Fear of falling and associated factors in older adults with heart failure.

BACKGROUND: This study aimed to evaluate the prevalence of fear of falling and associated factors in older adults with heart failure. METHODS: A prospective, cross-sectional study. The study included 100 geriatric patients who were hospitalised and treated in the cardiology department of our hospital with ventricular ejection fraction (LVEF) lower than 50% for at least 1 year. A series of geriatric assessments were performed by face-to-face interview on the day of admission. Electrocardiography (ECG) and transthoracic echocardiography (TTE) were also performed on the day of admission. RESULTS: The median age of the patients was 72 years, and 72.0% were men. Falls Efficacy Scale scores indicated a fear of falling in 46 (46.0%) of the patients. Charlson Comorbidity Index (CCI) was significantly higher in patients with fear of falling (P < 0.001). Severe depression, severe clinical insomnia, daytime sleepiness, and malnutrition were significantly more frequent among patients with fear of falling. Fear of falling was associated with significantly lower LVEF (P = 0.001). The presence of severe depression increased the risk of fear of falling by 13.97 times (95% CI: 3.064-63.707; P = 0.001), and the presence of daytime sleepiness increased the risk by 3.49 times (95% CI: 1.012-12.037; P = 0.048). A one-unit increase in CCI increased the risk of fear of falling by 1.56 times (95% CI: 1.093-2.238; P = 0.014). CONCLUSIONS: Heart failure patients with concomitant depression, sleep disorders, and high comorbidities have greater fear of falling.

Frequency and Risk Factors of Re-hospitalization in Geriatric Inpatient Wards: A Multicenter Retrospective Analysis.

PURPOSE: We aimed to evaluate frequency and risk factors of re-hospitalization which are not stated in comorbidity indexes in geriatric wards. METHODS: A total of 585 patients who were admitted to tertiary care geriatric inpatient clinics at least once between 1 September 2017 and 1 September 2018 and who survived to discharge during initial hospitalization were included in this cross-sectional retrospective multicenter study. RESULTS: Overall, 507(86.7%) patients were hospitalized once for treatment during the study period, while re-hospitalization occurred in 78(13.3%) patients. Rates of previous surgery (10.3 vs. 3.0%, p = .006), urinary incontinence (UI) (50.0 vs. 36.3%, p = .021), controlled hypertension (64.1 vs. 46.4%, p = .024), malnutrition (55.1 vs. 29.6%, p = .014) were significantly higher in re-hospitalized patients. Re-hospitalized patients were younger (mean ± SD 76.4 ± 8.3 vs. 79.6 ± 7.9 years, p = .002) than once-hospitalized patients. Multivariate logistic regression analysis revealed the younger patient age (OR, 0.942, 95% CI 0.910 to 0.976, p = .001), higher Modified Charlson Comorbidity Index (MCCI) score (OR, 1.368, 95% CI 1.170 to 1.600, p < .001) to significantly predict the increased risk of re-hospitalization. CONCLUSIONS: Our findings showed that previous history of surgery and geriatric syndromes such as UI, malnutrition were determined to significantly predict the increased risk of re-hospitalization. We suggest that these risk factors be added to prognostic tools designed for elderly patients.

The impact of a videoconferencing-implemented program on older adults' psychosocial health in the COVID-19 pandemic: an experimental study.

BACKGROUND: Social distancing and 'stay-at-home' orders are essential to contain the coronavirus outbreak; however, it has affected older adults very negatively psychosocially. The present study explored the impact of a videoconferencing-implemented program on older adults' psychosocial health during the COVID-19 pandemic. METHODS: We carried out this experimental research with pretest-posttest and control groups between November 02 to December 26, 2020 on individuals aged 60 years and over who were enrolled at Fethiye Refreshment University (60+ FRU). While the intervention group consisted of 40 people, we recruited 52 participants in the control group. Unlike the control group, the intervention group participated in a structured videoconferencing program held there days a week for 8 weeks. We collected the data using the Fear of COVID-19 Scale (FCV-19S), the Multidimensional Scale of Perceived Social Support (MSPS), the Depression Anxiety Stress Scale (DASS-21), and the Loneliness Scale for Elderly (LSE). The data were then analysed on the SPSS 22.0 program. RESULTS: The participants had a mean age of 66.13 ± 5.13 years; 65.2% were females, 58.7% were married, 55.4% held a university degree and 93.5% had a regular income. Following the intervention, we found the experimental group to have significantly a lower posttest FCV-19S score (p < 0.05) and a higher posttest MSPS score than the control group (p < 0.05). Besides, the experimental group had significantly lower posttest scores on the DASS-21 and the anxiety and stress subscales than the control group (p < 0.05). Moreover, the posttest score of the experiential group on the emotional loneliness subscale (LSE) was found to be significantly lower than that of the control group (p < 0.05); nevertheless, we could not conclude significant differences between the groups' pretest and posttest LSE scores and their scores on the other LSE subscales (p > 0.05). CONCLUSION: Overall, the videoconferencing program was found to be efficient in providing older adults with psychosocial support amid social isolation.

Best Practice Recommendations for Stroke Patients with Dysphagia: A Delphi-Based Consensus Study of Experts in Turkey-Part I: Management, Diagnosis, and Follow-up.

Dysphagia is one of the most common and important complications of stroke. It is an independent marker of poor outcome after acute stroke and may become chronic after the acute period and continues to affect all aspects of the patient's life. Patients with stroke may encounter any of the medical branches in the emergency room or outpatient clinic, and as in our country, there may not be specialists specific for dysphagia, such as speech-language pathologists (SLP), in every hospital. This study aimed to raise awareness and create a common opinion of medical specialists for stroke patients with dysphagia. This recommendation paper has been written by a multidisciplinary team and offers 45 recommendations for stroke patients with dysphagia. It was created using the eight-step Delphi round via e-mail. This study is mostly specific to Turkey. However, since it contains detailed recommendations from the perspective of various disciplines associated with stroke, this consensus-based recommendation paper is not only a useful guide to address clinical questions in practice for the clinical management of dysphagia in terms of management, diagnosis, and follow-up, but also includes detailed comments for these topics.

Best Practice Recommendations for Stroke Patients with Dysphagia: A Delphi-Based Consensus Study of Experts in Turkey-Part II: Rehabilitation.

Dysphagia is one of the most common and important complications of stroke. It is an independent marker of poor outcome following acute stroke and it continues to be effective for many years. This consensus-based guideline is not only a good address to clinical questions in practice for the clinical management of dysphagia including management, diagnosis, follow-up, and rehabilitation methods, but also includes detailed algorithms for these topics. The recommendation paper has been written by a multidisciplinary team and offers 117 recommendations for stroke patients with dysphagia. While focusing on management principles, diagnosis, and follow-up in the 1st part (45 items), rehabilitation details were evaluated in the 2nd part (72 items).

The value of C-reactive protein in infection diagnosis and prognosis in elderly patients.

BACKGROUND: The aim of this study was to determine the value of C-reactive protein level in the diagnosis and prognosis of infection in elderly patients. STUDY POPULATION: This prospective study included inpatients in the palliative care unit during the 1-year period between January 2016 and January 2017. Patients' demographic data, Acute Physiology and Chronic Health Evaluation score, and Charlson Comorbidity Index were recorded. RESULTS: A total of 233 patients were included in the study. A total of 199 instances of infection were diagnosed in 175 of those patients; 75.3% of the infections were detected at admission and 24.7% during hospitalization. At a cut-off value of 4.82, CRP value had 81.0% specificity and 75.4% sensitivity in the diagnosis of infection. Among the patients with infection, there was no difference between those who died and those who survived in terms of baseline CRP level, but a significant difference emerged in CRP level at 48 and 96 h. Factors which were found to significantly reduce survival time were the presence of chronic kidney disease, chronic obstructive pulmonary disease, hypoxia and tachycardia at admission, APACHE-II score over 20.5, initial albumin level below 2.44 g/dL, and serum CRP clearance rates of less than 11% at 48 h and 20% at 96 h. CONCLUSION: In elderly patients with infection, the initial CRP value alone does not have prognostic value, but changes observed in serial CRP measurement are a valid indicator of prognosis.

Delirium is associated with increased mortality in the geriatric population.

OBJECTIVE: The aim of this study was to investigate the prevalence of delirium and its association with mortality rates in elderly inpatients. METHODS: The medical records of 1435 patients over 65 years old who were treated at a regional university hospital and were referred to the university's Consultation and Liaison Psychiatry Clinic for psychological evaluation were retrospectively analyzed. Patients with and without a diagnosis of delirium were compared. The National Survival Database was used to determine mortality rates. RESULTS: The prevalence of delirium was 25.5%. The delirium group was older (p < .0001) and had a larger proportion of males (p < .0001). Mortality rate was higher in the delirium group at 1, 2, 3, 4, and 5 years (p < .0001 for all). Age, gender, lower urinary system diseases, chronic liver disease, solid hematologic malignancy, infections, and Alzheimer's disease emerged as significant parameters associated with mortality. Multivariate analysis of these parameters indicated that comorbid diseases (lower urinary system diseases, chronic liver disease, solid hematologic malignancy, infections, and Alzheimer's disease) are risk factors for mortality independent of demographic data such as age and gender. CONCLUSIONS: Independent of all other factors, delirium is associated with higher mortality risk.

Prevalence of anemia and malnutrition and their association in elderly nursing home residents.

PURPOSE: Malnutrition is one of the most important geriatric syndromes in the elderly. The aim of this study was to investigate the association between anemia and malnutrition in elderly nursing home residents. MATERIALS AND METHODS: Local nursing home residents over 60 years old in the Izmir were included in the study. Blood samples were taken from study participants for hemogram, iron, ferritin, total iron-binding capacity, vitamin B12 and folic acid analysis. WHO criteria were used to define anemia. Causes of anemia were classified as iron deficiency, vitamin B12 or folic acid deficiency, anemia of chronic disease or other hematologic causes. Anemia was defined as the dependent variable and malnutrition was defined as the independent variable. Correlation between MNA scores and Hb levels was determined using Pearson correlation analysis. The slope of causality between malnutrition and anemia was determined using the χ (2) test and logistic regression analysis. RESULTS: The study included 257 elderly nursing home residents with a mean age of 78.5 ± 7.8 years. The overall prevalence of anemia was 54.9 %; 35.8 % of the study participants were at risk of malnutrition and 8.2 % were malnourished. Anemia risk was 2.12-fold higher in participants at risk of malnutrition and 5.05-fold higher in those with malnutrition. In the participants with malnutrition or malnutrition risk, the most common cause of anemia was anemia of chronic disease (57.1 and 46.5 %, respectively). CONCLUSION: The prevalence of anemia among elderly nursing home residents is high in Turkey. Malnutrition and malnutrition risk increase the incidence of anemia.

Features of pressure ulcers in hospitalized older adults.

BACKGROUND: The objectives of this study were to examine the prevalence and risk of pressure ulcers (PrUs) among hospitalized patients 65 years or older in a university hospital setting and to assess the potential for prevention and healing in that population. METHODS: The retrospective study conducted at the general medicine departments of Ege University Hospital in Izmir, Turkey, included 209 patients (115 females, 94 males) 65 years or older, who had been admitted to the hospital for a variety of reasons between April 1, 2011, and October 1, 2011. The following tools were used to collect data: a data collection form to identify the sociodemographic and medical characteristics of the patients, the Braden Risk Assessment Scale to assess the risk of PrUs, and a form to monitor PrUs, which included the site of the PrU, the category, and the PUSH (Pressure Ulcer Scale for Healing) score, a tool for tracking changes in PrUs status applied at weekly intervals. RESULTS: The mean patient age was 73 (6.4) years. The prevalence of PrUs was 5.8% during the hospital stay. Pressure ulcers appeared most frequently in the ischeal tuberosity area (40%), and 45.2% of all PrUs observed were category II. The comorbidities of the patients who had PrUs were as follows: rheumatoid arthritis, 40% (n = 5); acute renal failure, 24% (n = 3); multiple myeloma, 8% (n = 1); chronic renal failure, 8% (n = 1); pneumonia, 8% (n = 1); and acute lymphoblastic leukemia, 8% (n = 1). CONCLUSIONS: Pressure ulcers are a common healthcare complication in the older adult population, with potentially severe consequences. The most important intervention that healthcare professionals can make to reduce PrUs is to determine and address risk factors.

Hope, coping strategies, and their predictors in older patients with prostate and breast cancer undergoing radiotherapy: A cross-sectional study.

INTRODUCTION: The aim of this paper was to evaluate the level of hope, coping methods, and the factors affecting them in patients aged 60 years and over who were diagnosed with breast and prostate cancer and who were receiving radiotherapy (RT) as part of their treatment. METHODS: A total of 66 patients (37 breast cancer and 29 prostate cancer patients) were included in this cross-sectional study. The RT and treatment information of the patients were collected by using the records in the hospital database. The scale responses, baseline characteristics, and demographic information of the participants were collected through the questionnaire form and scales [HHI (Heart Hope Index), COPE (Coping Attitudes Assessment Scale), and VAS (Visual Analogue Scale)]. Two surveys were administered to the participants before and after radiotherapy treatment. A first survey was administered to the participants 10-15 days before radiotherapy treatment, and the second survey was administered within 2-3 weeks after radiotherapy treatment. The weight and waist circumference of the patients were also measured before and after radiotherapy. RESULTS: The median age of the participants was 65 (interquartile range (IQR): 62.0-70.2) years. There was a decrease in the weight (mean change (MC): -1.5, 95% CI: -2.9 to -0.2, P = 0.029) and waist circumference (MC: -1.8, 95% CI: -3.2 to -0.4, P = 0.014) of the participants after RT. There was no significant change in the HHI (MC: 0.4, 95% CI: -0.7 to 1.5) and COPE (MC: -0.6, 95% CI: -3.2 to 2.0) total scores of the patients before and after RT (P = 0.459 and P = 0.650, respectively). When only patients with prostate cancer were studied, the self-help sub-dimension of COPE (MC: -1.5, 95% CI: -2.7 to -0.3, P = 0.013) was found to be lower. CONCLUSION: Multidimensional evaluations and interventions may be required in terms of hope levels and coping attitudes of cancer patients receiving radiotherapy. There is an increasing need for further studies in larger populations and cohorts related to this topic in the literature.

Evaluation of the quality of life in the university of third age students: a cross-sectional study.

PURPOSE: The purpose of this paper was to determine the quality of life (QoL) and related factors in university of third age (U3A) students, as well as to compare the QoL between those who participated in education and those who did not. METHODS: Two hundred seventy-one people aged 60 and over who are students at Ege U3A, were included in this cross-sectional study. Demographic data of participants were collected through a pre-prepared form. Data on the QoL of individuals were collected through the short form of the WHO QoL Scale (WHOQOL-BREF). RESULTS: A total of 271 participants were included in this study. 82.2% (n = 221) of the research group were women. In U3A, 65.3% (n = 177) of the individuals were former students. The highest value was found in the psychological and general health sub-parameter with 75.0%, and the lowest value in the social relations sub-parameters with 66.7%. The scores of sub-parameters of social environment were significantly higher in men than in women (p < 0.001, respectively). The physical health scores of the former students were higher than those of the new students (p < 0.001). CONCLUSIONS: It was determined that the QoL of U3A students was higher among males, those with higher education levels, and those who were married, as well as that the QoL of the individuals participating in the U3A training was positive in the physical health sub-dimension. There is a need for future studies in which pre- and post-training evaluations will be conducted to determine the impact of the U3A training program.

Hypomagnesemia Is Associated with Excessive Daytime Sleepiness, but Not Insomnia, in Older Adults.

The aim of this study was to investigate associations between serum magnesium levels with insomnia and excessive daytime sleepiness (EDS) in older adults. A total of 938 older outpatients were included in the study. Hypomagnesemia was defined as serum magnesium concentration below <1.6 mg/dL. Patients were divided into two groups: hypomagnesemia and normomagnesia (1.6-2.6 mg/dL). The Epworth Sleepiness Scale was implemented and scores of ≥11 points were categorized as EDS. The Insomnia Severity Index was implemented and scores of ≥8 indicated insomnia. The mean age was 81.1 ± 7.6 years. While the presence of EDS, hypertension, diabetes mellitus, and coronary artery disease were more common in the hypomagnesemia group than the normomagnesia group, Parkinson's disease was less common (p < 0.05). Hemoglobin and HDL cholesterol were lower, whereas HbA1c, triglyceride, and number of drugs used were higher in the hypomagnesemia group compared to the normomagnesia group (p < 0.05). In both univariate analysis and multivariate analysis adjusted for gender, age and all confounders, there were significant associations between hypomagnesemia and EDS [odds ratio (OR):1.7; 95% confidence interval (CI): 1.6-2.6, and OR: 1.9; 95%CI: 1.2-3.3, respectively (p < 0.05)]. There was no significant relationship between hypomagnesemia and insomnia (p > 0.05). The present study identified an association between hypomagnesemia and EDS in older adults. Therefore, it may be prudent to consider hypomagnesemia when evaluating older adults with EDS and vice versa.

Mortality-Related Risk Factors in Geriatric Patients with Hip Fracture.

BACKGROUND: Mortality rates after hip fractures increase by up to 30% with age. This study investigated the contribution of various parameters to prognosis and mortality. METHODS: Our study prospectively examined patients with hip fracture aged 65 years and over who applied to the Atatürk University Medical Faculty Hospital Orthopedics Service in 2020-2021. RESULTS: The 120 patients included in the study had a mean age of 79.71±7.27 years, and 51.7% were female. Twenty patients (16.7%) died within the first 30 days after a hip fracture. They had a significantly lower median Lawton-Brody instrumental activities of daily living (IADL) scale score (p=0.045) and a higher rate of malnutrition according to the Mini Nutritional Assessment (MNA) score (p=0.016). Additionally, these patients with 30-day mortality had a significantly lower rate of surgical treatment (p=0.027) and a longer time from injury to surgery (p=0.014). The time to surgery was a significant independent risk factor for 30-day mortality, with each 1-hour delay increasing the odds of mortality by 1.066 (odds ratio [OR]=1.066; 95% confidence interval [CI], 1.001-1.013; p=0.013). In addition, the presence of malnutrition was another independent risk factor that increased the odds of mortality by 4.166 times (OR=4.166; 95% CI, 1.285-13.427; p=0.017). CONCLUSION: We recommend placing more importance on supportive treatment in patients presenting with hip fractures, especially in those with malnutrition; performing surgical intervention as early as possible; and more closely following up with patients with the aforementioned risk factors.

Comparison of the C14 urea breath test and histopathology in the diagnosis of Helicobacter pylori in the elderly.

OBJECTIVES: To compare the sensitivity and specificity of C[14] urea breath test with histopathological findings in biopsies obtained through endoscopy. METHODS: In this cross-sectional study, conducted at the Medical Faculty Ankara University, Ankara, Turkey between January and October 2009, 100 patients aged 65 and above who fulfilled the criteria for inclusion were enrolled. Oesophago-gastroduodenoscopy was carried out on the patients after eight hours of fasting, using a Fujinon endoscope, by the same expert. C14 urea breath tests were carried out on all patients with a capsule containing 37 kBq(1micro Ci) C14 urea/citric acid. Evaluation of all data was carried out using SPSS 11.5. Categorical variables were compared through Pearson Chi squared or Fisher's exact test. P < 0.005 was taken as statistically significant. RESULTS: The average age of the patients was 71 +/- 5 years; 43 (43%) were male; and 57 (57%) were female. Helicobacter pylori positivity was found to be 35 (35%) in histopathological evaluation, and 36 (36%) in the C14 urea breath test. Of the 35 patients, 32 (91.4%) were found to be positive by the C14 urea breath test also. Of the 65 patients who were found to be negative on histopathology, 61 (93.8%) were also found to be Hp negative by the C14 urea breath test, and 4 (6.2%) were evaluated as false positive. A statistically significant correlation (p < 0.001) was found between histopathological and C14 urea breath test results. Compared with histopathology, the sensitivity of the urea breath test was 91.4%, and its specificity was 93.8%. A statistically significant (p < 0.001) relationship was found between histopathological results and the results of the C14 urea breath test. CONCLUSION: The sensitivity and specificity of the C[14] urea breath test in the group of elderly patients selected was high. The C14 urea breath test can be considered in the elderly group for diagnosis of Helicobacter pylori infection.

The Impact of the Otago Exercise Program on Frailty and Empowerment in Older Nursing Home Residents: A Randomized Controlled Trial.

BACKGROUND: This study assessed the impact of Otago exercises on frailty and empowerment in older nursing home residents. METHODS: This randomized controlled trial included 72 individuals aged over 65 years residing in a single nursing home in Izmir, Turkey. The participants were randomly assigned to the Otago exercise group (OEG) or control group (CG). The OEG performed Otago exercises for 45 minutes, 3 days per week for 12 weeks plus a walking program the 3 other days of the week. In addition to Otago exercise training, the OEG received training based on empowerment consisting of 10 sessions lasting 30 minutes each. The CG received no intervention except routine care in the nursing home. The data collected were sociodemographic characteristics, Edmonton Frail Scale (EFS) scores, and Elderly Empowerment Scale (EES) scores before and 3 months after the intervention. RESULTS: We observed significant differences between the mean EFS (p=0.0001) and mean EES (p=0.0001) before and 3 months after the intervention in the OEG compared to the CG. We also observed a significant difference between the OEG and CG in mean EFS (p=0.018) and EES (p=0.0001) 3 months after the intervention. CONCLUSION: The results of the present study demonstrated the positive impact of the Otago exercise program on preventing/delaying frailty and enhancing empowerment in older people.

The test-retest reliability and concurrent validity of the 3-m backward walk test and 50-ft walk test in community-dwelling older adults.

BACKGROUND: Three-meter backward walk test (3MBWT) and 50-ft walk test (50FWT) are frequent physical performance tests in clinical practice. AIMS: The aim of the study was to determine the test-retest reliability and concurrent validity of the 3MBWT and 50FWT in community-dwelling older adults. METHODS: A cross-sectional study was carried out with 65 participants. 3MBWT, 50FWT, Timed Up and Go Test (TUG), and Five Times Sit to Stand Test (FTST) were evaluated in the first assessment. The test-retest reliability was evaluated by performing two repetitions of the 3MBWT and 50FWT with 1-h interval. The test-retest reliability and validity were assessed by the intraclass correlation coefficient (ICC) and the Spearman correlation coefficient, respectively. RESULTS: The mean age of the participants was 68.9±3.7 years. The ICC score of 3MBWT and 50FWT were 0.940 and 0.820, respectively. The test-retest reliability of both tests was excellent (> 0.80). Both the test and retest assessment of the 3MBWT were strongly correlated with TUG (rtest = 0.649, rretest = 0.645, p < 0.01). 50FWT (test) was not significantly correlated with FTST (r = 0.215, p > 0.05). 50FWT (retest) were weakly correlated with FTST (r = 0.260, p < 0.05). Both the test and retest assessments of the 50FWT was strongly correlated with TUG (rtest = 0.550, rretest = 0.596, p < 0.01). CONCLUSIONS: The 3MBWT and 50FWT are valid and reliable performance tests in community-dwelling older adults. MDC value of both tests provides an essential contribution to clinical practice.

Cross-cultural adaptation, reliability and validity of the Turkish version of the modified Gait Efficacy Scale in community-dwelling older adults.

BACKGROUND: There are no published studies on the cross-cultural adaptation of the modified Gait Efficacy Scale (mGES) to Turkish and investigated its reliability and validity. PURPOSE: The aim of the study was to cross-culturally adapt the mGES to Turkish (T-mGES) and to prove its psychometric properties in community-dwelling older adults. METHODS: International translation strategies and cultural adaptation procedures were used. A total of 103 community-dwelling older adults (73 women, 30 men) have participated in psychometric property analysis. Participants were assessed using the T-mGES, Activity Specific Balance Confidence Scale (ABC) and the Falls Efficacy Scale-International (FES-I). T-mGES was recompleted one week later. RESULTS: The mean age of the individuals was 67.8 ± 4.8 years. The T-mGES had strong test-retest reliability (ICC: 0.835, CI 95%: 0.72-0.90). The T-mGES' overall score had strong internal consistency (Cronbach's α: 0.961). The SEM95 and MDC95 values for the total score were 6.62 and 18.34, respectively. T-mGES had a strong relationship with ABC and FES-I (r1: 0.899, r2: -0.707, p < .01), indicating a high (r > 0.50) construct validity. On the other hand, factor analysis results proved a one-dimensioned structure of the T-mGES. CONCLUSION: T-mGES is a reliable and valid questionnaire for assessing gait efficacy in Turkish speaking community-dwelling older adults. T-mGES provides a straightforward measure due to its unidimensional form.

Potentially Inappropriate Medication Use among Nursing Home Residents: Medication Errors Associated with Pro re nata Medications and the Importance of Pill Burden.

BACKGROUND: The use of potentially inappropriate medications (PIM) has become more common among nursing home residents (NHR). This study focused on drugs initially prescribed as pro re nata (PRN) medications and pill burden in association with PIM among NHR. METHODS: This observational cross-sectional study was conducted between March and April 2019 on 225 adult NHR aged ≥60 years. RESULTS: The prevalence of PIM was 47.6% among NHR according to the Screening Tool of Older Persons' Prescriptions (STOPP) criteria version 2. The most frequent PIM was the use of any drug prescribed without evidence-based clinical indication; most medication errors were associated with PRN medications. The prevalence rates of PRN in non-PIM and PIM users were 12% and 62.4%, respectively. PRN medications that most commonly caused PIM were non-steroidal anti-inflammatory drugs and proton pump inhibitors. The cut-off value for both medications and pills to correctly identify participants with PIM was 5.5. Pill burden had a similar sensitivity to polypharmacy in identifying individuals with PIM. CONCLUSION: Medication errors associated with PRN medications were overlooked as factors that increased the risk of PIMs. The most common error related to PRN medications was the continued daily use despite symptom resolution.

Translation, Cross-cultural Adaptation, and Psychometric Properties of the Turkish Version of the Self-care Ability Scale for the Elderly.

PURPOSE: The Self-care Ability Scale for the Elderly (SASE) is a frequently used scale that was created in Sweden according to Orem's self-care deficit theory and later modified according to Pörn's theory of environment and purpose. This study translated and cross-culturally adapted the Turkish version of the SASE (T-SASE) and demonstrated its psychometric properties, including its reliability and construct validity. METHODS: This study recruited a total of 122 participants and applied international guidelines for the translation and adaptation of the scale. The test-retest reliability of the SASE was calculated at 1-week intervals. Internal consistency was analyzed using Cronbach's alpha. For construct validity, we compared the T-SASE to the Nottingham Extended Activities of Daily Living Scale (NEADLS) and the Exercise of Self-Care Agency Scale (ESCAS). RESULTS: The mean age of the participants was 68.6±5.7 years. The test-retest reliability of the T-SASE was excellent (intraclass correlation coefficient=0.914; 95% confidence interval, 0.81-0.95). The internal consistency of the total T-SASE score was also excellent (Cronbach's α=0.912), as were the Cronbach's alpha scores for the individual items, ranging from 0.901 to 0.915. The items were also highly consistent with each other (Cronbach's α>0.80). The construct validity of the T-SASE was acceptable (0.35<r<0.50) in a convergent manner. The T-SASE was also strongly correlated with the NEADLS and ESCAS (r1=0.405, r2=0.437, p<0.01). Conclusions: The T-SASE was a reliable and valid tool for assessing the self-care ability of community-dwelling older adults. Owing to its multidimensional structure, the T-SASE is an essential tool for evaluating self-care in older adults.

Effects of the Otago exercise program on falls, balance, and physical performance in older nursing home residents with high fall risk: a randomized controlled trial.

PURPOSE: The aim of this study was to evaluate the effects of Otago exercises on falls, balance, and physical performance in old-aged adults with high fall risk living in a nursing home. METHODS: This randomized controlled trial included 72 individuals over 65 years of age residing in a single nursing home in Izmir, Turkey. The participants were randomized into the Otago exercise group and walking (control) group. The Otago group performed 45 min of Otago exercises 3 days/week for 12 weeks plus a walking program on 3 other days of the week. The control group did only the walking program (minimum of 30 min 3 days/week). Number of falls, Berg Balance Scale (BBS), 30-s Chair Stand Test (30 s-CST), and 6-min Walk Test (6MWT) were assessed before the intervention and at the end of the 3-month intervention. The primary outcome was number of falls. RESULTS: The groups were well matched in terms of age (74.6 ± 5.9 vs. 75.8 ± 4.5) and sex (p > 0.05). The Otago group showed a significantly greater reduction in number of falls at the end of the intervention (p < 0.05). Of the secondary outcomes, the Otago group had greater median increases in BBS score (p < 0.05) and 30 s-CST score (p < 0.05) post-intervention compared to the walking group. There was no significant difference between the groups in terms of post-intervention change in 6MWT distance (p > 0.05). CONCLUSION: The Otago exercise program improved balance and physical performance and reduced falls in our sample and may be effective in falls prevention interventions for old-aged nursing home residents.