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Background: The prevalence of frailty and its components may be affected by age, diseases and geriatric deficits. However, the current operational definition of frailty assigns equal weight to the five components of frailty. Aims: To perform a population-based assessment of physical frailty, its prevalence, and distribution of its components across different age, disease and deficit spectrum. Methods: From 2018 to 2019, we conducted a face-to-face cross-sectional assessment of a representative sample of older Poles. We obtained data on frailty components, chronic disease burden, and prevalence of particular diseases and geriatric deficits. We calculated weighted population estimates, representative of 8.5 million older Poles, of prevalence of frailty and its components across the disease burden, associated with the particular diseases and the geriatric deficits present. Results: Of 10,635 screened persons ≥ 60 years, 5987 entered the face-to-face assessment. Data of 5410 have been used for the present analysis. Seventy-two percent of the population are burdened with at least one frailty component. The estimated weighted population prevalence (95% CI) of frailty was 15.9% (14.6–17.1%), and of pre-frailty 55.8% (53.3–58.2%). Slow gait speed predominated across disease burden, specific diseases, geriatric deficits and the age spectrum. Overall, the prevalence of slow gait speed was 56.3% (52.7–60.0%), followed by weakness 26.9% (25.4–28.4%), exhaustion 19.2% (17.6–20.8%), low physical activity 16.5% (14.8–18.3%), and weight loss 9.4% (8.4–10.3%). Conclusions: Slow gait speed predominates among the components of frailty in older Poles. This may affect the component-tailored preventive and therapeutic actions to tackle frailty. [ABSTRACT FROM AUTHOR]

Background: Ankle-brachial index (ABI) is a screening tool for peripheral arterial disease (PAD). However, persons with normal ABI may still exhibit abnormalities in the physical examination of arterial system (PHEA). Objective: In older persons from the PolSenior study, we aimed to assess the risk of total mortality associated with abnormalities in PHEA in the context of dichotomised ABI. Methods: We used data from the PolSenior survey and matched them with mortality information from the Polish Census Bureau. We obtained sociodemographic, medical history, and lifestyle data. The PHEA by a geriatrician included carotid, femoral, popliteal, posterior tibial and the dorsalis pedis arterial pulses, and auscultation of aorta, carotid, femoral, and renal arteries. Ankle-brachial index was tibial to brachial SBP ratio. We plotted the stratified Kaplan–Meier curves and used Cox's regression to assess the unadjusted and adjusted influence of PHEA result on time to death. Results: The mean (standard deviation, SD) age of 852 persons (46.7% women) was 74.7 (10.6) years. In the ABI < 0.9 group, the PHEA was not associated with mortality. However, in the ABI ≥ 0.9 group, both in unadjusted and adjusted (RHR; 95% CI: 1.08; 1.02–1.16, p = 0.01) Cox regression, PHEA greater by 1 score was associated with mortality. Presence of 4 or more PHEA abnormalities was raising the risk in the ABI ≥ 0.9 group to the level associated with ABI < 0.9. Conclusions: In the older persons with normal ABI, the greater number of abnormalities during physical examination of arteries may be indicative of higher risk of death. [ABSTRACT FROM AUTHOR]

Background: It seems that caregivers (CGs) may be a reliable source of information for determining health condition of seniors. This might be important for general practitioners (GPs) and facilitate them conducting comprehensive geriatric assessment (CGA). The objectives of our study were to: compare populations of older patients with and without CGs, characterise the group of CGs, establish whether CGs are aware of patients' deficiencies in areas of CGA. Methods: Patients aged at least 65 years underwent CGA using eight tools in GPs' practices in and around Krakow, Poland. Seniors were divided into two groups: with and without CGs. CGs filled in an authors' questionnaire on their data and assessed seniors in eight domains corresponding to the tests used in CGA. Patients with and without CGs were also compared in terms of CGA results and basic demographic and medical data. Subjective CGs' responses were compared with objective CGA results. Results: We conducted CGA on 438 senior patients. Two hundred fifty eight (59%) of them were classified as patients with CGs. Patients with CGs were older, less educated, more often lived in rural areas and were more frequently in a relationship (as all p < 0.05). In seniors with CGs, the results of frailty (p < 0.008) and insomnia scales (p = 0.049) were significantly worse. Mostly, CGs could properly assess seniors in basic and complex living activities and nutritional status. They were less precise in determining deficits like depressive tendency and insomnia. Conclusions: CGs' assessment of older patients can be a valuable source of information about seniors and can be helpful in diagnosing important health issues. CGs have difficulties when asked to properly assess depression and insomnia in the older adults they care for and their answers do not always correspond with the results of CGA. GPs should pay more attention to the needs of CGs themselves and provide them with the necessary knowledge about caring for older people. [ABSTRACT FROM AUTHOR]

To assess the relationship between ankle-brachial index (ABI) and up to 10-year mortality in older individuals below and above the age of 80 years. In a multicenter survey of health status in the community dwelling subjects aged 55–59 and 65 + years in Poland, we assessed baseline medical history including risk-factors. We measured ABI, and serum creatinine, cholesterol, NT-proBNP, and interleukin-6 (IL-6) concentrations. We assessed mortality based on public registry. Between 2009 and 2019, 27.3% of 561 participants < 80 years, and 79.4% of 291 participants ≥ 80 years, died (p < 0.001); 67.8, 41.5, and 40.3% in the ABI groups < 0.9, 0.9–1.4, and > 1.4, respectively (p < 0.01). In the unadjusted Cox models, ABI was associated with mortality in the entire group, and < 80 years. In the entire group, analysis adjusted for age and sex showed mortality risk increased by 11% per year, and 50% with male sex. Mortality decreased by 37% per 1 unit ABI increase. In the group of people ≥ 80 years, only age was significantly associated with mortality (p < 0.001). In stepwise regression ABI < 0.9, male sex, active smoking, and NT-proBNP level were associated with risk of death < 80 years. In the ≥ 80 years old, mortality risk was associated with older age, and higher levels of IL-6, but not ABI. The ABI < 0.9 is associated with higher mortality in older people, but not among the oldest-old. In the oldest age group, age is the strongest predictor of death. In this age group, inflammageing is of importance. [ABSTRACT FROM AUTHOR]

Objective: The impact of fast changes in obesity indices on other measures of metabolic health is poorly defined in the general population. Using the Polish accession to the European Union as a model of political and social transformation we examined how an expected rapid increase in body mass index (BMI) and waist circumference relates to changes in lipid profile, both at the population and personal level. Methods: Through primary care centres in 444 Polish cities, two cross-sectional nationwide population-based surveys (LIPIDOGRAM 2004 and LIPIDOGRAM 2006) examined 15,404 and 15,453 adult individuals in 2004 and 2006, respectively. A separate prospective sample of 1,840 individuals recruited in 2004 had a follow-up in 2006 (LIPIDOGRAM PLUS). Results: Two years after Polish accession to European Union, mean population BMI and waist circumference increased by 0.6% and 0.9%, respectively. This tracked with a 7.6% drop in HDL-cholesterol and a 2.1% increase in triglycerides (all p<0.001) nationwide. The direction and magnitude of the population changes were replicated at the personal level in LIPIDOGRAM PLUS (0.7%, 0.3%, 8.6% and 1.8%, respectively). However, increases in BMI and waist circumference were both only weakly associated with HDL-cholesterol and triglycerides changes prospectively. The relation of BMI to the magnitude of change in both lipid fractions was comparable to that of waist circumference. Conclusions: Moderate changes in obesity measures tracked with a significant deterioration in measures of pro-atherogenic dyslipidaemia at both personal and population level. These associations were predominantly driven by factors not measureable directly through either BMI or waist circumference. [ABSTRACT FROM AUTHOR]

Background: To evaluate the relationship between bone loss and new bone formation in ankylosing spondylitis (AS) using 10-year X-ray, dual-energy x-ray absorptiometry (DXA) and quantitative computed tomography (QCT) follow-up.Methods: Fifteen AS patients free from medical conditions and drugs affecting bone metabolism underwent X-ray, DXA and QCT in 1999 and 2009.Results: In spine QCT a statistically significant (p = 0,001) decrease of trabecular bone mineral content (BMC) was observed (change ± SD: 18.0 ± 7.3 mg/cm3). In contrast, spine DXA revealed a significant increase of bone mineral density (change ± SD: -0.15 ± 0.14 g/cm2). The mean BMC, both at baseline and follow-up was significantly lower (p = 0.02 and p = 0.005, respectively) in advanced radiological group as compared to early radiological group. However, in multiple regression model after adjustment for baseline BMC, the baseline radiological scoring did not influence the progression of bone loss as assessed with QCT (p = 0.22, p for BMC*X-ray syndesmophyte scoring interaction = 0.65, p for ANOVA-based X-ray syndesmophyte scoring*time interaction = 0.39). Baseline BMC was the only significant determinant of 10-year BMC change, to date the longest QCT follow-up data in AS.Conclusions: In AS patients who were not using antiosteoporotic therapy spine trabecular bone density evaluated by QCT decreased over 10-year follow-up and was not related to baseline radiological severity of spine involvement. [ABSTRACT FROM AUTHOR]

Abstract: Falls are a geriatric syndrome which affects the physical and psychological well-being of the aged. So far, in Poland there have not been any population-based data on the prevalence of falls among the elderly. The aim of this analysis was to assess the prevalence of falls, their circumstances and consequences in the Polish population aged 65years and older in comparison to younger respondents aged 55–59years, and the relation of falls to visual and hearing deficits. Mean age of the 4920 elderly subjects (51.6% men) was 79.4±8.7years. Falls in the past year were reported by 10.4% of the younger and 19.1% of the older subjects. In both groups falls occurred more frequently in women (11.9% vs. 8.7%, p=0.03 in the younger and 22.7% vs. 13.2%, p<0.001 in the older group). In the group of older subjects falls occurred most often during walking (66.7% vs. 50.7% in the group of 55–59years old), p=0.005), while the younger more often fell while practicing sports (5.48% vs. 0.8% in the group 65+, p<0.001) and risky activities (respectively: 13.7% vs. 4.9%, p=0.002). A similar percentage of younger and older fallers reported one (44.0% and 46.1% respectively) or more falls (56.1% and 53.9%; p=0.6). The percentage of recurrent fallers grew with increasing age (Cc=0.177; p<0.001). The prevalence of injurious falls was similar in the younger and older groups (45.4% and 42.8%, p=0.53). In both genders fall-related injuries were more frequent in younger elderly (65–74years old) and in subjects 90years old and older. In the non-standardized analysis and after adjustment for age and gender visual and hearing impairments and its degree were associated with falls but both relations lost statistical significance after adjustment for a set of explanatory variables. Despite somewhat lower estimates, falls in older Poles are no less an important factor influencing overall health than in other populations. The higher prevalence of multiple falls should draw attention of the health-care policy makers. Sensory impairment may add to the risk of falls and should be adequately taken care of, however the priority in the future fall prevention initiative should be given to stronger factors, such as age, type of activity, overall health, cognitive function and functional status. [Copyright &y& Elsevier]

I n t r o d u c t i o n: Despite increased awareness of malnutrition and improved nutrition-related policies, there are still cases of deterioration of nutritional status during hospitalisation. NutritionDay is an audit organised by the European Society for Clinical Nutrition and Metabolism (ESPEN), the Medical University of Vienna and the Friedrich-Alexander University Erlangen-Nürnberg (FAU) to prevent the onset of malnutrition and to improve hospital policies to deal with this problem. The aim of the study was to analyse the results of the audit with regard to factors that may contribute to the deterioration of a patients' nutritional status in hospital setting. Materials and Methods: This cross-sectional study was performed in a tertiary teaching hospital and was part of an international audit. The questionnaires used were provided by the nutritionDay office, and included information on weight loss, patients' appetite, dietary restrictions, food intake and reasons for food rejection during hospital stay. R e s u l t s: Of the examined patients, 61% reported weight loss prior to the current hospital stay. We identified 25 patients who did not consume a whole portion of their main meal on the day the audit took place. Approximately 17% of the patients' complaints could be resolved within a hospital ward. C o n c l u s i o n s: Hospital patients often eat less than a standard meal portion. Identifying the reasons for meal rejection may be helpful for development of standards for nutritional care in the hospitals.

B a c k g r o u n d: Due to current increased life expectancy, the quality of life (QoL) of senior patients is gaining in importance. The aims of this study were: to estimate QoL in a group of patients, aged above 64 years, that is cared for by general practitioners (GPs) in Krakow, Poland, and to find relation- ships between elements of QoL and the results of comprehensive geriatric assessment (CGA) and other important medical and social factors. M e t h o d s: We designed a cross-sectional, questionnaire study among patients who attended GPs' surgeries from April 2018 to April 2019. To examine the patients, we used the Euro-Quality of Life Questionnaire (EQ-5D-5L) and eight scales forming CGA: the Activities of Daily Living, the Instrumental Activities of Daily Living, Mini-Mental State Examination, Geriatric Depression Scale, Timed Up and Go Test, Mini Nutritional Assessment, Clinical Frailty Scale and Athens Insomnia Scale. R e s u l t s: The lowest QoL was observed in dimensions of pain/discomfort and mobility, where 70% and 52% of patients, respectively, reported problems in these areas. Only 91 (21%) respondents had highest results in all five dimensions of QoL. The average score in the Visual Analogue Scale (VAS) of the EQ-5D-5L (representing self-rated health on a given day) was 62.36 ± 18.98 points. Statistically significant relationships were observed between QoL and age, physical activity and multimorbidity (in all cases p <0.001). The results of QoL were correlated with every aspect of CGA, while the strongest relationship was noticed between scores in the EQ-5D-5L VAS scale and scales assessing depression and frailty (p <0.001; r = -0.57 both).

Background: COVID-19 has affected older persons the most. The propensity to have severe COVID-19 or die of the infection was especially prevalent among older subjects with multimorbidity, frailty and sarcopenia. The aim of our study was to check which of the simple clinical biomarkers, including the assessment of muscle and frailty, would associate with the survival and the length of hospital stay in older patients with COVID-19. An additional aim was to report the influence of chronic diseases, chronic medication use, and COVID-19 signs and symptoms on the aforementioned outcome measures., Methods: The CRACoV study was a prospective single-center (University Hospital in Krakow, Krakow, Poland) observational study of clinical outcomes in symptomatic COVID-19 patients that required hospital treatment. We analysed data of persons aged ≥ 65 years. We assessed muscular parameters in accordance with EWGSOP2, frailty with the Rockwood Clinical Frailty Scale. We used the data of the initial and 3-month assessment. Demographic characteristics, past medical history, and baseline laboratory values were gathered as a part of routine care. We calculated sex and age, and additionally number-of-diseases adjusted odds ratios of mortality associated with studied factors and betas of the relation with these factors and the length of hospital stay., Results: The mean (standard deviation, SD) age of 163 participants (44.8% women, 14.8% died) was 71.8 (5.6) years, age range 65-89 years. One score greater SARC-F was associated with 34% (p = 0.003) greater risk of death, and 16.8 h longer hospital stay (p = 0.01). One score greater Rockwood was associated with 86% (p = 0.002) greater risk of death, but was unrelated to the length of hospital stay. Hand grip strength and dynapenia were unrelated to mortality, but dynapenia was related to longer hospital stay. Probable sarcopenia was associated with 441% (p = 0.01) greater risk of death., Conclusions: In conclusion, the patient assessment with SARC-F and the Rockwood Clinical Frailty Scale may significantly improve the prediction of outcomes in older patients with COVID-19 and by extension might be of use in other acute severe infections. This, however, requires further research to confirm., (© 2022. The Author(s).)

Background: Sarcopenia is a potentially reversible condition, which requires proper screening and diagnosis., Aims: To validate a Polish version of sarcopenia screening questionnaire (SARC-F), and assess its clinical performance., Methods: Cross-sectional validation study in community-dwelling subjects ≥ 65 years of age. Diagnosis of sarcopenia was based on the 2018 2nd European Working Group on Sarcopenia in Older People (EWGSOP2) consensus. Hand grip and 4-m gait speed were measured, and the Polish version of SARC-F was administered., Results: The mean (SD) age of 73 participants (21.9% men) was 77.8 (7.3) years. Seventeen participants (23.3%) fulfilled the EWGSOP2 criteria of sarcopenia, and 9 (12.3%) criteria for severe sarcopenia. Fourteen (19.2%) participants fulfilled the SARC-F criteria for clinical suspicion of sarcopenia. The Cronbach's alpha coefficient for internal was 0.84. With EWGSOP2 sarcopenia as a gold standard, the sensitivity of SARC-F was 35.3% (95% CI 14.2-61.7, p = 0.33), specificity was 85.7% (95% CI 73.8-93.6, p < 0.0001). The corresponding positive and negative predictive values were 42.9% (p = 0.79) and 81.4% (p < 0.0001), respectively. The probability of false-positive result was 14.3% (95% CI 6.4-26.2, p < 0.0001) and the probability of false-negative result was 64.7% (95% CI 38.3-85.8, p = 0.33). Overall the predictive power of SARC-F was low (c-statistic 0.64)., Discussion: SARC-F is currently recommended for sarcopenia case finding in general population of older adults. However, its sensitivity is low, despite high specificity., Conclusions: At present SARC-F is better suited to rule out sarcopenia then to case-finding. Further refinement of screening for sarcopenia with the use of SARC-F seems needed.

Bariatric surgery is considered as a first line treatment in extreme obese patients to achieve a reduction in health risks. However, after surgical procedure obese patients with normal blood pressure (BP) levels still present residual risk, which may be partly related to lack of correction of BP profile and variability., Aim: To evaluate short (10 days) and mid-term (6 months) changes of mean values, profile and variability of BP after bariatric surgery in extremely obese patients with and without hypertension., Materials & Methods: A follow-up of cross-sectional study was conducted in 90 obese patients (aged 41.7 ± 11.3, BMI = 46.7 ± 5.7 kg/m2), who met the eligibility criteria and underwent bariatric surgery. Each patient underwent 24-h ambulatory BP monitoring with profile and variability estimation before, 10 days and 6 months after the intervention., Results: Sixty-seven (74.4%) patients had hypertension. Significant decrease from baseline in mean values of systolic and diastolic BP in 10 days (p < .005) and 6 months (p < .005) follow-up were observed only in patients with hypertension. Moreover, only hypertensive subjects revealed significant reduction (p < 0,05) from baseline in 24-h systolic and diastolic BP weighted standard deviation and average real variability after surgical procedure. No changes were found in dipping status., Conclusions: Bariatric surgery not only decreased BP levels, but also contributed to reduction in BP variability in early period after intervention mainly in patients with pre-existing hypertension., (Copyright © 2018 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.)

Background and Purpose: Spontaneous intracerebral haemorrhage (ICH) is the most fatal form of stroke with the highest morbidity and disability rate of all stroke types. Recent data suggest that the genetic background has a sizeable and mostly undiscovered effect on the brain haemorrhage risk. Since the coagulation system is crucial to ICH pathology, we studied the significance of the FGA Thr312Ala polymorphism in two European populations., Materials and Methods: We genotyped 550 and 224 controls as well as 261 and 242 stroke patients in Polish and Greek populations, respectively. The ICH diagnosis was confirmed by computed tomography. The FGA Thr312Ala polymorphism was analysed using real-time polymorphism chain reaction., Results: Both crude and multivariable regression analyses showed that the studied polymorphism is a protective factor in the Polish population under the dominant and additive models of inheritance. Those results did not replicate in the Greek population. The meta-analysis of results from the Polish and the Greek populations proved that FGA Thr312Ala polymorphism affects the risk of ICH in the dominant model of inheritance., Conclusions: The FGA Thr312Ala polymorphism affects a risk for ICH in the Polish but not in the Greek population. An advanced meta-analysis of well-designed studies with a significant number of cases might provide useful information of novel polymorphisms, including the FGA Thr312Ala polymorphism, and their role in ICH pathology., (Copyright © 2014 Polish Neurological Society. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.)

Introduction: Heart failure (HF) in the elderly is frequently associated with limited therapeutic options and may cause severe complications. Unfortunately, these patients are often excluded from clinical trials., Objectives: The aim of the study was to determine the relationship between HF, coexisting diseases, and use of medications in patients of advanced age living in nursing homes., Patients and Methods: The study group included 79 women and 21 men between 65 and 102 years of age living in 2 nursing homes. Information about the health status of patients was gathered from history and medical records. We conducted a physical examination and, in eligible cases, also an orthostatic test. Comorbidity was assessed using the age‑adjusted Charlson comorbidity index (ACCI)., Results: The prevalence of HF was 26%. The number of chronic diseases coexisting with HF was remarkably higher than the number of diseases among patients without HF (median, 6 [0-11] vs. 3 [0-8]; P <0.0001). The ACCI was also higher in the HF group compared with patients without HF (median, 7 [5-12] vs. 5.5 [2-9]; P <0.0001). Patients with HF took significantly more medications, although HF was treated according to the current guidelines in less than half of the cases., Conclusions: Our data revealed that HF is associated with significant morbidity and polypharmacy. There is a need for further research that would guide therapy of HF in elderly patients with limited life expectancy and multiple comorbidities as inhabitants of nursing homes. Nonetheless, the current treatment of nursing home patients with HF seems to be suboptimal.

Frailty syndrome (FS) and cognitive impairment are associated with an increased risk of falls, disability, hospitalization and death. We investigated prognostic meaning of FS and cognitive impairment in persons ≥ 65 years, living in 2 nursing homes. Information about the health status of patients was gathered from history, medical documentation, test assessing FS, according to the Canadian Study of Health and Aging-Clinical Frailty Scale (CSHA-CFS) and the Mini-Mental State Examination (MMSE). The study group included 66 women and 20 men, between 66 and 101 years of age (mean ± S.D.=83.8 ± 8.3 years). The frequency of severe frailty (CSHA-CFS=7) among the elderly living in nursing homes was 34.9%, while severe cognitive impairment (MMSE<18) was present in 55.8%. Residents with severe FS and MMSE<18 consisted 33.7% of examined and 50.0% of those who died during 12-month follow-up, p<0.05. Individuals with severe FS and severe cognitive impairment (n=29) as compared to all other patients, were significantly less probable (59% vs. 79%, p=0.03) to survive one year. Neither frailty, nor dementia, nor severe FS or cognitive impairment when considered separately was associated with higher mortality rate. The risk assessment in severely disabled geriatric patients is best performed with measures of functional and cognitive function considered jointly, but not separately., (Copyright © 2011. Published by Elsevier Ireland Ltd.)

Introduction: Atrial fibrillation (AF) is the most common arrhythmia complicating heart failure (HF). The coexistence of these diseases may be partially explained by the presence of common risk factors. Although the effect of AF on the prognosis in HF is still debatable, it is associated with specific complications and affects therapy., Objectives: The aim of this analysis was to evaluate epidemiology and management of coexisting HF and AF among Polish outpatients., Patients and Methods: The present study was performed within the framework of the Polish National Cardiovascular Disease Prevention and Treatment Program, POLKARD 2003-2005, and included patients with HF treated in a representative number of 400 outpatient clinics. Data was collected using questionnaires and included demographic characteristics as well as information about coexisting diseases and treatment, provided by patients and physicians on the basis of the available medical records., Results: The study involved 3682 patients with HF (mean age 67.1 ±11.7 years; 58% of patients were men). AF was present in 38% of the patients. The prevalence of arrhythmia increased with the New York Heart Association class. We observed significant differences between the subgroups of patients with AF and those with sinus rhythm in terms of demographic parameters, risk factors, concomitant diseases, and therapy. Although the use of angiotensin-converting enzyme inhibitors and β-blockers was significantly lower in the subgroup with AF, a multivariable analysis showed that it was associated with specific demographic characteristics and comorbidities rather than with arrythmia itself. Specialty patient care was associated with increased use of therapy aimed to improve the prognosis of HF patients., Conclusions: Patients with AF constitute a particular subgroup within the population of patients with HF. A specific distribution of risk factors with a significant effect of noncardiac diseases may confound HF therapy in this patient group. Specialty care may be able to optimize treatment in patients with coexisting HF and AF.