition prevalence in older adults suffering from DM compared with standard older adults. Furthermore, overweight older adults have been reported to have the lowest risk of mortality compared with other groups. On the other hand, obese older individuals may benefit from intensive lifestyle interventions including caloric restriction and regular exercise with the assurance of at least 1 g/kg/day high-quality protein intake. Besides metformin (MF), sodium-glucose cotransporter-2 inhibitors (SGLT-2i) or glucagon-like peptide-1 receptor agonists (GLP-1RA) should be considered in appropriate SO cases, due to high evidence of cardiorenal benefits. MF should be avoided in the AM phenotype due to their weight loss property. Although weight loss is not desired in AM phenotype, SGLT-2i may still be preferred with close follow-up in certain individuals demonstrating high cardiovascular disease (CVD) risk. Of note, SGLT-2i should be considered earlier in the diabetes treatment in both groups due to their multiple benefits, i.e., organ protective effects, the potential to reduce polypharmacy, and improve frailty status. The concept of different metabolic phenotypes in frail older adults with diabetes once again shows "one size fits all" cannot be applied in geriatric medicine, and a tailored, individualized approach should be adopted to get the highest benefit from treatments.

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.

Association of periodontitis with handgrip strength and skeletal muscle mass in middle-aged US adults from NHANES 2013-2014.

OBJECTIVES: The relationship between periodontitis and sarcopenia parameters in middle-aged adults is largely unexplored. This study investigated the association between periodontitis and combined handgrip strength and skeletal muscle mass in middle-aged adults. MATERIALS AND METHODS: A sub-cohort of 1912 individuals with complete periodontal and whole-body dual X-ray absorptiometry examinations from the 2013-2014 wave of the National Health and Nutrition Examination Survey (n = 10,175) were analyzed using fully adjusted multiple linear regression models for associations between periodontitis and skeletal muscle mass index (kg/m2) and combined handgrip strength (kg). RESULTS: The mean age of the study cohort was 43 (± 8.4) years and 49.4% of the participants were male. In total, 612 participants (32%) were determined to have periodontitis, of which 513 (26.8%) had non-severe (mild or moderate) periodontitis, and 99 (5.2%) had severe periodontitis. In unadjusted regression models, both non-severe and severe periodontitis were associated with SMMI (ßnon-severe = 1.01, 95% CI 0.50; 1.52 and ßsevere = 1.42, 95% CI 0.59; 2.25) but not with cHGS. After adjusting for age, sex, education, body mass index, bone mineral density, diabetic status, education, total energy intake, total protein intake, and serum vitamin D2 + D3, periodontitis was associated with cHGS (ßnon-severe = -2.81, 95% CI - 4.7; - 1.15 and ßsevere = - 2.73, 95% CI - 6.31; 0.83). The association between periodontitis and SMMI remained for non-severe periodontitis (ßnon-severe = 0.07, 95% CI - 0.26; 0.40 and ßsevere = 0.22, 95% CI - 0.34; 0.78). CONCLUSION: The present study highlights the need of further prospective research to investigate the nature and direction of the relationship between periodontitis and sarcopenia indicators. Future studies can support the screening, prevention and clinical management of sarcopenia and periodontitis, and emphasize the interdisciplinary and complementary approach between the disciplines of geriatric medicine and periodontology.

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

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

STOPP/START criteria for potentially inappropriate prescribing in older people: version 3.

PURPOSE: STOPP/START is a physiological systems-based explicit set of criteria that attempts to define the clinically important prescribing problems relating to potentially inappropriate medications (PIMs-STOPP criteria) and potential prescribing omissions (PPOs-START criteria). The previous two versions of STOPP/START criteria were published in 2008 and 2015. The present study describes the revised and updated third version of the criteria. METHODS: A detailed system-by-system review of the published literature from April 2014 to March 2022 was undertaken with the aim of including clinically important new explicit PIM and PPO criteria and removing any criteria considered to be no longer correct or outdated. A panel of 11 academic physicians with recognized expertise in geriatric pharmacotherapy from 8 European countries participated in a Delphi panel with the task of validating the draft criteria. The panel was presented with the draft new criteria using the SurveyMonkey® on-line platform in which panelists were asked to indicate their level of agreement on a five-point Likert scale. RESULTS: Two hundred and four evidence-based draft criteria (one hundred and forty-five STOPP criteria, fifty-nine START criteria) were presented to panelists for assessment using the Delphi validation method. Over the course of four rounds of Delphi validation, the panel achieved consensus on 133 STOPP criteria and 57 START criteria, i.e., 190 STOPP/START criteria in total representing a 66.7% increase in the number of criteria compared to STOPP/START version 2 published in 2015. CONCLUSION: A fully revised and updated version of STOPP/START criteria has been validated by a European expert panel using the Delphi consensus process.

Management of use of urinary antimuscarinics and alpha blockers for benign prostatic hyperplasia in older adults at risk of falls: a clinical review.

PURPOSE: We aimed to outline the existing information and the underlying mechanisms of risk of falls associated with the use of urinary antimuscarinics for overactive bladder (OAB) or alpha-blockers for benign prostatic hyperplasia (BPH) in older adults. In addition, we aimed to provide assistance to clinicians in decision-making about (de-)prescribing these drugs in older adults. METHODOLOGY: Based on a literature search in PubMed and Google Scholar, we reviewed the literature, and identified additional relevant articles from reference lists, with an emphasis on the most commonly prescribed drugs in OAB and BPH in older patients. We discussed the use of bladder antimuscarinics and alpha-blockers, their potential side effects related to falls, and the deprescribing of these drugs in older adults. RESULTS: Urinary urgency or incontinence and lower urinary tract symptoms due to untreated OAB and BPH contribute to fall risk. On the other hand, the use of bladder antimuscarinics and alpha-blockers is also related to fall risk. They contribute to (or cause) falling through dizziness, somnolence, visual impairment, and orthostatic hypotension while they differ in their side-effect profiles regarding these problems. Falls are common and can cause a remarkable amount of morbidity and mortality. Thus, preventive measures should be taken to lower the risk. If the clinical condition allows, withdrawal of bladder antimuscarinics and alpha-blockers is recommended in fall-prone older adults. There are practical resources and algorithms that guide and assist clinicians in deprescribing these drug groups. CONCLUSIONS: The decision to prescribe or deprescribe these treatments in patients at high risk of falls should be individualized. In addition to explicit tools that are helpful for clinical decision-making in (de-)prescribing these drugs, STOPPFall (a recently developed expert-based decision aid specifically aiming to prevent falls) is present to assist prescribers in attaining decisions.

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.