Is comprehensive geriatric testing guiding in the identification of multiple myeloma patients who are candidates for autologous stem cell transplantation? A prospective analysis.

Multiple myeloma (MM) is a hematological malignancy of older adults. This study aimed to investigate the differences in performance, comorbidity scores, and comprehensive geriatric assessment (CGA) before and after induction therapy in newly diagnosed MM patients, as well as the factors that may be associated with improved performance status after induction therapy. Thirty-seven consecutive patients aged 50 years and older, who were newly diagnosed with MM, were included in the study. The patients underwent performance status evaluation and CGA when first diagnosed and after 4 cycles of induction chemotherapy. The performance status of 11 patients (40.7%) changed after induction therapy. Improvement in performance status was significantly lower in patients who were frail according to the Fried frailty criteria and IMWG scores (60% vs. 25%, p = 0.04), (30.0% vs. 6.2%, p = 0.02), taking more than 2 medications due to comorbidities (p = 0.01, confidence interval 0.06-0.09) and those with renal involvement (80.0% vs. 18.7%, p = 0.002). Those with bone involvement were more prevalent among the patients whose performance status improved (87.5% and 50.0%, p = 0.03). This study demonstrated that performance status might improve after induction therapy. Results suggest that CGA before induction therapy can predict performance status change. These results might have implications for predicting at the time of diagnosis, whether an MM patient can be a transplant candidate after induction therapy.

Validity and reliability of Fried frailty phenotype in Turkish population.

BACKGROUND: Frailty is an important, multidimensional geriatric syndrome defined as increased vulnerability to stressors. Fried frailty phenotype (FFP) is one of the most widely used models to define physical frailty. The aim of this study is to investigate the crosscultural validity and reliability of Fried frailty phenotype (FFP) in older Turkish population. METHODS: A total of 450 patients, aged 59 years and over, were included. FFP translated into Turkish was used. Hand grip strength cut-off values that best predict low skeletal muscle mass index (SMI) for Turkish men and women were calculated. A modified version of FFP was created by rescoring FFP according to these cut-off values applicable to Turkish population. Correlation analysis between the frailty assessment by comprehensive geriatric evaluation of clinician experienced in geriatric medicine, and FFP and modified version of FFP were performed for validation. Thirty-five patients underwent frailty assessment with FFP twice for reliability assessment. Inter-rater and intra-rater agreements were investigated. RESULTS: Clinician's decision of frailty status demonstrated significant agreement with the results of FFP, as well as modified FFP. Interrater and intra-rater compliance were good. Best hand grip strength cut-off values for predicting low SMI in older Turkish population were determined as ≤13.6 kg (AUC: 0.841, p < 0.001) for women and ≤27.7 kg for men (AUC: 0.779; p < 0.001). Modified FFP had a good agreement with the FFP. DISCUSSION: FFP is a valid and reliable tool for Turkish population.

Predictive ability of the G8 screening test to determine probable sarcopenia and abnormal comprehensive geriatric assessment in older patients with solid malignancies.

BACKGROUND: Pre-treatment evaluation for sarcopenia is recommended in cancer patients. New screening tests that are less time-consuming and can identify patients who will potentially benefit from geriatric assessment are being developed; the G8 geriatric screening test is one such example. We aimed to investigate whether the G8 screening test can detect probable sarcopenia and is valid and reliable compared to a comprehensive geriatric assessment (CGA) in Turkish older adults with solid cancers. METHODS: We included solid cancer patients referred to a single center. Probable sarcopenia and abnormal CGA were defined as low handgrip strength. Cut-offs for handgrip strength in the Turkish population have been previously determined to be 32 kg for males and 22 kg for females and impairment in at least one of the CGA tests, respectively. The CGA tests comprised KATZ Basic Activities of Daily Living Scale Lawton-Brody Instrumental Activities of Daily Living Scale, Mini-Mental-State Examination Scale, Geriatric Depression Scale-15, and Mini-Nutritional Assessment Short Form. Receiver operating characteristic curve analyses evaluated the test's predictive ability. Intra-rater and inter-rater reliabilities were assessed. RESULTS: The median age of the 76 patients included was 72 (65-91) years. There was a moderate correlation between handgrip strength and the G8 test total score. The sensitivity and specificity of the G8 test to detect probable sarcopenia alone (cut off score = 12.5) were 50 and 92%, respectively (AUC: 0.747; p < 0.001); to determine abnormal CGA plus probable sarcopenia (cut off score = 13) were 93.33 and 86.89%, respectively (AUC: 0.939; p < 0.001); and to detect abnormal CGA alone (cut off score = 14) were 79.63 and 95.45%, respectively (AUC: 0.893; p < 0.001). The G8 test results agreed with those of CGA (κ = 0.638; p < 0.001). Both inter- and intra-rater assessments of G8 scores revealed a strong agreement (Interclass correlation coefficient = 0.979, p < 0.001 and ρ = 0.994, p < 0.001, respectively). CONCLUSIONS: The Turkish version of the G8 test is a good screening tool to detect probable sarcopenia alone and in conjunction with abnormal CGA in older patients with solid malignancies. The G8 screening tool may thus be useful in detecting probable sarcopenia in Turkish older adults with solid cancers.

Comparative Evaluation of Predictive Ability of Comprehensive Geriatric Assessment Components Including Frailty on Long-Term Mortality.

Background: This study aims to compare the predictive value of all comprehensive geriatric assessment (CGA) parameters with the predictive value of frailty assessment (with Edmonton Frailty Scale (EFS) and Fried Frailty Index (FFI)) for long-term mortality, in older adults.Methods: A total of 967 patients were included, consecutively. At the first admission, age, gender, comorbidities, number of drugs, and laboratory values of the patients were recorded. Each patient underwent CGA which consisted of anthropometric measurements, functional, cognitive, mood, nutritional, gait, fall, sleep duration, and frailty assessment. Fifty-seven months after the first admission, CGA parameters were analyzed to determine their predictive abilities on long-term mortality due to all causes, comparatively.Results: The median age was 73 years (range 65-94 years). The median follow-up time was 39.9 months (range 0.5-57.3 months). Serum albumin level, FFI, EFS, instrumental activity of daily living (IADL) score, and walking time were the best predictors of mortality. There was no significant difference between these parameters in predicting mortality.Conclusion: FFI and EFS have similar predictive value for mortality. In busy clinical practice, a new index based on IADL, walking time, and serum albumin level may be an alternative of frailty assessment for predicting mortality.

Does Preoperative Comprehensive Geriatric Assessment and Frailty Predict Postoperative Complications?

BACKGROUND: The influence of preoperative comprehensive geriatric assessment and frailty on postoperative morbidity, mortality, delirium were examined. METHODS: A total of 108 patients were evaluated. The Katz Index of Independence in Activities of Daily Living (ADL), the Lawton Brody Instrumental Activities of Daily Living Scale (IADL), the Mini-Nutrition Assessment test (MNA), the Mini-Mental State Examination (MMSE), Yesavage Geriatric Depression Scale (GDS) were performed. Fried Criteria were used to assess physical frailty. We used the Physiological and Operative Severity Scores for the Enumeration of Mortality and Morbidity score (POSSUM), the American Society of Anesthesiologists Score (ASA), and the Charlson Comorbidity Index (CCI) to determine the risk of postoperative morbidity and mortality. Assessment Test for Delirium (4AT) was applied for detection of delirium. RESULTS: The median age was 71 years (min-max: 65-84). IADL (p = 0.032), MNA (p = 0.01), MMSE scores (p = 0.026) were found to be significantly lower in patients with morbidity. POSSUM physiology score (p = 0.005), operative score (p = 0.015) and CCI (p = 0.029) were significantly higher in the patients with morbidity. Patients developed morbidity were found to be more frail (p < 0.001). The patients with delirium were found to have lower IADL (p = 0.049) and MMSE scores (p = 0.004), higher POSSUM physiology score (p = 0.005) and all of them were frail. It was found that frailty (OR = 23.695 95% CI: 6.912-81.231 p < 0.001), POSSUM operative score (OR:1.118 95% CI: 1.021-1.224 p = 0.016) and preoperative systolic blood pressure (OR:0.937%95 CI: 0.879-0.999 p = 0.048) were independently related factors for postoperative morbidity. CONCLUSION: In our study, CGA and frailty in preoperative period were found to be indicators for postoperative morbidity and delirium.

Higher Serum Endocan Level Is Associated with Alzheimer Disease.

BACKGROUND: The novel molecule endocan, which is released by endothelium and is regulated by proangiogenic and proinflammatory cytokines, may have a role in the pathophysiology of Alzheimer disease (AD). The aim of this study was to evaluate the relationship between serum endocan levels and AD. METHODS: A total of 134 patients (47 AD, 42 amnestic mild cognitive impairment [aMCI], and 45 control patients) 65 years of age and older were recruited in this study. Cognitive status of the patients was evaluated by performing the Montreal Cognitive Assessment (MOCA) and the Mini-Mental State Examination (MMSE). Serum endocan levels were measured with an enzyme-linked immunosorbent assay kit. RESULTS: Median serum endocan level was significantly higher in AD patients (380.1 ng/mL) than in both aMCI patients (247.7 ng/mL) and controls (277.6 ng/mL; p < 0.01). Serum endocan level had a weak but significant correlation with MMSE and MOCA scores (r = -0.219 and r = -0.232; p = 0.012 and p = 0.01, respectively). Serum endocan level was detected as a factor independently associated with AD. The cutoff serum level of endocan predicting AD was >288.94 ng/mL in receiver operating characteristic curve analysis (area under the curve 0.71, 95% CI 66.7-90.9, sensitivity 80.9%, specificity 59.8%; p < 0.01). CONCLUSION: Higher serum endocan levels may be associated with the pathogenesis of AD.

Elasticity of leg muscles and incidence of falls in older adults: a prospective cohort analysis.

PURPOSE: Aging impacts muscle strength and elasticity, which in turn influence dynamic balance, walking speed, and physical performance. We aimed to evaluate the relationship between the elasticity of leg muscles and incidence of falls in older adults. METHODS: We conducted a prospective cohort analysis with outpatients from a geriatric clinic. Any history of falls in the past year was recorded. Timed up and go test, muscle thickness, and handgrip strength tests were performed. Elasticities of the gastrocnemius medialis (GM) and rectus femoris (RF) muscles were evaluated using shear wave elastography. Patients self-recorded their falls, and additional phone calls were made to them each month for 6 months. RESULTS: The median age of the patients (n = 55) was 72 years (66-86); and 72% were women. The GM showed significantly lower elasticity in patients with history of falls in the past year than in those without it (8.08 kPa [3.90-16.17] vs. 9.70 kPa [4.99-20.95]; p = 0.028). A similar negative correlation between GM and fall incidence was noted among those with additional falls during the follow-up period (6.96 kPa [3.90-12.41] vs. 9.13 kPa [4.99-20.95]; p = 0.019). GM elasticity was significantly correlated with the timed up and go test score (r = - 0.612, p < 0.001), handgrip strength (r = 0.384, p = 0.015), and muscle thickness (r = 0.232, p = 0.049). No such associations were observed for the RF muscles. CONCLUSION: GM muscle elasticity is associated with alterations in muscle structure that may lead to falls in older adults. Therefore, muscle elasticity may be a fall predictor in older adults.

A Reliable Tool for Assessing MCI and Dementia: Validation Study of DemTect for Turkish Population.

BACKGROUND AND AIM: Mild cognitive impairment (MCI) and dementia prevalence are expected to increase with aging. The DemTect is a very quick and easy tool to administer and recognize the early stages of dementia and MCI. In this study we aimed to evaluate the reliability and validity of a Turkish version of the DemTect and define cut off values for different age and educational levels. One of our aims is also to compare the sensitivity and specifity of the DemTect to other common screening tools. PATIENTS AND METHODS: Fifty-four patients with MCI, 55 patients with dementia and 91 patients with subjective memory complaints (SMC) were enrolled in the study. The DemTect was translated into Turkish by forward-backward translation and compared with the Mini Mental State Examination (MMSE), the Quick Mild Cognitive Impairment Turkish version (QMCI-TR) and the Montreal Cognitive Assessment (MoCA). In order to test interrater reliability, the DemTect was administered to 11 patients, on the same day, by 2 trained raters. To establish test-retest reliability, the same rater scored the tool a second time on 11 patients within 2 weeks. RESULTS: The median age of the patients was 73 (min-max: 65-90) years, 54.5% were female. We found a strong correlation between DemTect scores and the MMSE, the QMCI, and the MoCA (r = 0.725, r = 0.816, r = 0.821, respectively; p < 0.001). In ROC analysis, the cut-off point of the DemTect to differentiate MCI from SMC was 11.5 with 92.6% sensitivity, 91.2% specificity, AUC 0.973 and the cut-off point of the DemTect to differentiate dementia from SMC was 9.5 with 96.4% sensitivity, 100% specificity, AUC 0.916. Cronbach α was 0.823. Intraclass correlation coefficient was 0.873 (95% CI: 0.598-0.964) for interrater reliability and 0.966 (95% 0.777-0.982) for test-retest reliability (Cronbach α = 0.932, 0.966 respectively). CONCLUSION: The DemTect is a very reliable tool to assess Turkish patients with MCI and dementia.

Turkish validation of a new scale from older people's perspectives: Older people's quality of life-brief (OPQOL-brief).

INTRODUCTION: There are various 'quality of life' scales developed for older people. Although quality of life is a subjective concept, most of these scales are based on expert opinions rather than perspectives of older people. The aim of this study is to evaluate validity and reliability of Older People's Quality of Life-brief scale (OPQOL-brief), which is based on perspectives of older people, in Turkish population. METHODS: A cross-sectional study was implemented in a Geriatric medicine outpatient clinic. Total number of 168 older patients who speak in Turkish fluently were recruited. Comprehensive geriatric assessment and OPQOL-brief was applied to all participants together with another quality of life scale validated in Turkish population, CASP-19 (Control, Autonomy, Self-realization, Pleasure). Validity was evaluated with construct validity, convergent validity and discriminant validity. Reliability was assessed with internal consistency and test-retest reliability. RESULTS: Mean age of the study population was 73.3 ± 5.9 years. Female participants were 64.9% (n = 109). Internal consistency was assessed by Cronbach's α coefficient. OPQOL-brief scale demonstrated high internal consistency (Cronbach's α = 0.876). Test-retest reliability was assessed by interclass correlation coefficient (ICC) and showed high reliability (ICC = 0.98, 95%CI = 0.96-0.99, p < 0.001). Strong and significant correlation was detected between OPQOL-brief and CASP-19 scales (r = 0.763, p < 0.001). CONCLUSION: Turkish version of OPQOL-brief has acceptable validity and reliability in Turkish population. The scale can be used to measure quality of life of older people.

Validation of the Turkish Version of the Quick Mild Cognitive Impairment Screen.

BACKGROUND: The objective of this study was to validate the Turkish version of the Quick Mild Cognitive Impairment (Q mci-TR) screen. METHODS: In total, 100 patients aged ≥65 years referred to a geriatric outpatient clinic with memory loss were included. The Q mci was compared to the Turkish versions of the standardized Mini-Mental State Examination and the Montreal Cognitive Assessment (MoCA). RESULTS: The Q mci-TR had higher accuracy than the MoCA in discriminating subjective memory complaints (SMCs) from cognitive impairment (mild cognitive impairment [MCI] or dementia), of borderline significance after adjusting for age and education ( P = .06). The Q mci-TR also had higher accuracy than the MoCA in differentiating MCI from SMC, which became nonsignificant after adjustment ( P = .15). A similar pattern was shown for distinguishing MCI from dementia. Test reliability for the Q mci-TR was strong. CONCLUSION: The Q mci-TR is a reliable and useful screening tool for discriminating MCI from SMC and dementia in a Turkish population.