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Aim: Many factors affecting noninvasive ventilation (NIV) in critically ill patients have been reported in the literature, but there is no study about the effect of frailty. With this study, the frailty prevalence was evaluated with two different frailty scores among the NIV population of a medical intensive care unit (ICU). Besides, the impact of frailty on NIV success and mortality and its association with NIV application problems were evaluated.Method: A prospective observational cohort study was performed on patients who were over 50 years of age and assigned to NIV due to hypercapnic respiratory failure. For the assessment of frailty, Clinical Frailty Scale (CFS) and The Edmonton Frailty Scale (EFS) were used and the ones with CFS ≥5 and EFS ≥8 were considered as fragile. The study population was classified and compared according to NIV success, ICU outcome (discharge or exitus) and NIV application problems.Results: A total of 103 patients with the mean age of 73 ± 11 years were included. The incidence of frailty was 41% with CFS ≥5 and 36% with EFS ≥8. The NIV failure occurred in 30 (29%) patients. Among them frailty and SOFA score was higher; Glasgow Coma Scale (GCS) was lower. In multivariate analysis GCS (OR: 1.2, p: 0.042) and frailty with EFS (OR: 2.8, p: 0.027) were identified as independent risk factors of NIV failure. Sixty-five (63%) patients had NIV application problems and frailty was higher among them with both CFS and EFS (p < 0.05). Mortality occurred in 18 (17%) patients; NIV failure and frailty according to CFS were independent risk factors of mortality.Conclusion: The frailty is associated with higher NIV application problems, failure and mortality risk in elderly ICU patients. The CFS and EFS frailty scores can be used to predict NIV success and outcomes in ICUs. [ABSTRACT FROM AUTHOR]

Introduction: In Mini-Nutritional Assessment-Short Form (MNA-SF) test, a practical and reliable alternative parameter is still necessary for patients with difficult body mass index evaluation. We aimed to show whether or not handgrip strength may be used instead of body mass index (BMI) in MNA-SF test. Materials and Methods: MNA-SF test scores, calf circumferences (CC), handgrip strength (HGS), and BMI of 191 patients were evaluated. The first one of calculated MNA-SF tests was with BMI, the second one with CC, and the last one with HGS. Zero point was given if CC was <31 cm and 3 points were given if CC was ≥31 cm. Zero, 1, 2, and 3 points were given if the loss of HGS when compared to expected HGS were ≥%60, from ≥%30 to <%60, from ≥%10 to <%30, and <%10 or greater than expected HGS, respectively. MNA-SF scores and nutritional status according to these three measures were compared. Results: Mean age and median MNA-SF scores of the patients were 75±7.6 years and 12 points (min-max: 0-14) respectively. There were strongly positive correlations between MNA-SF scores with BMI and CC, with BMI and HGS, and with CC and HGS (r=0.938 p<0.001, r=0.938 p<0.001, r=0.914 p<0.001, respectively). Substantial agreement in nutritional status of the patients were seen between MNA-SF groups with BMI and CC, with CC and HGS, and with BMI and HGS (kappa: 0.795 p<0.001, kappa: 0.709 p<0.001, and kappa: 0.760 p<0.001, respectively). Conclusions: HGS might be considered instead of BMI in MNA-SF test to assess nutritional status of geriatric patients. [ABSTRACT FROM AUTHOR]

Vitamin D has a well-known critical role in calcium and bone homeostasis. In recent years, there has been an increased interest in the potential regulatory role of vitamin D on metabolic pathways implicated in muscle functions. Evidence coming from epidemiologic studies has demonstrated that poor vitamin D status is associated with worse muscle functions. However, whether vitamin D deficiency and supplementation has a role on sarcopenia is not fully known. This review will focus on current knowledge and emerging data regarding the role of vitamin D in muscle functions and sarcopenia. [ABSTRACT FROM AUTHOR]

Background/objectives:Sarcopenia and sarcopenic obesity (SO) are geriatric syndromes leading to physical disability, poor quality of life and death. The aim of this study was to investigate the prevalence of sarcopenia and SO in nursing homes in Turkey and to define local disparities for diagnosing sarcopenia and SO.Subjects/methods:This cross-sectional multicenter study was performed in 711 patients in 14 nursing homes. Comprehensive geriatric assessment tests, handgrip strength and calf circumference (CC) measurements were carried out. Sarcopenia was both defined by handgrip strength and CC criteria.Results:According to handgrip strength measurement, 483 (68%) of patients were sarcopenic (male: 72%, female: 63.8%), 228 were non-sarcopenic. The prevalence of SO was 22% (13.7% in men, 30.2% in women). Patients (82.5%) who were diagnosed as sarcopenic by the handgrip strength test were not sarcopenic according to CC sarcopenia criteria. Therefore, we tried to determine the optimal CC value for diagnosing sarcopenia in our population.Conclusions:Both sarcopenia and SO were prevalent among Turkish nursing home elderly residents. Most of the patients with sarcopenia were obese or overweight. We showed that diagnosing sarcopenia with CC measurement underestimated the sarcopenia prevalence assessed by handgrip strength. So we concluded that, although different assessment methods are recommended for the diagnosis of sarcopenia local disparities should be considered. [ABSTRACT FROM AUTHOR]

Abstract: Background and aim: Malnutrition is related with serious morbidity and mortality in institutionalized older adults. The aim of this study is to determine the frequency of malnutrition in nursing homes and care homes and to identify the factors associated with malnutrition in these settings. Methods: This multicenter study was conducted in 14 centers of nursing homes/care homes in three different cities. Total number of 1797 residents aged≥65 years was enrolled. Malnutrition screening was made by Mini Nutritional Assessment Short Form (MNA-SF) and full MNA. Statistical analyses were conducted by SPSS 15.0. Results: The median age (min–max) of the study population was 78.0 (65.0–108.0) and 917 (51%) were female. MNA-SF score of the residents was 11 (0-14). According to the MNA-SF 850 (49.3%) residents had normal nutritional status, 654 (38.3%) residents were at malnutrition risk, and 204 (11.9%) had malnutrition. Number of medications, gender, duration of stay in the institution, frequency of family visits, social security status, type of nursing home (government or not), daily life activities (ADL), Geriatric Depression Scale (GDS) and MMSE scores, get up & go test, hypertension, dementia, depression, and Parkinson disease were associated with malnutrition. Regression analyses revealed that get up&go test, GDS, hypertension, and ADL were independently related to malnutrition diagnosed by MNA-SF. Conclusion: This study provides important information on the prevalence and associated factors of malnutrition in a large multicentered setting of nursing homes and care homes. It will direct the screening plans and interventions taken in order to detect, prevent, and manage malnutrition in these settings. [Copyright &y& Elsevier]

Abstract: Purpose: The mini-nutritional assessment (MNA) has been used most frequently for the determination of malnutrition in older adults; however it is not suitable for some hospitalized patients. The aim of this study was to identify the nutritional status of the elderly hospitalized patients by MNA and by other assessment methods including anthropometric measurements, bioelectrical impedance analysis (BIA) and laboratory parameters and to demonstrate the correlation of them with MNA. Patients: A total of 100 patients were included in the study. Linear regression analysis was performed to compare the effects of parameters on MNA scores. Results: By MNA; 69% of the patients were found to have nutritional risk, 12% were malnourished and 19% were well nourished. Skinfold thicknesses, calf circumference, prealbumin, albumin, C-reactive protein (CRP), glomerular filtration rate (GFR) and some of the BIA parameters including body fat, free fat mass index, extracellular, intracellular and total body water were significantly correlated with MNA score in univariate analysis. On the other hand; only suprailiac skinfold thickness (OR: 0.106, 95%CI: 0.031–0.181, P: 0.006), prealbumin (OR: 0.256, 95%CI: 0.158–0.354, P <0.001) and GFR (OR: 0.036, 95%CI: 0.014–0.057, P: 0.01) were significantly correlated with MNA in multivariate analysis. Conclusions: These parameters or their combinations can be used for the evaluation of nutritional status in hospitalized older adults when the MNA cannot be used. [Copyright &y& Elsevier]

Objective: Elderly nursing home residents are under high risk of malnutrition. Early interventions to prevent malnutrition may play a critical role in malnutrition-mortality correlation. This study aimed to obtain insight into the prevalence of malnutrition in nursing homes in the capital city of Turkey and the role of malnutrition in predicting the risk for short-term mortality. Design: This study was conducted in seven different residential care facilities in Ankara. Measurements: Nutritional status was evaluated by Mini Nutritional Assessment-Short Form. Results: The mean age of the 534 participants was 79.46±7.22 years. Nutritional assessment revealed that 15.9% of all older adults suffered from malnutrition and another 53.6% were at risk of malnutrition. The mortality rate for all subjects was 118 (22.1%) over 18 months, which was significantly higher in participants with malnutrition. Conclusions: We noted a high prevalence of malnutrition and a strong correlation of increased mortality with malnutrition in nursing home residents. Given the negative impact of malnutrition on mortality and morbidity, an emphasis should be placed on an effective nutritional policy in nursing homes. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Metabolic bone disorders are very common in the elderly population. As fingernail clippings are easily available for analysis, this makes them an interesting screening instrument for stored mineral components in the body. Measurements of calcium concentrations in fingernail clippings are thought to give some insight into their value as an alternative screening test for metabolic bone disorders and our aim was to determine whether fingernail calcium concentrations could be used for this purpose. Patients and methods: This is a cross-sectional study, carried out in a Geriatric medicine outpatient clinic of a university hospital. A total of 159 patients with a mean age of 72.1±5.8 years were involved. Fingernail calcium levels were analyzed with atomic absorption spectrophotometry. Results: There was no statistically significant difference in nail calcium levels between osteoporotic and non-osteoporotic patients and similarly between vitamin D deficient and normal patients. The correlation between nail calcium concentrations and femur neck t-score and serum 25-OH vitamin D levels was very weak and non-significant. Conclusion: We found no change in nail calcium concentrations in osteoporosis and vitamin D deficiency, and therefore nail calcium measurements do not seem to be a good alternative screening instrument for metabolic bone disorders in the elderly. [Copyright &y& Elsevier]

Abstract: Background and aim: Ferritin level is decreased in iron deficiency (ID) and increased in inflammation as an acute-phase reacting protein. In the case of inflammation ferritin, level may not decrease even if ID is present. Inflammation is regarded as one of the mechanisms of aging. This subclinical systemic inflammatory state is named as “inflammaging”. The aim of this study is to assess whether serum ferritin levels could indicate aging-associated inflammation rather than ID in older adults. Methods: Consecutive 1310 patients admitted to the geriatric medicine outpatient clinic were enrolled. The clinical conditions, which could alter acute-phase reactants, were excluded. ID diagnosis was made by transferrin saturation (<15%), MCV and serum iron. Patients with increased levels of either one of Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), white blood cell (WBC), or decreased level of albumin were diagnosed as having subclinical inflammatory state. The correlations of ferritin with those groups were analyzed. Results: Mean age was 71.8±6.9 years and 827 (63.1%) were female. Ferritin levels were significantly higher in patients with subclinical inflammatory state and significantly lower in patients with ID. The interrelationships of the ferritin with acute-phase reactants were stronger than its relationship with the ID. Conclusion: The results of this study suggested that the ferritin level can increase with aging as a part of the ongoing asymptomatic chronic systemic inflammatory state called inflammaging. Inflammaging can result with increased ferritin levels, even if there is ID. Normal or elevated levels of ferritin in the geriatric population should not exclude ID in clinical practice. [Copyright &y& Elsevier]

Objectives: Deficiency of iron, which plays an important role in oxygen transport and storage, may lead to cerebral hypoxia and cognitive decline. This relationship which was studied in children and adults was not evaluated in the elderly. The objective of this study is to examine the effect of iron deficiency on cognitive function in the elderly. Design, Setting, Participants: This is a cross-sectional study conducted in a geriatric medicine outpatient clinic of a university hospital. Consecutive 2009 patients admitted to Geriatric Medicine outpatient clinic were examined and 622 patients who fulfilled the inclusion criteria were enrolled in the study. Measurements: Comprehensive geriatric assessment, cognitive assessment and laboratory analysis including blood count, iron, total iron binding capacity, ferritin, and transferrin saturation were performed. Results: Mean age of the study group was 72.5±6.5 and 439 (70.6%) were women. MMSE scores were moderately and significantly correlated with iron levels (r=0.33, p<0.001) and transferrin saturation (r=0.32, p<0.001). Transferrin saturation was significantly lower in the patients with dementia (p=0.040). It was found that patients with iron deficiency had lower MMSE scores (p<0.001) and this relationship was also present in patients without anemia (p=0.004). Conclusion: The results of this study revealed a negative influence of iron deficiency on cognitive function and this influence was independent from the presence of anemia. As iron deficiency can be easily diagnosed and treated, detecting its effect on cognitive function is of importance. Screening for iron deficiency and initiating appropriate treatment should be a routine part of comprehensive geriatric assessment. [ABSTRACT FROM AUTHOR]

Abstract: Background: Autonomic nervous system disturbance and cardiovascular disorders may be underestimated causes of falls. Heart rate turbulence (HRT), heart rate variability (HRV) and QT dynamicity parameters are noninvasive cardiac autonomic activity markers. The aim of this study was to evaluate autonomic cardiovascular markers in falling older adults. Methods: This was a case-control study conducted at a geriatric medicine outpatient clinic of a university hospital. Study group consisted of 33 older adults who had falls in the last 12months and the control group included 31 subjects who had never experienced falls. The patients in the study group were examined with 24-hour Holter electrocardiogram (ECG) and carotid sinus massage was done under monitorization. The 24-hour Holter ECG data were recorded and assessed with the ELATEC software. HRV, QT dynamicity and HRT parameters were analysed. Results: Thirty-three faller and 31 non-faller patients were examined in this study. Age and gender were similar between groups. All patients and control subjects had normal ejection fraction. Carotid sinus massage was done to the patients in the study group and three of 33 were positive (9.09%). There was no significant difference in HRV and QT dynamicity parameters between groups. Both HRT onset (2.51±1.48 vs. 7.29±3.28 P <0.001) and turbulence slope (0.15±1.10 vs. −0.73±1.89; P =0.031) were significantly different between the groups. Conclusion: Elderly subjects with recent falls have significantly worse HRT parameters than matched non-falling counterparts. Blunted baroreflex sensitivity and impaired cardiac autonomic function can be an important reason for falls in the geriatric age group. [Copyright &y& Elsevier]

Objectives: Magnesium deficiency has been implicated as a factor in numerous chronic diseases and previous studies suggest a greater prevalence of occult magnesium deficiency among older adults. Serum is the choice for the assessment of most analyses used in clinical medicine, although serum magnesium concentrations have been shown to be poor predictors of intracellular magnesium concentration. The aim of this study was to compare intracellular and extracellular magnesium concentrations in geriatric outpatients. Moreover, we examined whether a significant correlation between magnesium parameters and clinical outcome existed. Design: Cross-sectional study. Setting: Geriatric medicine outpatient clinic of a university hospital. Participants: A total of 246 patients with a mean age of 71.9±5.7 years were involved. Measurements: Intra-erythrocyte magnesium levels were analyzed with atomic absorption spectrophotometry. Results: Serum magnesium levels were within normal range in all patients, whereas intra-erythrocyte magnesium measurements were low in 57% of the patients. Increase in serum levels were together with just only a slightly increase in intra-erythrocyte measurements and the relationship was very weak. Intra-erythrocyte Mg levels were not significantly correlated with many laboratory or clinical parameters. Conclusion: Our results confirm that intra-erythrocyte Mg does not correlate with serum levels and clinical parameters in geriatric outpatients, but further studies are needed to define the correlation. [ABSTRACT FROM AUTHOR]

BACKGROUND AND AIMS: Aging is accompanied by a progressive decline in serum testosterone. Evidence concerning the clinical manifestations of low serum testosterone levels is contradictory. We aimed to examine the age-related decline in testosterone and the possible clinical outcomes, including erectile dysfunction, prostatism, cognitive function, daily life activities, depression, and osteoporosis. METHODS: One hundred and twenty men underwent comprehensive geriatric assessment. Testosterone and free testosterone levels were measured, geriatric assessment scales, International Index of Erectile Function (IIEF) and International Prostate Symptom Scale (IPSS) were performed, and bone mineral densities were determined. RESULTS: The mean age of the 120 men was 73.8+/-5.90. A significant decrease in testosterone and free testosterone levels with increasing age was determined (p=0.021). It was also found that erectile dysfunction, as determined by IIEF (r=0.66, p<0.001), and symptoms of prostatism determined by IPSS (r=-0.23, p=0.016), were significantly associated with low free testosterone levels. Laboratory parameters, obesity, osteoporosis, cognitive function, daily life activities, and cardiovascular diseases were not significantly different between groups with low and normal free testosterone levels. CONCLUSION: Age-related decrease in free testosterone may lead to erectile dysfunction and symptoms of prostatism in elderly men. [ABSTRACT FROM AUTHOR]