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Older adults are mostly exposed to polypharmacy and inappropriate medication use (IMU) due to the increasing incidence of chronic diseases and geriatric syndromes with aging. Polypharmacy and IMU use are well-known risk factors for adverse drug reactions (1,2).

Gulistan Bahat, 1 Serdar Ozkok, 1 Savaş Ozturk, 2 Mehmet Akif Karan 1 1Istanbul University, Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics, Istanbul, Turkey; 2Istanbul Haseki Training and Research Hospital, Department of Internal Medicine, Istanbul, TurkeyCorrespondence: Gulistan Bahat Tel +90 212 414 20 00 Ext. 31478Email gbahatozturk@yahoo.comWe have read the article by Huang et al with great interest. 1 Authors aimed toreveal the relationship between serum vitamin D levels and stroke-associatedpneumonia (SAP). They measured the serum vitamin D levels of the acuteischemic stroke (AIS) patients within 24 hrs of admission and divided theminto three groups accordingly. Compared to the patients without SAP, patientswith SAP had significantly lower vitamin D levels. The prevalence of SAP washigher in the vitamin D deficient group. In the logistic regression analysis, it wasdetected that vitamin D deficiency and insufficiency were independently associatedwith SAP. View the original paper by Huang and colleagues

Objective: To determine the prevalence and the factors associated with urinary incontinence (UI) among inpatients in Turkey. Method: The population of this study comprised of patients screened by the "National Prevalence Measurement of Quality of Care (LPZ)" study in 2017 and 2018. Age, gender, comorbidities, length of hospital stay, sedative medications, SARC-F score, anthropometric measurements, and care parameters such as malnutrition, falls, UI-fecal incontinence (FI), restraints, and care dependency score (CDS) were noted. The LPZ questionnaire was performed by trained researchers, and multiple logistic regression analysis was performed to determine the factors associated with UI. Results: The prevalence of UI was 29.4 % among 1176 inpatients, and 41.6 % in patients ≥65 years. Urinary incontinence was associated with older age (OR, 1.966, 95 % CI 1.330-2.905), female sex (OR, 2.055, 95 % CI 1.393-3.030), CDS (OR, 3.236, 95 % CI 2.080-5.035), the number of comorbidities (OR, 1.312, 95 % CI 1.106-1.556), end-of life management (OR, 3.156, 95 % CI 1.412-7.052), sedative medications (OR, 1.981, 95 % CI 1.230-3.191), and FI (OR, 12.533, 95 % CI 4.892-32.112) in all adults, where CDS (OR, 2.589, 95% CI 1.458-4.599), end-of life management (OR, 2.851, 95 % CI 1.095-7.424), sedative medications (OR, 2.529, 95 % CI 1.406-4.548), and FI (OR, 13.138, 95 % CI 4.352-39.661) were associated with UI among geriatric patients. Conclusions: The factors associated with UI in geriatric and all adult inpatients are CDS, sedative medications, end-of life management, and FI plus older age, female sex, and comorbidities for the latter. The factors associated with UI vary in different age groups.

World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (WCO-IOF-ESCEO) --APR 04-07, 2019 -- Paris, FRANCE, nofulltext# --- WOS: 000475685502031, …, Int Osteoporosis Fdn, ESCEO, Mylan, UCB, IBSA, Medimaps, Lilly, Hologic, Strax Corp, Kyowa Kirin, Galgo Med, EffRx, Amgen, Abiogen Pharma, Medi, Fidia Pharma Grp, TRB Chemedica Sa, AgNovos Healthcare GmbH, Expanscience Labs, Wisepress Com, GE, Pierre Fabre, Roche, Echolight, Thuasne, Theramex, Bindex, Gedeon Richter, Sinklar Conf Management B V, Nestle Health Science, This study is supported by Nestle Health Science.

Dear editor We have read the article entitled “Association between frailty and delirium in older adult patients discharged from hospital” by Verloo et al1 with great interest. In their study, the authors observed that frailty is strongly associated with delirium in older patients at hospital discharge. Consequently, they concluded that assessing frailty gives health care professionals the opportunity to improve the effectiveness of primary prevention strategies for delirium, by promptly ascertaining which discharged older adults are at a higher risk of presenting with that syndrome. We would like to give comments on a few points of this study. In the methodology section, the authors stated that frailty was assessed using the Edmonton Frailty Scale, which includes nine domains as two of cognitive impairment and functional dependency by using the Mini-Mental State Examination (MMSE) and Lawton Index of instrumental activities of daily life, respectively, at hospital discharge. According to these MMSE scores, patients have been divided into categories with regard to cognitive impairment. We would like to ask the authors about how they distinguished the impact of delirium on MMSE scores; because delirium itself may lead to lower MMSE scores independent of basal cognitive state. And this may cause misinterpretation of the patients as frail. Also, no information was given if the patients have had dementia diagnosis, which is known as one of the important risk factors for delirium.2 Regarding the assessment of functional dependency, the authors stated that a score of

Yaşlılardadüşme sık karşılaşılan ve önemli bir sağlık sorunudur. Kırıklar, düşme korkusu,mobilitede azalma ve bağımlılık ile kurumsal bakıma ihtiyaç duyma gibi olumsuzsonuçlara yol açar. Hastalarda genellikle birden fazla risk faktörü birliktebulunur, bunlar arasında alt ekstremitede güçsüzlük, düşme hikayesi, yürüme vedenge sorunları, tıbbi sorunlar, fonksiyonel bozukluklar, görme sorunları,polifarmasi ve kognitif bozukluk sayılabilir. Hekimler toplum içinde yaşayan,hastanede yatan veya bakımevlerinde bulunan tüm yaşlılarda düşme riskfaktörlerini tarama ve değerlendirmenin önemini bilmelidir. Tüm yaşlılaratarama amacıyla son bir yıl içinde düşüp düşmediği sorulmalıdır. Düşmenedenlerini belirlemede kapsamlı geriatrik değerlendirme oldukça yararlıdır;böylece düşme hikayesi öğrenilir, tıbbi sorunlar değerlendirilir, ayrıntılı birilaç anamnezi alınır, fizik muayene, ilgili laboratuvar testleri vegörüntülemeler yapılır, çevresel faktörler değerlendirilir. Falls in older people:importance, and risk assessment Falls in older people are a common and serioushealth problem with devastating consequences including fractures, fear offalling, reduced mobility and dependcency, and need for institutional care. Risk factors for falls are often multifactorialand include lower limb weakness, history of falls, gait or balance disorders,medical problems, functional impairment, visual deficits, polypharmacy, and cognitiveimpairment. The clinicians must be aware ofappropriate fall risk screens and assessments for community, hospital, andresidential aged care settings. All olderadults should be screened for "falls in the past year" by theclinician. Comprehensive geriatric assessment that includes history offalls, evaluation of medical comorbidities, medication review; physicalexamination, relevant laboratory and imaging investigations, and environmentalsurveillance, is likely to identify the reasons for falls. Key words: Falls,risk factors, geriatric assessment

Dear editor We read with interest the article by Kortas et al1 entitled “Effect of Nordic Walking training on iron metabolism in elderly women.” In their study, the authors investigated the effect of Nordic Walking (NW) training on serum ferritin, C-reactive protein (CRP), hepcidin, hemojuvelin, and vitamin D, which have been stated as components of the inflammatory system. In this study, while NW training significantly reduced iron stores and increased hemojuvelin and tended to reduce CRP levels, it did not affect hepcidin levels. The authors also observed a significant weight loss after training. The authors concluded NW training has pro-healthy effects manifested by decreased inflammation and a drop in iron stores. It is well known that obesity is associated with insulin resistance and physical exercise and weight loss reduce insulin resistance. Several studies indicate a positive correlation between iron levels and insulin resistance.2,3 There is also a relationship between insulin resistance and CRP levels.4 The possibility of decreased insulin resistance with weight loss after training can also contribute to the decline in CRP and ferritin levels in this study. The authors mentioned that they did not observe the anticipated increase in hepcidin levels after exercise. As the authors stated, hepcidin levels increase in response to both inflammation and exercise. Because the mean body mass index of the study population is in the overweight range, these subjects might have insulin resistance and associated inflammation. Thus, the anticipated increase in hepcidin levels with exercise might have been attenuated via decreased inflammation in this study. This two-way interaction may account for the unchanged hepcidin levels. The authors did not report insulin levels in this study and did not discuss the probable effect of insulin resistance on the relationship between ferritin and exercise. We suggest that consideration of these factors may facilitate interpretation of the findings of this study. We also suggest that insulin resistance would better be assessed in future studies in this field.

Amaç: Vasküler endotelyal disfonksiyon (VED) ateroskleroz gelişiminde önemli bir etkendir. VED ile yaşlanma arasında ilişki olduğuna dair veriler mevcuttur. Bu çalışmadaki amacımız, yaşlıda ortaya çıkan VED’e serum homosistein, lipoprotein (a) ve dihidroepiandrostenedion sülfat (DHEAS) düzeylerindeki değişikliklerin katkısının olup olmadığının araştırılmasıdır. Gereç ve yöntem: Tümü hipertansif olan 67 ileri yaşlı ve 35 orta yaşlı hasta çalışmaya dahil edildi. Diyabet ve diğer kardiyovasküler risk faktörleri olan hastalar çalışmaya alınmadı. Hastaların brakiyal arterlerinde oluşturulan geçici iskemi sonrası ortaya çıkan vazodilatasyon (flow mediated dilation, FMD) düzeyi ve karotis arterlerinin intima media kalınlıkları (KAIMK), yaş, vücut kitle indeksi, sistolik ve diyastolik kan basıncı, serum lipid, glukoz, kreatinin, lipoprotein (a), homosistein ve DHEAS düzeyi ile karşılaştırıldı. Bulgular: FMD’nin yaş ve KAIMK ile ters orantılı olduğu bulundu (p < 0,001, r = -0,317, p < 0,001, r = -0,350). FMD ile serum homosistein, lipoprotein (a) ve DHEAS değerleri arasında anlamlı bir ilişkiye rastlanılmadı. Dışlanma kriterleri ve grupların homojenizasyonu sonucu FMD ile hastaların diğer biyoşimik parametreleri, VKİ ve kan basınçları arasında anlamlı bir ilişki bulunmadı. FMD ile brakiyal arter bazal çapı birbirleriyle ters orantılı bulundu (p=0,014, r = -0,243). Brakiyal arter bazal çapı yaşlılarda anlamlı olarak daha genişti (4,06 ± 0,50 mm’ye karşı 3,73 ± 0,55 mm, p=0,005, t = 2,927). Bu nedenle ileri yaşta ortaya çıkan VED’in bazal arter çapındaki değişimle alakalı olup olmadığını anlamak için ileri yaş grubundaki hastalarda bu ilişki tekrar araştırıldı. Spearman’s korelasyon testi anlamlı sonuç vermedi (p=0,286). Sonuç: Serum homosistein, lipoprotein (a) ve DHEAS düzeylerindeki değişikliklerin, ileri yaşta ortaya çıkan VED’e katkıda bulunmadığı düşünülmektedir.

Sarcopenia is a geriatric syndrome characterized by progressive loss of skeletal muscle mass and strength, accompanied by physical disability, low quality of life, and increased mortality. Studies have suggested that there may be a relationship between protein intake and muscle strength in geriatric individuals. The aim of this study was to evaluate the relationship between protein intake level and protein quality in relation to nutritional status and sarcopenia in the elderly. In this study, a total of 103 elderly individuals, 23 male and 80 female, who applied to geriatric polyclinic, were evaluated. The energy and nutrients intake of the individuals were determined by the food consumption frequency form and Mini Nutritional Assessment-Short form (MNA-SF) was applied by taking physical activity records and anthropometric measurements. The prevalence of sarcopenia in study was 37,90%. There was a statistically significant correlation between the MNA-SF scores of the individuals and the upper middle arm circumference (cm) (p

Introduction: Sleep disorders are commonly under-diagnosed in the geriatric population. We aimed to determine the prevalence of sleep problems among older adults admitted to the geriatrics out-patient clinic. Methods: Two hundred and three patients (136 female) older than 75 years of age were included in the study. Patients underwent comprehensive geriatric assessment, including identification of sleep problems using the Sleep Disturbance Scale, Rapid eye movement (REM) sleep behavior disorder (RBD) Single-Question Screen questionnaire (RBD1Q) and The Johns Hopkins Restless Leg Syndrome Severity Scale. Demographic and clinical data including age, sex, medications, comorbid diseases, body mass index and functional scores was noted. Results: The mean age of the patients was 80.92±4.3 years. 35.5% of the patients had findings of REM-SBD and 32.5% of the patients had restless legs syndrome. Ninety-seven percent of the patients answered ‘yes’ to at least one of the sleep disturbance scale questions. There was no significant difference between male and female groups. Conclusion: We observed that sleep disorders were common among older adults. For this reason, the course and quality of sleep should be examined in all patients as a routine part of comprehensive geriatric assessment. Keywords: Comprehensive geriatric assessment, older adults, sleep disorders