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.

SARC-F and other screening tests for sarcopenia.

PURPOSE OF REVIEW: Sarcopenia screening tools can enable clinicians to select individuals for more demanding evaluations, and hence, may facilitate its timely diagnosis and management. The most common recommended screening test is SARC-F, whereas many others are proposed. We aimed to summarize the recent studies and evidence performed on SARC-F and other sarcopenia screening tools. RECENT FINDINGS: Meta-analysis studies reported that despite having moderate-high specificity, SARC-F has low-moderate sensitivity to detect sarcopenia, which would cause a significant number of individuals having sarcopenia to be unrecognized. Several recent studies aimed to increase sensitivity and utility of SARC-F as a screening tool by i.e., application of lower cut-offs, adding extra-items, and combining with other screening tests. Some of these approaches increased its screening efficacy significantly. In line with its previous studies, SARC-F showed success to predict adverse outcomes in the latest studies as well. Recently, it has also been suggested as a reasonable screening test for frailty. In addition to the long-standing screening tests i.e., anthropometric measures, Ishii Test and Mini Sarcopenia Risk Assessment (MSRA) Questionnaire; new tests, i.e., Taiwan Risk Score for Sarcopenia, Sarcopenia Scoring Assessment Model (SarSA-Mod) and re-purposed tests, i.e., SARQoL questionnaire and fracture risk assessment tool have been investigated as potential screening tests for sarcopenia. Some of these tests performed as well as or superior to standard SARC-F. SUMMARY: Screening of sarcopenia is critical for public health given its significant prevalence and adverse outcomes. SARC-F is the most recommended tool for screening but has low-moderate sensitivity. Studies performed recently indicate that its sensitivity can be increased by some attempts and it may be used as a reasonable test to screen frailty as well. Some other tests have also been developed/re-purposed for an efficient screening, needing to be tested for their performance and usability with future studies in different populations and settings.

Clarifying the relationship between sarcopenia and depression in geriatric outpatients.

OBJECTIVE: We investigate the relationship between sarcopenia components and depression in geriatric outpatients, considering the effects of potential confounding factors. METHODS: Adults ≥60 years of age were selected from outpatient clinics. Muscle strength was assessed using handgrip strength (HGS) measured using a hydraulic hand dynamometer and chair stand test (CSST). Physical performance was evaluated by usual gait speed (UGS), nutritional status, and frailty were screened by mini-nutritional assessment (MNA) questionnaire and FRAIL scale. Depression was diagnosed through a psychiatric interview and the administration of the Geriatric Depression Scale (GDS). RESULTS: Participants with depression were similar to participants without depression regarding age (p = .055), education (p = .095), frailty (p = .857), and HGS scores (p = .053). The group with depression had longer CSST duration (p = .023), slower UGS (p = .027), and more malnutrition (p = .001). Multivariate regression analysis revealed that only the malnutrition was independently associated factor with depression after adjusting for confounding factors. CONCLUSIONS: Depression is associated with malnutrition and some components of sarcopenia in geriatric outpatients. Our results revealed that sarcopenia might be associated with depression through malnutrition. If malnutrition lasts for a long time, sarcopenia may become evident in the later stages of depression.

STOPPFall (Screening Tool of Older Persons Prescriptions in older adults with high fall risk): a Delphi study by the EuGMS Task and Finish Group on Fall-Risk-Increasing Drugs.

BACKGROUND: Healthcare professionals are often reluctant to deprescribe fall-risk-increasing drugs (FRIDs). Lack of knowledge and skills form a significant barrier and furthermore, there is no consensus on which medications are considered as FRIDs despite several systematic reviews. To support clinicians in the management of FRIDs and to facilitate the deprescribing process, STOPPFall (Screening Tool of Older Persons Prescriptions in older adults with high fall risk) and a deprescribing tool were developed by a European expert group. METHODS: STOPPFall was created by two facilitators based on evidence from recent meta-analyses and national fall prevention guidelines in Europe. Twenty-four panellists chose their level of agreement on a Likert scale with the items in the STOPPFall in three Delphi panel rounds. A threshold of 70% was selected for consensus a priori. The panellists were asked whether some agents are more fall-risk-increasing than others within the same pharmacological class. In an additional questionnaire, panellists were asked in which cases deprescribing of FRIDs should be considered and how it should be performed. RESULTS: The panellists agreed on 14 medication classes to be included in the STOPPFall. They were mostly psychotropic medications. The panellists indicated 18 differences between pharmacological subclasses with regard to fall-risk-increasing properties. Practical deprescribing guidance was developed for STOPPFall medication classes. CONCLUSION: STOPPFall was created using an expert Delphi consensus process and combined with a practical deprescribing tool designed to optimise medication review. The effectiveness of these tools in falls prevention should be further evaluated in intervention studies.

A new screening tool for self-neglect in community-dwelling older adults: IMSelf-neglect questionnaire.

OBJECTIVE: We aimed to develop a new screening tool for self-neglect in community-dwelling self-sufficient older adults. METHODS: Istanbul Medical School Elder Self-Neglect questionnaire (IMSelf-neglect) was developed as a screening tool. Community-dwelling, self-sufficient older adults were recruited in a geriatric outpatient clinic (n = 226, 142 female, 84 male). Construct validity was based on social-worker's interview as a gold-standard method. The cut-off threshold for IMSelf-neglect questionnaire was calculated from ROC-analysis using cut-off values that predicted social-worker's opinion whether the older adult has self-neglect. RESULTS: Mean age was 74 ± 6.5 years. The inter-rater and test-retest reliability were excellent (r = 0.887, p < .05; r = 0.942, p < .05, respectively). The internal consistency was good (Cronbach's alpha: 0.708). Cut-off threshold for IM Self-neglect questionnaire was calculated as 7 with 92.1% sensitivity and 70.7% specificity. Positive predictive value and negative predictive value of IMSelf-neglect questionnaire were 38.9% and 97.8%, respectively. There was significant moderate agreement between social worker's assessment and results of IMSelf-neglect questionnaire (κ = 0.407, p < .001). The social worker confirmed 16.8% of the participants have self-neglect by the gold-standard clinical interview. Participants with self-neglect had decreased functionality, worse quality of life and tended to have more depression compared with participants without self-neglect. DISCUSSION/CONCLUSION: We developed the IMSelf-neglect questionnaire as a valid and reliable tool to screen self-neglect in outpatient clinics complementary to comprehensive geriatric assessment.

Explicit versus implicit evaluation to detect inappropriate medication use in geriatric outpatients.

Aim: The rates and reasons why clinicians decide not to follow recommendations from explicit-criteria have been studied scarce. We aimed to compare STOPP version 2 representing one of the most commonly used excplicit tool with the implicit comprehensive geriatric assessment mediated clinical evaluation considered as gold standard.Methods: Two hundred and six (n = 206) outpatients ≥65 years old were included. The study was designed as retrospective, cross-sectional, and randomised. STOPP version 2 criteria were systematically used to assess pre-admission treatments followed by implicit clinical evaluation regarding two questions: Were the STOPP criteria recommendations valid for the individual patient and were there any potentially inappropriate-prescription other than depicted by STOPP version 2 criteria? The underlying reason(s) and associated clinical-features were noted.Results: About 62.6% potentially inappropriate-prescriptions were identified (0.6 per-subject) according to systematic application of STOPP v2 while it was 53.4% (0.5 potentially inappropriate-prescriptions per subject) by clinician's application of STOPP v2. Prevalence of non-compliance was 14.7% in 18 (21.7%) of 83 patients identified by systematic application. Suggestion to stop a drug was not accepted because of need of treatment despite likelihood of anticipated side-effects in about 2/3 and with no-anticipated side-effects in about 1/3 of non-compliances. Not following STOPP v2 was significantly associated with lower functional level. According to clinician's implicit-evaluation, there were an extra 59.2% potentially inappropriate-prescriptions (0.6 per subject) in 80 (38.8%) patients yielding a total of 112.6% potentially inappropriate-prescription.Conclusions: Most of the STOPP v2 directed drug cessations are decided valid by the clinicians. In patients with higher functional dependency, it is likely that they are not followed due to palliation focussed care/patient-family preferences. There may be as much as STOPP v2 identified potentially inappropriate-prescriptions by implicit evaluation in a significant percent of geriatric patients signifying need for comprehensive geriatric evaluation in practice.

Low glomerular filtration rate as an associated risk factor for sarcopenic muscle strength: is creatinine or cystatin C-based estimation more relevant?

INTRODUCTION: We aimed to evaluate the association of a decreased glomerular-filtration-rate (GFR <60 ml/min/1.73 m2), estimated using Modification of Diet in Renal Disease (MDRD), creatinine- and cystatin C-based (CKDEPI-CR and CKDEPI-CC) Chronic Kidney Disease Epidemiology Collaboration equations with handgrip strength (HGS). METHODS: Community-dwelling males aged ≥60 years admitted to outpatient clinic were included. We used MDRD, CKDEPI-CR, and CKDEPI-CC formulas for GFR estimation and corrected these for body surface area. Muscle strength was assessed by HGS. RESULTS: 209 men (mean age 67.8 ± 6.4) were enrolled. Sixty-two patients (29.7%) had sarcopenic HGS. Subjects with sarcopenic HGS were older, had higher rate of a GFR < 60 ml/min/1.73 m2, had lower mid-upper arm circumference; tended to have lower creatine kinase, albumin, CKDEPI-CC-GFR levels; and higher BUN/creatinine ratio and cystatin C. Multivariate logistic regression analysis revealed a CKDEPI-CC lower than 60 ml/min/1.73 m2 as the only independent factor underlying sarcopenic HGS. Higher age tended to have an independent association. Only higher age was independently associated with low HGS when other estimations were used (p = 0.013 and p = 0.021 when MDRD and CKDEPI-CR were used, respectively). CONCLUSIONS: There is a strong association of a GFR level of <60 ml/min/1.73 m2 with sarcopenic HGS, when CKDEPI-CC formula is used.

The role of rheumatoid arthritis (RA) flare and cumulative burden of RA severity in the risk of cardiovascular disease.

OBJECTIVE: To examine the role of rheumatoid arthritis (RA) flare, remission and RA severity burden in cardiovascular disease (CVD). METHODS: In a population-based cohort of patients with RA without CVD (age ≥30 years; 1987 American College of Rheumatology criteria met in 1988-2007), we performed medical record review at each clinical visit to estimate flare/remission status. The previously validated RA medical Records-Based Index of Severity (RARBIS) and Claims-Based Index of RA Severity (CIRAS) were applied. Age- and sex-matched non-RA subjects without CVD comprised the comparison cohort. Cox models were used to assess the association of RA activity/severity with CVD, adjusting for age, sex, calendar year of RA, CVD risk factors and antirheumatic medications. RESULTS: Study included 525 patients with RA and 524 non-RA subjects. There was a significant increase in CVD risk in RA per time spent in each acute flare versus remission (HR 1.07 per 6-week flare, 95% CI 1.01 to 1.15). The CVD risk for patients with RA in remission was similar to the non-RA subjects (HR 0.90, 95% CI 0.51 to 1.59). Increased cumulative moving average of daily RARBIS (HR 1.16, 95% CI 1.03 to 1.30) and CIRAS (HR 1.38, 95% CI 1.12 to 1.70) was associated with CVD. CVD risk was higher in patients with RA who spent more time in medium (HR 1.08, 95% CI 0.98 to 1.20) and high CIRAS tertiles (HR 1.18, 95% CI 1.06 to 1.31) versus lower tertile. CONCLUSIONS: Our findings show substantial detrimental role of exposure to RA flare and cumulative burden of RA disease severity in CVD risk in RA, suggesting important cardiovascular benefits associated with tight inflammation control and improved flare management in patients with RA.

Body mass index and functional status in community dwelling older Turkish males.

Disability is utmost important on an aging population's health. Obesity is associated with increased risk for disability. On-the-other-hand, higher-BMI is reported as associated with better functionality in older people in some reports defined as "obesity paradox". There is some evidence on differential relationship between body weight status and functionality by living setting gender, and different populations. We studied the relation between body mass index and functionality in Turkish community dwelling older males accounting for the most confounding factors: age, multimorbidity, polypharmacy and nutritional status. This is a cross-sectional study in a geriatric outpatient clinic of a university hospital. Functionality was assessed with evaluation of activities of daily living (ADL) and instrumental activities of daily living (IADL) scales. Nutrition was assessed by mini-nutritional assessment test. Two hundred seventy-four subjects comprised our study cohort. Mean age was 74.4 ± 7.1 years, BMI was 25.8 ± 4.4 kg/m(2). Linear regression analysis revealed significant and independent association of lower BMI with higher ADL and IADL scores (B = 0.047 and B = 0.128, respectively) (p < 0.05) and better nutritional status (B = 1.94 and B = 3.05, respectively) (p < 0.001) but not with the total number of medications. Higher IADL score was associated with younger age and lower total number of diseases (B = 0.121, B = 0.595, respectively) (p < 0.05) while ADL was not. We suggest that lower BMI is associated with better functional status in Turkish community-dwelling male older people. Our study recommends longitudinal studies with higher participants from different populations, genders and living settings are needed to comment more.

Impaired quality of life, disability and mental health in Takayasu's arteritis.

OBJECTIVE: Patient-reported outcomes (PROs) are increasingly accepted to be among the major tools for outcome assessment in rheumatic disorders. In this study we aimed to assess quality of life (QoL), disability, anxiety and depression in patients with Takayasu's arteritis (TAK). METHODS: Patients followed with the diagnosis of TAK (n = 165) and healthy controls (HCs) (n = 109) were enrolled to the study. The 36-item Short Form Health Survey (SF-36) and hospital anxiety and depression scales (HADS) were used to assess QoL and mental status together with HAQ for disability. RESULTS: In SF-36 subscale assessment, all items were observed to be statistically lower in TAK patients; similarly HAQ scores were also higher (P < 0.001) in this group. In mental assessment, anxiety was found to be more common in TAK patients [90 (54.5%) vs 38 (34.9%), P = 0.001]. Depression also tended to be higher in TAK patients [70 (66.7%) vs 35 (33.3%)], without reaching significance (P = 0.086). Most of the SF-36 subgroup parameters were lower in TAK patients with active disease. Patients having anxiety and depression or with high HAQ scores reported worse SF-36 scores. In multivariate analysis, HADS-A, HADS-D and HAQ were associated with most SF-36 subscales. CONCLUSION: PROs demonstrate that not only general health but also physical and social functioning with physical role limitations and mental health parameters were impaired in TAK. Our results, especially in active disease, suggest that PROs such as SF-36 can be core domains of disease assessment in TAK, similar to ANCA-associated vasculitides.

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.

Associations between obesity, self-reported weakness and their combinations with mortality in nursing home residents.

OBJECTIVES: There are studies on associations between obesity and mortality in nursing home (NH) residents, but the presence of concomitant muscle weakness has not been examined. We considered that self-reported weakness might be a low muscle strength proxy marker. We aimed to examine associations of obesity alone, self-reported muscle weakness alone, and their combination with mortality in NH residents. METHODS: This is a retrospective longitudinal follow-up study. We noted age, sex, nutritional status, functionality, number of chronic diseases, and regular medication. Obesity was assessed by the body fat-percentage method estimated by bioimpedance analysis. Weakness was identified by self-reported muscle weakness. Survival was evaluated with a univariate log-rank test and multivariate Cox regression analyses. RESULTS: We included 214 participants. In a median follow-up time of 46 months, mortality occurred in 37.4%. In multivariate analysis adjusted by age, sex, undernutrition, number of chronic diseases, and regular medication, functional scores; 'non-weak non-obese' participants or 'weak alone' participants or 'weak+obese' participants had higher mortality risk when compared with the 'obesity alone' participants [hazard ratio (HR) = 2.6, 95% confidence interval (CI) = 1.2-5.5, p = 0.01; HR = 2.6, 95% CI = 1.2-5.9, p = 0.02; HR = 3.0, 95% CI = 1.2-7.7, p = 0.02]. CONCLUSION: This is the first report showing that obesity was associated with lower mortality risk if the weakness was not present in NH residents. However, obesity with concomitant weakness was associated with mortality risk similar to non-weak non-obese or weak alone participants. Our study suggests a simple consideration of weakness that can easily be integrated into everyday practice.

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.

Nutrition risk assessed by Nutritional Risk Screening 2002 is associated with in-hospital mortality in older patients with COVID-19.

BACKGROUND: Although numerous studies have been performed to determine predictors of coronavirus disease 2019 (COVID-19) mortality, studies that address the geriatric age group are limited. The aim of this study was to investigate the utility of the Nutritional Risk Screening 2002 (NRS-2002) and the Geriatric 8 (G8) screening tools in predicting clinical outcomes in older adults hospitalized with COVID-19. METHODS: Patients aged ≥60 years who were hospitalized with COVID-19 in the second wave of the pandemic were included in the study. COVID-19 infection was demonstrated by a positive real-time reverse transcriptase-polymerase chain reaction on nasopharyngeal swab or positive radiological findings. Disease severity was determined as defined by the National Institutes of Health. Patient demographics, laboratory values on admission, comorbidities, and medications were recorded. The NRS-2002 and the G8 screening tools were performed for all patients by the same geriatrician. Primary outcome was in-hospital mortality. RESULTS: A total of 121 patients were included. Mean age was 75 ± 9 years, and 51% were female. Mean body mass index was 27 ± 4.5 kg/m2 . Sixty-nine percent of the patients had nutrition risk according to the NRS-2002. Eighty-nine percent of the patients had a G8 score ≤14. In-hospital mortality occurred in 26 (22%) patients. Older age and having nutrition risk as determined by the NRS-2002 were independently associated with a higher risk of in-hospital mortality in older patients with COVID-19. CONCLUSION: The NRS-2002 tool provides rapid assessment for risk stratification in hospitalized older patients with COVID-19.

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

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

Potentially inappropriate medications based on TIME criteria and risk of in-hospital mortality in COVID-19 patients.

OBJECTIVE: This study aimed to evaluate the relationship between hospital admission potentially inappropriate medications use (PIM) and in-hospital mortality of COVID-19, considering other possible factors related to mortality. METHODS: The Turkish inappropriate medication use in the elderly (TIME) criteria were used to define PIM. The primary outcome of this study was in-hospital mortality. RESULTS: We included 201 older adults (mean age 73.1±9.4, 48.9% females). The in-hospital mortality rate and prevalence of PIM were 18.9% (n=38) and 96% (n=193), respectively. The most common PIM according to TIME to START was insufficient vitamin D and/or calcium intake per day. Proton-pump inhibitor use for multiple drug indications was the most prevalent PIM based on TIME to STOP findings. Mortality was related to PIM in univariate analysis (p=0.005) but not in multivariate analysis (p=0.599). Older age (hazards ratio (HR): 1.08; 95% confidence interval (CI): 1.02-1.13; p=0.005) and higher Nutritional Risk Screening 2002 (NRS-2002) scores were correlated with in-hospital mortality (HR: 1.29; 95%CI 1.00-1.65; p=0.042). CONCLUSION: Mortality was not associated with PIM. Older age and malnutrition were related to in-hospital mortality in COVID-19.

Simpler modified fried frailty scale as a practical tool to evaluate physical frailty: Methodological report for its cross-cultural adaptation and validation.

Frailty is a common geriatric syndrome that indicates homeostenosis and increased risk of disability and mortality. It is amenable to intervention when detected. Hence, screening frailty is of utmost importance to preserve quality-of-life and function in older age. Simpler Modified Fried Frailty Scale is a very practical frailty screening tool that has recently been introduced and has rooted from the original Fried Scale. It is developed in Turkish and has been shown to predict mortality in nursing home residents. Considering the variety of languages in Europe, it seems valid to adapt and validate this tool in different European languages. Thereby, it is expected that clinicians will have the possibility to screen for frailty more quickly and easily in their practice across many countries. This report is written to explain the details of the final consensus methodology suggested for Simpler Modified Fried Frailty Scale validation in order to guide and help the research teams in their studies.

Barriers and facilitators in using a Clinical Decision Support System for fall risk management for older people: a European survey.

PURPOSE: Fall-Risk Increasing Drugs (FRIDs) are an important and modifiable fall-risk factor. A Clinical Decision Support System (CDSS) could support doctors in optimal FRIDs deprescribing. Understanding barriers and facilitators is important for a successful implementation of any CDSS. We conducted a European survey to assess barriers and facilitators to CDSS use and explored differences in their perceptions. METHODS: We examined and compared the relative importance and the occurrence of regional differences of a literature-based list of barriers and facilitators for CDSS usage among physicians treating older fallers from 11 European countries. RESULTS: We surveyed 581 physicians (mean age 44.9 years, 64.5% female, 71.3% geriatricians). The main barriers were technical issues (66%) and indicating a reason before overriding an alert (58%). The main facilitators were a CDSS that is beneficial for patient care (68%) and easy-to-use (64%). We identified regional differences, e.g., expense and legal issues were barriers for significantly more Eastern-European physicians compared to other regions, while training was selected less often as a facilitator by West-European physicians. Some physicians believed that due to the medical complexity of their patients, their own clinical judgement is better than advice from the CDSS. CONCLUSION: When designing a CDSS for Geriatric Medicine, the patient's medical complexity must be addressed whilst maintaining the doctor's decision-making autonomy. For a successful CDSS implementation in Europe, regional differences in barrier perception should be overcome. Equipping a CDSS with prediction models has the potential to provide individualized recommendations for deprescribing FRIDs in older falls patients.

Deprescribing practices, habits and attitudes of geriatricians and geriatricians-in-training across Europe: a large web-based survey.

PURPOSE: To provide an overview of the current deprescribing attitudes, practices, and approaches of geriatricians and geriatricians-in-training across Europe. METHODS: An online survey was disseminated among European geriatricians and geriatricians-in-training. The survey comprised Likert scale and multiple-choice questions on deprescribing approaches and practices, deprescribing education and knowledge, and facilitators/barriers of deprescribing. Responses to the survey questions and participant characteristics were quantified and differences evaluated between geriatricians and geriatricians-in-training and between European regions. RESULTS: The 964 respondents (median age 42 years old; 64% female; 21% geriatricians-in-training) were generally willing to deprescribe (98%) and felt confident about deprescribing (85%). Despite differences across European regions, the most commonly reported reasons for deprescribing were functional impairment and occurrence of adverse drug reactions. The most important barriers for deprescribing were patients' unwillingness, fear of negative consequences, lack of time, and poor communication between multiple prescribers. Perceived risk of adverse drug reactions was highest for psychotropic drugs, nonsteroidal anti-inflammatory drugs, cardiovascular drugs, and opioid analgesics. Only one in four respondents (23% of geriatricians and 37% of geriatricians-in-training) think education in medical school had sufficiently prepared them for deprescribing in clinical practice. They reported that their future deprescribing activities would probably increase with improved information sharing between various prescribers, deprescribing recommendations in guidelines, and increased education and training. Approximately 90% think that a paradigm shift is required for prescribers and patients, increasing focus on the possible benefits of deprescribing (potentially) inappropriate medications. CONCLUSIONS: Based on the outcomes of this survey, we recommend investing in improved inter-professional communication, better education and evidence-based recommendations to improve future patient-centered deprescribing practices.