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Limited literature has investigated the association between food insecurity and sarcopenia in low- and middle-income countries (LMICs). Therefore, the aim of the present study was to investigate the association between food insecurity and sarcopenia among adults aged ≥65 years in six LMICs. Community-based cross-sectional data of the Study on Global Ageing and Adult Health were analyzed. Sarcopenia was defined as the presence of low skeletal muscle mass based on indirect population formula, and either slow gait or low handgrip strength. In the past, 12-month food insecurity was assessed with two questions on frequency of eating less and hunger due to lack of food. Multivariable logistic regression analysis was conducted. The final sample consisted of 14,585 individuals aged ≥65 years (mean (SD) age 72.6 (11.5) years, 55.0% females). The prevalence of sarcopenia among those with no food insecurity was 13.0% but this increased to 24.4% among those with severe food insecurity. After adjustment for potential confounders, compared to no food insecurity, severe food insecurity was associated with 2.05 (95%CI = 1.12–3.73) times higher odds for sarcopenia. In this large representative sample of older adults from multiple LMICs, it was found that severe food insecurity is associated with higher odds for sarcopenia. Addressing food insecurity in such settings may be an effective strategy to curb the high prevalence of sarcopenia in LMICs.

BackgroundPrevalence of erectile dysfunction (ED) in male survivors of cancer across cancer types has not been systematically analysed.AimTo estimate the prevalence of ED in all types of cancer and identify characteristics associated with ED in survivors of cancer.Design and settingSystematic review and meta-analysis (MA) of cross-sectional studies.MethodMEDLINE, CINAHL, PsycINFO, and EMBASE were searched, targeting reports published from inception to 1 February 2020. All retrospective or prospective studies reporting prevalence of ED in male patients with cancer and using a validated tool for detection of ED were included. A random-effects MA model was used to pool prevalence of ED as absolute estimates at three different stages, that is, ‘healthy’, ‘at diagnosis’, and ‘after treatment’. A univariate MA regression including the three-level group variable as the only independent variable was used to assess the difference in ED prevalence across the three groups. Further MAs were conducted for studies involving patients at diagnosis and after treatment, and statistical inferences were made with setting for multiple testing controlling for a false discovery rate (FDR) ResultsIn total, 1301 studies were assessed for inclusion. Of these, 141 were potentially eligible and subsequently scrutinised in full text. Finally, 43 studies were included with a total of 13 148 participants. Overall, pooled data of the included studies showed an ED prevalence of 40.72% (95% confidence interval [CI] = 31.80 to 50.29) in patients with cancer, with prevalences of 28.60% (95% CI = 12.10 to 53.83) at time of diagnosis and 42.70% (95% CI = 32.97 to 53.03) after treatment, with significant difference between these two stages and across cancer locations, controlling for an FDR ConclusionErectile dysfunction was particularly high in male survivors of cancer and was associated with cancer treatment, cancer site, and age.

Objectives: The objective of this study was to investigate associations between anemia with geriatric syndromes and comprehensive geriatric assessment (CGA) parameters in older women.\ud \ud Methods: 886 older outpatient women were included . Anemia was defined as a hemoglobin concentration below 12 g/dL. patients were divided into two groups as anemic and non-anemic. The relationships between anemia and CGA parameters/geriatric syndromes were determined.\ud \ud Results: The mean age of the participants was 76.00 ± 8.91. The prevalence of patients with anemia was 15.35%. There was a significant difference between anemic and non-anemic groups in terms of age, Charlson Comorbidity Index, body mass index, the number of drugs used, and the presence of chronic renal failure (p < 0.05). After adjustment for these covariates, anemia was associated with Timed Up and Go test (OR: 1.10, 95% CI: 1.02–1.18), muscle strength (OR: 0.99, 95% CI: 0.83–0.99), dynapenia (OR: 1.92, 95% CI: 1.06–3.47), Mini Nutritional Assessment scores (OR: 0.88, 95% CI: 0.83–0.94), poor nutritional status (OR: 1.97, 95% CI: 1.10–3.48), Fried scores (OR: 1.42, 95% CI: 1.24–1.68), frailty (OR: 2.58, 95% CI: 1.42–4.69), falls (OR: 1.78, 95% CI: 1.10–2.92) and polypharmacy (OR: 2.31, 95% CI: 1.38–3.86).\ud \ud Conclusion: In the present study anemia was associated with frailty, polypharmacy, poor nutritional status, falls, and decreased muscle strength. Therefore, anemia may be a sign of poor health status in older women. When anemia is detected in an older woman, CGA should be strongly considered if not routinely performed.

Introduction Osteoporosis and sarcopenia are significant health problems that mainly affect older adults. This study aimed to investigate the relationship between sarcopenia and osteoporosis. Materials and methods The study included 444 participants who had undergone a dual-energy X-ray absorptiometry scan, handgrip test, 4-m walking speed test, and bioimpedance analysis within the past year. Participants were classified into control, osteopenia, or osteoporosis groups according to the World Health Organization classification. Sarcopenia was diagnosed according to the European Working Group on Sarcopenia in Older People-2 criteria. Results The mean age of the participants was 75.88 +/- 7.20 years, and 80.9% were females. There were 144, 230, and 70 participants in the osteoporosis, osteopenia, and control groups, respectively. Probable sarcopenia was identified in 94 subjects, sarcopenia in 61, and severe sarcopenia in 72 participants. After adjusting for age, gender, and body mass index, probable sarcopenia and severe sarcopenia were associated with osteoporosis (p < 0.05). Low muscle strength, and low physical performance were associated with osteoporosis (p < 0.02). When osteoporosis was evaluated only according to the femoral neck T score, low muscle strength and low physical performance were found to be related not only to osteoporosis (p < 0.001), but also to osteopenia (p < 0.05). Additionally, probable sarcopenia was associated with femoral neck osteopenia (p < 0.01). Conclusions In this study, probable sarcopenia and severe sarcopenia were associated with osteoporosis in older adults. Furthermore, we found that low muscle strength, or dynapenia, which is the determining criterion of sarcopenia, was related to femoral neck osteopenia and osteoporosis.

Background:\ud \ud To examine the association between self‐reported food insecurity and depression in 34,129 individuals aged ≥50 years from six low‐ and middle‐income countries (LMICs) (China, Ghana, India, Mexico, Russia, and South Africa).\ud \ud Methods:\ud \ud Cross‐sectional, community‐based, nationally representative data from the WHO Study on global AGEing and adult health (SAGE) were analyzed. Self‐reported past 12‐month food insecurity was assessed with two questions on frequency of eating less and hunger due to lack of food. Questions based on the World Mental Health Survey version of the Composite International Diagnostic Interview were used for the endorsement of past 12‐month DSM‐IV depression. Multivariable logistic regression analysis and meta‐analysis were conducted to assess associations.\ud \ud Results:\ud \ud In total, 34,129 individuals aged ≥50 years [mean (SD) age, 62.4 (16.0) years; 52.1% females] were included in the analysis. Overall, the prevalence of moderate and severe food insecurity was 6.7% and 5.1%, respectively, while the prevalence of depression was 6.0%. Meta‐analyses based on countrywise estimates showed that overall, moderate food insecurity (vs. no food insecurity) is associated with a nonsignificant 1.69 (95% confidence interval [CI] = 0.82–3.48) times higher odds for depression, while severe food insecurity is significantly associated with 2.43 (95% CI = 1.65–3.57) times higher odds for depression.\ud \ud Conclusions:\ud \ud In this large representative sample of older adults from six LMICs, those with severe food insecurity were over two times more likely to suffer from depression (compared with no food insecurity). Utilizing lay health counselors and psychological interventions may be effective mechanisms to reduce depression among food‐insecure populations. Interventions to address food insecurity (e.g., supplemental nutrition programs) may reduce depression at the population level but future longitudinal studies are warranted.

Background:\ud \ud This cross-sectional study aimed to examine associations between excessive daytime sleepiness (EDS) with falls and falls related conditions in older adults.\ud \ud Methods:\ud \ud To assess EDS, the Epworth Sleepiness Scale was used, with a score of ≥11/24 points indicating EDS. Number of falls and fall history (at least one) in the last year were recorded. Timed Up and Go test (TUG) was used to assess fall risk. Sarcopenia was defined by SARC-F tool. A grip strength score of the dominant hand, measured with a hand-grip dynamometer, less than 16 kg in females and 27 kg in males was accepted as dynapenia. Frailty status was defined by five dimensions including shrinking, exhaustion, low levels of activity, weakness, and slowness with those scoring positive on ≥3 dimensions being categorized as frail. The relationship between EDS with outcomes including fall, number of falls, falls risk, dynapenia, sarcopenia and frailty was investigated.\ud \ud Results:\ud \ud Of the 575 outpatients (mean age 78.7 ± 7.5 years, female:70.4%), the prevalence of EDS was 19.8%. In the multivariable model adjusted for age, sex, living status, marital status, polypharmacy, osteoarthritis, Parkinson disease, depression and dementia; EDS was significantly associated with the number of falls last year (IRR = 1.94, 95% CI: 1.42–2.65) and sarcopenia (OR = 2.41, 95% CI: 1.41–4.12). EDS was not significantly associated with TUG based fall risk, frailty and dynapenia.\ud \ud Conclusions:\ud \ud EDS was observed in approximately one in every five older adults. EDS should be evaluated as part of geriatric assessment. Moreover, older patients with EDS should be further assessed for falls and sarcopenia.

The impact of mild hyponatremia on geriatric syndromes is not clear. Our aim was to determine associations between mild hyponatremia and results of comprehensive geriatric assessment tools in outpatient settings. We reviewed medical records of 1255 consecutive outpatient elderly subjects and compared results of comprehensive geriatric assessment measures among patients with mild hyponatremia (serum Na+ 130–135 mEq/L) versus normonatremia (serum Na+ 136–145 mEq/L). The comprehensive geriatric assessment measures included the Basic and Instrumental Activities of Daily Living, Mini Mental State Examination, Geriatric Depression Score, Tinetti Mobility Test, the Timed Up&Go Test, the Mini Nutritional Assessment, the handgrip test, the Insomnia Severity Index, polypharmacy, recurrent falls, urinary incontinence, orthostatic hypotension, and nocturia. Of the 1255 patients, 855 were female (68.1%), and the mean age was 73.7 ± 8.3 years. Mild hyponatremia was detected in 108 patients (8.6%). The median serum sodium was 140.5 [interquartile range (IQR) 138.4–141.8] versus 133.8 [IQR, 132.3–134.2] in normonatremia and mild hyponatremia groups, respectively (p

Background Motor signs in patients with dementia are associated with a higher risk of cognitive decline, institutionalisation, death and increased health care costs, but prevalences differ between studies. The aims of this study were to employ a natural language processing pipeline to detect motor signs in a patient cohort in routine care; to explore which other difficulties occur co-morbid to motor signs; and whether these, as a group and individually, predict adverse outcomes. Methods A cohort of 11,106 patients with dementia in Alzheimer's disease, vascular dementia or a combination was assembled from a large dementia care health records database in Southeast London. A natural language processing algorithm was devised in order to establish the presence of motor signs (bradykinesia, Parkinsonian gait, rigidity, tremor) recorded around the time of dementia diagnosis. We examined the co-morbidity profile of patients with these symptoms and used Cox regression models to analyse associations with survival and hospitalisation, adjusting for twenty-four potential confounders. Results Less than 10% of patients were recorded to display any motor sign, and tremor was most frequently detected. Presence of motor signs was associated with younger age at diagnosis, neuropsychiatric symptoms, poor physical health and higher prescribing of psychotropics. Rigidity was independently associated with a 23% increased mortality risk after adjustment for confounders (p = 0.014). A non-significant trend for a 15% higher risk of hospitalisation was detected in those with a recorded Parkinsonian gait (p = 0.094). Conclusions With the exception of tremor, motor signs appear to be under-recorded in routine care. They are part of a complex clinical picture and often accompanied by neuropsychiatric and functional difficulties, and thereby associated with adverse outcomes. This underlines the need to establish structured examinations in routine clinical practice via easy-to-use tools.

Purpose:\ud \ud We investigated the association between food insecurity and fall-related injury among older adults from six low- and middle-income countries (LMICs), and the extent to which this association is mediated by mental health.\ud \ud Methods:\ud \ud Cross-sectional, community-based, nationally representative data from the WHO Study on global AGEing and adult health (SAGE) were analyzed. Past 12-month food insecurity was assessed with two questions on frequency of eating less and hunger due to lack of food. Fall-related injury referred to those that occurred in the past 12 months. Multivariable logistic regression analysis and mediation analysis were conducted to assess associations.\ud \ud Results:\ud \ud Data on 14,585 adults aged ≥65 years [mean (SD) age 72.5 (11.5) years; 54.9% females] were analyzed. After adjustment for potential confounders, severe food insecurity (versus no food insecurity) was associated with 1.95 (95%CI = 1.11–3.41) times higher odds for fall-related injury. Moderate food insecurity was not significantly associated with fall-related injury (OR = 1.34; 95%CI = 0.81–2.25). The mediation analysis showed that 37.3%, 21.8%, 17.7%, and 14.0% of the association between severe food insecurity and fall-related injury was explained by anxiety, sleep problems, depression, and cognition, respectively.\ud \ud Conclusion:\ud \ud Severe food insecurity was associated with higher odds for injurious falls among older adults in LMICs, and a large proportion of this association may be explained by mental health complications. Interventions to improve mental health among those who are food insecure and a strong focus on societal and government efforts to reduce food insecurity may contribute to a decrease in injurious falls.

The present study aimed to investigate associations between alcohol consumption, including binge drinking, and sexual activity. Data were from 1,622 men and 2,195 women aged ≥50 years participating in the English Longitudinal Study of Ageing. Multivariable logistic regression was used to prospectively assess sex-specific associations between baseline frequency of alcohol use in the last year or binge drinking in the last week (self-reported in 2004/05) and sexual activity at 8-year follow-up (2012/13). Covariates included partner status, age, ethnicity, wealth, limiting long-standing illness, smoking status, physical activity, and depressive symptoms. After adjustment, regular alcohol consumption in the last year at baseline was associated with 111% higher odds (95% CI 1.36-3.27) of any past-year sexual activity at follow-up in men and 76% higher odds (95% CI 1.26-2.46) in women, while frequent alcohol consumption was associated with 175% higher odds (95% CI 1.75-4.32) of sexual activity in men and 100% higher odds (95% CI 1.38-2.89) in women, relative to drinking alcohol never or rarely. Binge drinking was also positively associated with sexual activity at follow-up after adjustment for covariates, with odds of being sexually active at follow-up 52% higher (95% CI 1.07-2.15) among men who reported binge drinking at baseline and 57% higher (95% CI 1.11-2.23) among female binge drinkers. These results suggest that regular, frequent or binge drinking may protect against a decline in sexual activity as people grow old. While this does not outweigh the health risks associated with excessive alcohol consumption, health practitioners should consider the association between alcohol use and sexual activity when screening older adults for alcohol use and when encouraging older adults to reduce their alcohol consumption.

PURPOSE: Ejaculatory dysfunction (EjD) and erectile dysfunction after cancer treatment are clinically important complications, but their exact prevalence by various kinds of cancer site and type of treatment is unknown. The aim of this systematic review and meta-analysis was to examine the available evidence and provide pooled estimates for prevalence of EjD and erectile dysfunction in relation to all cancer sites and identify characteristics associated with EjD in cancer patients. MATERIALS AND METHODS: We performed a systematic review and meta-analysis of cross-sectional and case-control studies. We searched 4 electronic databases (Medline®, CINAHL, PsychInfo and Embase®) until July 22, 2020. All retrospective or prospective studies reporting the prevalence of EjD in male patients with cancer were included in this review. A random effects meta-analysis was conducted calculating prevalence proportions with 95% confidence intervals. Prevalence proportions were calculated for the incidences of EjD by cancer site and type of treatment. RESULTS: A total of 64 studies (a total of 10,057 participants) were included for analysis. The most common cancer sites were bladder, colon, testis and rectum. The prevalence rates of EjD after surgical intervention ranged from 14.5% (95% CI 2.2-56.3) in colon cancer to 53.0% (95% CI 23.3-80.7) in bladder cancer. The prevalence rates of erectile dysfunction ranged from 6.8% (95% CI 0.8-39.1) in bladder cancer to 68.7% (95% CI 55.2-79.6) in cancer of the rectum. CONCLUSIONS: In a large study-level meta-analysis, we looked at a high prevalence of EjD and erectile dysfunction at various cancer sites and across different treatment types. Prospective studies of EjD and erectile dysfunction after various kinds of cancer treatments are warranted.

Background: Body weight may be arisk factor for anxiety; however, there is ascarcity of studies on this association in older adults especially from low and middle income countries (LMICs). Therefore, we investigated the association between body mass index (BMI) and anxiety symptoms among adults aged ≥ 50years from 6 LMICs. Methods: Cross-sectional, community-based, nationally representative data from the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) were analyzed. The BMI was based on measured weight and height and was categorized as

Objectives:\ud \ud The aim was to analyse the overall and sex-specific associations between cannabis use and physical activity and sedentary behaviour.\ud \ud Study design:\ud \ud Cross-sectional analyses from the National Health and Nutrition Examination Survey (NHANES).\ud \ud Methods:\ud \ud Data on cannabis use and leisure time physical activity and sedentary behaviour from NHANES cycles 2007–2008 to 2015–2016 were analysed. Multivariable regression models were carried out.\ud \ud Results:\ud \ud About 15,822 participants were analysed (mean age ± standard error = 37.5 ± 0.19 years, range 20–59 years). Significantly higher odds were found for being active and ever used cannabis in the overall sample (odds ratio [OR] = 1.2, 95% confidence interval [CI]: 1.1–1.4) and in males (OR = 1.3, 95% CI: 1.1 to 1.5) and females (OR = 1.2, 95% CI: 1.0–1.4), respectively. In respective of sedentary behaviour, ever used cannabis was associated with higher odds of TV viewing ≥2 h/day in the overall sample (OR = 1.2, 95% CI: 1.0–1.4). However, this association was observed in males only (OR = 1.3, 95% CI: 1.1–1.6). Ever used cannabis was associated with total sitting time (beta-coefficient = 0.3, 95%CI: 0.1–0.4), which was more evident in females (beta-coefficient = 0.4, 95% CI: 0.1–0.6).\ud \ud Conclusions:\ud \ud Cannabis consumption was associated with higher levels of physical activity and sitting time. When intervening to reduce cannabis consumption in the US populations, it may be appropriate to promote physical activity and ensure physical activity is maintained once cannabis consumption is stopped.

Highlights • We carried out an umbrella review of systematic reviews with meta-analyses of observational studies on handgrip strength and all health outcomes. • Three outcomes (lower all-cause mortality, lower cardiovascular mortality, and lower risk of disability) were found to have highly suggestive evidence. • One outcome (chair rise performance over time) was found to have suggestive evidence. • Five outcomes (walking speed, inability to balance, hospital admissions, cardiac death, and mortality in those with chronic kidney disease) were found to have weak evidence., Purpose The aim of the present study was to assess both the credibility and strength of evidence arising from systematic reviews with meta-analyses of observational studies on handgrip strength and health outcomes. Methods An umbrella review of systematic reviews with meta-analyses of observational studies was conducted. We assessed meta-analyses of observational studies based on random-effect summary effect sizes and their p values, 95% prediction intervals, heterogeneity, small-study effects, and excess significance. We graded the evidence from convincing (Class I) to weak (Class IV). Results From 504 articles returned in a search of the literature, 8 systematic reviews were included in our review, with a total of 11 outcomes. Overall, nine of the 11 of the outcomes reported nominally significant summary results (p < 0.05), with 4 associations surviving the application of the more stringent p value (p, Graphical Abstract Image, graphical abstract

Background: Little is known about the association between cataract and multimorbidity. Therefore, the aim of the present study was to examine the relationship between cataract and chronic conditions and multimorbidity in a large representative sample of Spanish adults. Methods: This study used data from the Spanish National Health Survey 2017, a cross-sectional sample of 23,089 adults aged ≥15 years from Spain [54.1% female; mean (standard deviation) age 53.4 (18.9) years]. Cataract and 30 other physical and mental chronic conditions were self-reported. Multimorbidity was defined as the presence of at least two physical and/or mental chronic conditions (excluding cataract). Control variables included sex, age, marital status, education, smoking, and alcohol consumption. Multivariable logistic and negative binomial regression analyzes were conducted to assess associations. Results: The prevalence of cataract and multimorbidity was 12.5% and 56.5%, respectively. All chronic conditions were significantly more frequent in individuals with than in those without cataract. Overall, there was a positive relationship between cataract and multimorbidity [odds ratio (OR) = 2.77; 95% confidence interval (CI): 2.39–3.21]. In addition, cataract was significantly associated with the number of chronic conditions in the whole population [incidence rate ratio (IRR) = 1.34; 95% CI: 1.29–1.38]. Conclusions: Cataract is positively associated with chronic conditions and multimorbidity in adults. Interventions specifically designed for those with cataract to reduce or manage co-occurring chronic conditions and multimorbidity are urgently required. © 2020, The Author(s), under exclusive licence to The Royal College of Ophthalmologists.

AIMS:\ud \ud Stem cells are a promising therapy for various medical conditions. The literature regarding their adoption for the clinical care of cardiovascular diseases (CVD) is still conflicting. Therefore, our aim is to assess the strength and credibility of the evidence on clinical outcomes and application of stem cells derived from systematic reviews and meta-analyses of intervention studies in CVD.\ud \ud METHODS and RESULTS:\ud \ud Umbrella review of systematic reviews with meta-analyses of randomized controlled trials (RCTs) using placebo/no intervention as control group. For meta-analyses of RCTs, outcomes with a random-effect p-value< 0.05, the GRADE (Grading of Recommendations Assessment, Development and Evaluation) assessment was used, classifying the evidence from very low to high. From 184 abstracts initially identified, 11 meta-analyses (for a total of 34 outcomes) were included. Half of the outcomes were statistically significant (p

Background & aims: Hydroxychloroquine (HCQ) and chloroquine (CQ) are anti-malarial drugs frequently used in the rheumatologic field. They were recently identified as potential therapeutic options for Coronavirus Disease (COVID-19). The present study aims to map and grade the diverse health outcomes associated with HCQ/CQ using an umbrella review approach. Methods: Umbrella review of systematic reviews of observational and intervention studies. For observational studies, random-effects summary effect size, 95% confidence interval, and 95% prediction interval were estimated. We also assessed heterogeneity, evidence for small-study effect, and evidence for excess significance bias. The quality of evidence was then graded using validated criteria from highly convincing to weak. The evidence from randomized controlled trials (RCTs) was graded using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool. Results: From 313 articles returned in the literature search, six meta-analyses were included (n = 25 outcomes). Among meta-analyses (MAs) of observational studies, HCQ/CQ are weakly associated with a reduced risk for cardiovascular events and diabetes when used for autoimmune diseases and with spontaneous abortion; they are also associated with a higher risk of death in COVID-19 patients. Among MAs of RCTs, HCQ/CQ are associated with an improvement of articular manifestations of rheumatic diseases. Conclusions: There is high evidence of the efficacy of HCQ/CQ in the rheumatologic field. The lack of evidence for efficacy and the risk of death associated with the use of HCQ/CQ for COVID-19 indicate the inappropriateness of their inclusion in recent COVID-19 therapy guidelines and the urgent need for RCTs to determine eventual appropriateness as a COVID-19 therapy. Keywords: COVID-19; Chloroquine; Hydroxychloroquine; umbrella review. https://www.sciencedirect.com/science/article/pii/S1201971220325418?via%3Dihub

Objectives There is a scarcity of data on the association between mild cognitive impairment (MCI) and falls, especially from low- and middle-income countries (LMICs) where 70% of all older adults reside. Thus, we investigated the association between MCI and fall-related injury among older adults residing in six LMICs (China, Ghana, India, Mexico, Russia, South Africa). Design Cross-sectional, community-based data from the WHO Study on global AGEing and adult health (SAGE) were analyzed. Methods The definition of MCI was based on the National Institute on Ageing-Alzheimer's Association criteria, and information on past 12-month fall-related injury was also collected. Multivariable logistic regression analysis was conducted to assess associations. Results The analytical sample consisted of 13,623 individuals aged ≥65 years [mean (SD) age 72.3 (10.9) years; 45.6% males]. The prevalence of fall-related injury was higher among those with MCI (6.3%) vs. no MCI (4.1%). After adjustment for potential confounders, MCI was associated with a 1.53 (95%CI = 1.12–2.07) times higher odds for fall-related injury. Conclusions MCI was associated with higher odds for fall-related injury among older adults in LMICs. Future studies are warranted to investigate the mechanisms underlying this association and to elucidate whether targeting those with MCI can lead to reduced risk for falls among older adults.

In the last few decades, Hippocratic medicine has been replaced by syndromal medicine, and the concept of geriatric syndrome has emerged. So far dementia, delirium, depression, incontinence, falls, polypharmacy, malnutrition, pressure ulcers, sarcopenia, and frailty have been accepted as geriatric syndromes. Should orthostatic hypotension (OH), the frequency of which increases with age, in the development of which many pathological and etiological factors play a role, and that have many negative clinical results, be accepted as “geriatric syndrome”? In this chapter, an answer to this question will be sought.

Comorbidities are defined as the presence of more than 1 distinct condition in an individual, and the term geriatric syndrome is used to highlight the unique features of common health conditions in older adults. This chapter first discusses the relationship between key geriatric syndromes and OH, and then continues to discuss the relationship between OH and comorbidities. Finally, limitations of the available literature are considered and advise for geriatricians is provided.

Aim: Although mild hypomagnesemia is frequently asymptomatic, given it’s widespread physiological roles through the body system hypomagnesemia may be associated with crucial patient outcomes in elderly, whose body systems are more prone to disease states. In this study, we have evaluated association of hypomagnesemia with geriatric syndromes and mortality among subjects with an age of 65 years or more.Material and Methods: Electronic medical records of subjects who were evaluated in geriatrics clinic were reviewed retrospectively. A serum magnesium level of, Amaç: Hafif hipomagnezemi sıklıkla asemptomatik olmasına rağmen vücutta önemli olan çok sayıda sistem üzerindeki kofaktör rolü nedeniyle bu sistemleri daha duyarlı yaşlı bireylerde hipomagnezemi ciddi hasta sonlanımlarıyla birlikte olabilir. Ayaktan geriatri polikliniğinde değerlendirilen 65 yaş ve üzeri bireylerde hipomagnezeminin geriatrik sendromlar ve mortalite ile ilişkisini değerlendirmeyi hedefledik.Gereç ve Yöntemler: Geriatri polikliniğinde değerlendirilen tüm bireylerin (≥65 yaş) elektronik tıbbi kayıtları geriye dönük incelendi. Serum magnezyum düzeyi

Background:\ud \ud The development of cognitive impairment and Fear of Falling (FoF) are strongly linked, but prevalence of FoF is not known in patients with different types of dementia. This study aims to evaluate and compare the prevalence and severity of FoF in patients' with dementia with Lewy bodies (DLB), Alzheimer disease (AD), and non-dementia.\ud \ud Methods:\ud \ud 46 participants with DLB, 86 participants with AD and participants without dementia (controls), underwent Comprehensive Geriatric Assessment (CGA). The Falls Efficacy Scale–International (FES-I) was used to determine and classify FoF. An overall score on the FES-I of 16–19, 20–27 and ≥28, was accepted as low, moderate, and high concern about FoF, respectively.\ud \ud Results:\ud \ud Prevalence of high FoF was 86.9% in DLB, 36.0% in AD and 37.4% in controls. All CGA parameters were worse in the DLB and AD group than non-dementia group (p < 0.001). The prevalence of high FoF/FES-scores was significantly higher in the DLB group than in the AD and non-dementia group (p < 0.001), but was similar in AD and non-dementia groups (p > 0.05). The significant relationship between DLB and FoF was maintained when adjusted for age, CGA parameters, and orthostatic hypotension (OR: 2.55, CI: 1.03–6.25, p = 0.041 comparison to AD; OR: 4.79, CI: 2.10–10.92, p < 0.001 comparison to non-dementia).\ud \ud Conclusion:\ud \ud Eight out of ten elderly patients with DLB have high FoF, which is much higher than those with AD and without dementia. Therefore, clinicians should be aware of FoF and its related consequences in the management of DLB in older adults.

This study was aimed to compare early-stage Alzheimer's disease (AD) and dementia with Lewy bodies (DLB), the two most common types of dementia in the elderly, in terms of the prevalence of geriatric syndromes. Patients with early-stage dementia with DLB and AD were included, and were questioned in terms of geriatric syndromes including polypharmacy, malnutrition, frailty, sarcopenia, dynapenia, orthostatic hypotension (OH), urinary and fecal incontinence, falls, fear of falling (FoF), depression, insomnia, excessive daytime sleepiness, pressure ulcers. Of the 82 patients, 31 had DLB and 51 had AD. The mean age was 80.99 +/- 7.01, and 69.5% was female. The presence of OH, FoF, depression, and insomnia were more common in the DLB than AD (p < 0.05). 90.3% of patients with DLB and 54.9% of patients with AD had >= 3 geriatric syndromes simultaneously. The presence and co-incidence of geriatric syndromes is common in patients with even early-stage DLB and AD.

Objectives Orthostatic hypotension is a well-known disorder, but orthostatic hypertension (OHT) still remains unclear in older adults. The aim of this study was to determine the comparison orthostatic hypotension with OHT according to fall risk and geriatric assessment parameters. Methods A total of 741 patients who were admitted to the geriatric clinic and underwent comprehensive geriatric assessment were reviewed. Orthostatic blood pressure changes were measured by head-up-tilt Table test within the first three minutes. Orthostatic hypotension was defined as 20 or 10-mmHg drop in systolic and/or diastolic blood pressure from supine to standing position. OHT was defined as an increase in systolic blood pressure of 10 mmHg or more while the patient was standing up from the supine position. Results The mean age was 75 +/- 8 and 65. About 65% of all participants were female. The rate of orthostatic hypotension and OHT was 17.3 and 7.2%, respectively. The falls and dementia were more frequent, and the Instrumental Activities of Daily Living (IADL) score was lower in orthostatic hypotension group than in OHT and control groups (P < 0.05). These variables were similar between OHT and control groups (P > 0.05). The rates of falls [odds ratio (OR) = 2.02; 95% confidence interval (CI), (0.94-4.33);P = 0.044] and dementia [OR = 2.65; 95% CI, (1.08-6.48);P = 0.032] in orthostatic hypotension group were still higher than in OHT group, even after adjusting for age, sex, estimated glomerular filtration rate and drugs. Conclusion Orthostatic hypotension may be more significant in terms of falls, dementia and impaired IADLs scores in older adults than in OHT and control groups. It seems that OHT may be of no clinical importance in geriatric practice.

There are a few studies showing how nutritional parameters are affected according to dementia subtypes. The aim of this study was to compare the parameters characterizing nutritional status and micronutrient levels according to different dementia subtypes.Cross-sectional study.Four hundred forty outpatients aged 65 years or older.Newly diagnosed patients with dementia, who underwent comprehensive geriatric assessment (CGA), were retrospectively evaluated. The data on CGA including nutritional status (body mass index), Mini-Nutritional Assessment-Short Form, albumin, and micronutrients (vitamin B12, folate, and vitamin D) were recorded.Of the 396 patients, 195 were diagnosed with Alzheimer type dementia, 70 dementia with Lewy body (DLB), 25 with vascular dementia (VaD), 51 with frontotemporal dementia (FTD), and 55 with normal pressure hydrocephalus. The mean age of the study group was 76.87 ± 8.15 years. The prevalence of malnutrition and the risk of malnutrition were 17.17% and 43.18% in patients, with dementia, respectively. The results of ordinal logistic analysis adjusted by age, sex, and all comorbidities, showed that patients with DLB and VaD were more likely to develop malnutrition [odds ratios 6.834 and 5.414, respectively (P .001)], whereas FTD had a lower risk of developing malnutrition than the other dementia subtypes (odds ratio 2.883, P = .002).There was no difference in terms of other parameters including vitamin B12, folate, and vitamin D (P .05).and Implication: There is a close relationship between dementia and malnutrition. Clinical approaches to minimize malnutrition in persons with dementia should include regular screening for malnutrition and its risk factors, avoidance of dietary restrictions, and support of persons at risk for malnutrition with oral nutritional supplements. Moreover, the influence of nutritional status varies in different types of dementia. Nutritional status may be worse in DLB and VaD compared with other types of dementia, whereas nutritional status in FTD is less.

This study reports the results of the first brain tissue banking experience of Turkey in the Unit for Aging Brain and Dementia at Dokuz Eylul University, Department of Geriatric Medicine, Izmir. Here, we have briefly described our efforts on brain banking in our country, which consist of six brains from autopsies that had at least two years of clinical follow-up in the 2015-2017 period. The evaluation led to the diagnosis of two Alzheimer's disease (AD) with cerebral amyloid angiopathy, one AD with dementia with Lewy bodies, one corticobasal degeneration, one multiple system atrophy, one vascular dementia. We believe that the study is of a special importance because of its potential of becoming a brain banking center in the region and because of its contributing to the international knowledge of the neuropathological features of dementia, while characterizing the epidemiology of these diseases in the region.

Systematic reviews and meta-analyses pool data from individual studies to generate a higher level of evidence to be evaluated by guidelines. These reviews ultimately guide clinicians and stakeholders in health-related decisions. However, the informativeness and quality of evidence synthesis inherently depend on the quality of what has been pooled into meta-research projects. Moreover, beyond the quality of included individual studies, only a methodologically correct process, in relation to systematic reviews and meta-analyses themselves, can produce a reliable and valid evidence synthesis. Hence, quality of meta-research projects also affects evidence synthesis reliability. In this overview, the authors provide a synthesis of advantages and disadvantages and main characteristics of some of the most frequently used tools to assess quality of individual studies, systematic reviews, and meta-analyses. Specifically, the tools considered in this work are the Newcastle-Ottawa scale (NOS) and the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) for observational studies, the Consolidated Standards of Reporting Trials (CONSORT), the Jadad scale, the Cochrane risk of bias tool 2 (RoB2) for randomized controlled trials, the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) and the Assessment of Multiple Systematic Reviews 2 (AMSTAR2), and AMSTAR-PLUS for meta-analyses. What is already known?: The informativeness and quality of evidence synthesis inherently depend on the quality of what has been pooled into meta-research projects. Beyond the quality of included individual studies, only a methodologically correct process, in relation to systematic reviews and meta-analyses themselves, can produce a reliable and valid evidence synthesis. What is new?: In this overview, the authors provide a synthesis of advantages and disadvantages and main characteristics of some of the most frequently used tools to assess quality of individual studies, systematic reviews, and meta-analyses. Potential impact: This overview serves as a starting point and a brief guide to identify and understand the main and most frequently used tools for assessing the quality of studies included in meta-research. The authors here share their experience in publishing several meta-research-related articles covering different areas of medical sciences. © 2020 John Wiley & Sons Ltd

The coronavirus disease 2019 (COVID‐19) outbreak, which started in China in December 2019 and spread all over the world, affects people from all age groups, but it is more fatal in the elderly. The most common clinical presentations of COVID‐19 in the elderly are fever, dry cough, and chest distress, with a frequency of 94.5%, 69.1%, and 63.9%, respectively. 1 However, many hospitals screened for COVID‐19 based on the presence of only fever and cough. Therefore, elderly patients with these symptoms did not necessarily meet the criteria for screening, although it is well known in geriatric practice that older people do not always have a fever response to infectious diseases. In elderly patients, common infections, such as pneumonia and urinary tract infections, sometimes present only as acute mental state changes such as latergia and confusion. 2 As with other infections, it is quite possible that COVID‐19 can have this type of atypical presentation, but there is not yet any relevant information in the literature. In published studies that have investigated the clinical findings of elderly patients with COVID‐19, atypical presentations have not been addressed. Here, we present a case of an elderly male patient with COVID‐19 who had atypical presentation.

BackgroundWe investigated sex-specific associations between lifetime number of sexual partners and several health outcomes in a large sample of older adults in England.MethodsWe used cross-sectional data from 2537 men and 3185 women aged ≥50 years participating in the English Longitudinal Study of Ageing. Participants reported the number of sexual partners they had had in their lifetime. Outcomes were self-rated health and self-reported limiting long-standing illness, cancer, coronary heart disease, and stroke. We used logistic regression to analyse associations between lifetime number of sexual partners and health outcomes, adjusted for relevant sociodemographic and health-related covariates.ResultsHaving had 10 or more lifetime sexual partners was associated with higher odds of reporting a diagnosis of cancer than having had 0–1 sexual partners in men (OR 1.69, 95% CI 1.01 to 2.83) and women (OR 1.91, 95% CI 1.04 to 3.51), respectively. Women who had 10 or more lifetime sexual partners also had higher odds of reporting a limiting long-standing illness (OR 1.64, 95% CI 1.15 to 2.35). No other statistically significant associations were observed.ConclusionsA higher lifetime number of sexual partners is associated with increased odds of reported cancer. Longitudinal research is required to establish causality. Understanding the predictive value of lifetime number of sexual partners as a behavioural risk factor may improve clinical assessment of cancer risk in older adults.

Purpose: Increased nocturia episodes can be a clinical marker of poor health status. The present study aimed to evaluate patterns and temporal trends in nocturia and sociodemographic and lifestyle correlates in the US population. Methods: Participants, aged 20years or older, were included in this repeated cross-sectional study. The National Health and Nutrition Examination Survey from 2005 to 2016 was used. Participants were asked “During the past 30days, how many times per night did you most typically get up to urinate, from the time you went to bed at night until the time you got up in the morning?”. Individuals were categorized as either ≥ 1 nocturia episode or ≥ 2 nocturia episodes per night. Results: The estimated prevalence of ≥ 1 nocturia was high among men (20–39years, 56.8%; 40–59years, 70.2%; ≥ 60years, 82.7%) and women (20–39years, 68.9%; 40–59years, 74.3%; ≥ 60years, 84.7%), particularly in Non-Hispanic-blacks. From 2005–2016, the trends in prevalence of ≥ 1 nocturia increased for the age groups 20–39 and 40–59years among men (p < 0.001 and p = 0.001, respectively) and women 20–39 and 40–59years (p < 0.001 and p = 0.032, respectively), but a stable trend was observed among men and women who were 60years and older (p = 0.814, and p = 0.64, respectively). A significant increasing trend of ≥ 2 nocturia episodes was observed among men only aged 40–59years (p = 0.007). Conclusions: From 2005 through 2016, the secular trend in the frequency of nocturia increased in both men and women in general, which was significant under the age of 60years, particularly in Non-Hispanic-blacks. © 2019, Springer Nature B.V.

Aims Type 2 Diabetes Mellitus(DM) is a well-known risk factor for cognitive impairment. Recent evidences suggest that Dipeptidyl peptidase-4(DPP-4) inhibitors might have neuroprotective effects. Therefore, this study aimed to investigate vildagliptin, a DPP-4 inhibitor, effects on cognitive function in older patients with DM. Materials and Methods A retrospective longitudinal clinical trial was carried out on total 130 subjects with type 2 DM. Patients underwent comprehensive geriatric assessment twice within six months interval. The patients were divided into three groups according to antidiabetic treatment: untreated control group (patients achieve individual goal HbA1c without antidiabetic medication), vildagliptin(+) group(patients using vildagliptin alone or combination) and the vildagliptin(–) group. Results The mean age was 75.72 ± 7.46 years. The control group was older, of a lighter weight and also had a higher female gender ratio(p ≤ 0.01). When sex, age, educational level and metabolic profile were adjusted, there was only change in copying subdomain of Mini Mental State Examination between vildagliptin(+) and other groups at the end of 6 months. Vildagliptin also resulted in reduction of HbA1c and weight(p Conclusion The addition of vildagliptin to treatment improved the copying subdomain of cognitive function and metabolic control of the older patients with type 2 DM within 6 months.

The aim of this study was to determine the relationship between the fear of falling/the degree of fear of falling (FoF) and orthostatic hypotension (OH) in older adults. This cross-sectional study was conducted with 314 older outpatients. If the total score of the Falls Efficacy Scale-International scale was 16-19, 20-27 and >= 28, it was assumed that there was low FoF, moderate FoF and high FoF, respectively. OH was evaluated for the 1st (OH1) and 3rd (OH3) minutes, after transitioning from the supine position to standing. Participants were aged 65-93 years (mean age 74.2 +/- 8.5 years) and 193 (61.5%) were female. Among the FoF groups, significant differences were found for age, gender, education, marital status, who the patient lived with, the history of falling and hypertension, Timed Up-Go test score and hemoglobin levels (p < 0.005). The prevalence of OH1 and OH3 was found to be significantly higher in those with an FoF score of 20 and above than those below 20 (p < 0.005). After adjustment for potential confounders, participants who reported a high FoF had higher risk for OH1 and OH3 (OR 2.14, 95% CI 1.14-4.0, p = 0.017; and OR 2.72, 95% CI 1.46-5.09, p = 0.002, respectively), but those with moderate FoF had no increased risk of having OH compared to low FoF (p > 0.05). There is a close relationship between high FoF and OH in older adults. Therefore, when evaluating an older patient with OH, FoF should be evaluated, or FoF should also be questioned in older patients with OH.

Background This paper aims to examine associations between pet ownership and symptoms of depression in a large, population-based sample of older adults. Specifically, we tested whether: (i) people who report more depressive symptoms are more likely to own a pet; (ii) pet ownership protects against an increase in depressive symptoms over time; (iii) associations differ by symptom type. Methods Data were drawn from the English Longitudinal Study of Ageing, a longitudinal panel study of men and women aged 50 and older (n = 7,617, 52.5% female). Pet ownership (dog/cat/other/none) was self-reported in 2010/11. Depressive symptoms were assessed in 2010/11 and 2016/17 using the 8-item centre for Epidemiologic Studies Depression (CES-D) scale. We analysed total CES-D score and derived symptom subscales (depressed mood, anhedonia, somatic symptoms) in relation to pet ownership, adjusting for sociodemographic and health-related covariates. Results A one-symptom increase in total CES-D score was associated with 7% increased odds of dog ownership (OR=1.07, 95% CI 1.03–1.11). Significant associations were observed between each subset of depressive symptoms and dog ownership, with models run on z-scores showing a slightly stronger association for symptoms of depressed mood (OR=1.13, 95% CI 1.06–1.21) compared with anhedonia (OR=1.10, 95% CI 1.04–1.17) or somatic symptoms (OR=1.10, 95% CI 1.03–1.18). Prospectively, no significant associations were found. Limitations Self-reported data; small sample size for some pet categories. Conclusion Amongst older adults in England, those with more depressive symptoms are more likely to own a dog, but pet ownership is not significantly associated with change in depressive symptoms over time.

AimThe aim of this study was to investigate the impact of obesity on acute pancreatitis outcomes in older patients.FindingsObesity in older patients with acute pancreatitis was not associated with worse outcomes, including in-hospital mortality, long-term mortality, and recurrence.MessageThe impact of obesity in older people with acute pancreatitis may not be as deleterious as seen in younger patients.AbstractPurposeAlthough obesity is an established risk factor for a number of diseases, several epidemiological studies have demonstrated that older obese patients have better survival rates than non-obese old patients in various disease states. In this context, the relationship between obesity and acute pancreatitis outcome in older patients is controversial. Therefore, the authors aimed to investigate the impact of obesity on acute pancreatitis outcomes in older patients.MethodsPatients aged > 65years who had been hospitalized for acute pancreatitis were retrospectively analyzed. Among them, 190 patients were included. The median age was 73 (68–79) years, and 118 (62.1%) were women. Obesity was assessed according to body mass index, and patients were classified as either obese or non-obese. The primary endpoint of the study was in-hospital major adverse events (major in-hospital complications and death). The secondary endpoints were acute pancreatitis recurrence, 30-day all-cause mortality, and long-term all-cause mortality.ResultsA total of 77 (40.5%) patients were obese. In-hospital major adverse events were observed in 40 (21.1%) patients. There was no statistical difference in major in-hospital adverse events between the two groups (27 [23.9%] in non-obese patients vs. 13 [16.9%] in obese patients,p = 0.24). Further, the 30-day mortality, long-term survival, and acute pancreatitis recurrence rates were similar (allp > 0.05). The median follow-up time was 18 (0–80) months.ConclusionObesity does not result in higher mortality or complications in older patients with acute pancreatitis. Although the underlying mechanism needs to be elucidated, the deleterious effect of obesity seems to be diminished in older patients.

Chronic inflammation, which is called "inflamm-aging" , is characterized by an increased level of inflammatory cytokines in response to physiological and environmental stressors, and causes the immune system to function consistently at a low level, even though it is not effective. Possible causes of inflammaging include genetic susceptibility, visceral obesity, changes in gut microbiota and permeability, chronic infections and cellular senescence. Inflammation has a role in the development of many age-related diseases, such as frailty. Low grade chronic inflammation can also increase the risk of atherosclerosis and insulin resistance which are the leading mechanisms in the development of cardiovascular diseases (CVD). As it is well known that the risk of CVD is higher in older people with frailty and the risk of frailty is higher in patients with CVD, there may be relationship between inflammation and the development of CVD and frailty. Therefore, this important issue will be discussed in this chapter.

To know the knowledge of the EuGMS members regarding meta-research, especially systematic reviews and meta-analyses. Interest in systematic reviews and meta-analyses is high and there is a demand for education on these topics in relation to geriatric medicine. We need more resources in the EuGMS for education for meta-research tailored for geriatric medicine. There has been an exponential increase in meta-research, especially in the branch dealing with systematic reviews [SRs] and meta-analyses [MAs]. However, the knowledge regarding these topics in geriatric medicine is still poorly explored. We therefore undertook a survey of the current knowledge and needs in meta-research in geriatrics. A short survey (taking approximately 5 min to complete) was freely available on the European Geriatric Medicine Society (EuGMS) website and disseminated via social networks by the EuGMS and the authors of the survey. The questionnaire was available during the whole year of 2019. The questionnaire specifically addressed demographic information, previous research activities and the knowledge of the participants on meta-research in geriatric medicine. The survey was completed by 291 participants from 36 different countries of about 20,000 EuGMS members (mostly with an age between 55 and 64 years; 51.5% female; mainly from Italy and Germany). Most respondents (65.6%) reported reading more than 20 articles in the past year, but few (36.4%) read more than 10 SRs/MAs. Participants reported that SRs and/or MAs are important in clinical practice: 83.8% giving a score of > 6/10, and 23.0% reporting 10. The large majority of the participants asked for more education in meta-research. In particular, there is need for educational courses for meta-research in geriatric medicine, online or in person, organized by the EuGMS. Our survey shows that interest in SRs/MAs is high, and there is a demand for education on these topics in relation to geriatric medicine.

Chronic inflammation, which is called "inflamm-aging" , is characterized by an increased level of inflammatory cytokines in response to physiological and environmental stressors, and causes the immune system to function consistently at a low level, even though it is not effective. Possible causes of inflammaging include genetic susceptibility, visceral obesity, changes in gut microbiota and permeability, chronic infections and cellular senescence. Inflammation has a role in the development of many age-related diseases, such as frailty. Low grade chronic inflammation can also increase the risk of atherosclerosis and insulin resistance which are the leading mechanisms in the development of cardiovascular diseases (CVD). As it is well known that the risk of CVD is higher in older people with frailty and the risk of frailty is higher in patients with CVD, there may be relationship between inflammation and the development of CVD and frailty. Therefore, this important issue will be discussed in this chapter.

Background: Falling is an important health problem for older men. In this study, we aim to identify factors that increase risk of falling in only older men using four different fall risk assessment methods.\ud Method: 334 men, who attended a geriatric outpatient clinic and underwent comprehensive geriatric assessment, were included in the study. History of falling last year, the Timed Up and Go test, Performance-Oriented Mobility Assessment, and 4-meter walking speed test were carried out on all patients.\ud Results: The mean age (SD) of patients were 74.99 (7.26) years. According to all of the four clinical assessments to predict risk of falling the following risk factors for falling were identified (all p

The present study aimed to assess the association between sedentary behavior and sarcopenia among adults aged &ge, 65 years. Cross-sectional data from the Study on Global Ageing and Adult Health were analyzed. Sarcopenia was defined as having low skeletal muscle mass and either a slow gait speed or a weak handgrip strength. Self-reported sedentary behavior was assessed as a continuous variable (hours per day) and also as a categorical variable (0&ndash, &lt, 4, 4&ndash, 8, 8&ndash, 11, &ge, 11 hours/day). Multivariable logistic regression was conducted to assess the association between sedentary behavior and sarcopenia. Analyses using the overall sample and country-wise samples were conducted. A total of 14,585 participants aged &ge, 65 years were included in the analysis. Their mean age was 72.6 (standard deviation, 11.5) years and 55% were females. Compared to sedentary behavior of 0&ndash, 4 hours/day, &ge, 11hours/day was significantly associated with 2.14 (95% CI = 1.06&ndash, 4.33) times higher odds for sarcopenia. The country-wise analysis showed that overall, a one-hour increase in sedentary behavior per day was associated with 1.06 (95% CI = 1.04&ndash, 1.10) times higher odds for sarcopenia, while the level of between-country heterogeneity was low (I2 = 12.9%). Public health and healthcare practitioners may wish to target reductions in sedentary behavior to aid in the prevention of sarcopenia in older adults.

Background:\ud \ud This study aimed to investigate associations between mental health and several parameters of oral health, controlling for a variety of important covariates, in a large representative sample of Spanish people.\ud \ud Methods:\ud \ud Data from the Spanish National Health Survey 2017 were analysed. Mental (i.e., depression, chronic anxiety, other psychiatric disorders) and oral health (i.e., dental caries, dental extraction, dental filling, gingival bleeding, tooth movement, dental material, missing tooth) were evaluated. Control variables included sex, age, marital status, education, smoking, alcohol consumption, and physical multimorbidity. Associations between psychiatric conditions (independent variables) and the number of poor oral health outcomes (dependent variable) were assessed using Poisson regression models. The associations were investigated in the overall population, in married participants and in those who were single/widowed/divorced/separated.\ud \ud Results:\ud \ud There were 23,089 participants [54.1% women; mean (standard deviation) age 53.4 (18.9) years]. The prevalence of at least one psychiatric condition was 15.4% in the overall sample, while the mean (standard deviation) number of poor oral health outcomes was 2.9 (1.4). There was a positive association between any psychiatric condition and the number of poor oral health outcomes [incidence rate ratio (IRR)=1.10; 95% confidence interval: 1.07-1.12], and there was a significant interaction between any psychiatric condition and marital status. The association was stronger in those participants who were single/widowed/divorced/separated.\ud \ud Limitations:\ud \ud Cross-sectional study. Oral and mental health were assessed with Yes/No questions. Exposure, outcome and covariates were self-reported.\ud \ud Conclusions:\ud \ud Those with poor mental health have worse oral health but being married has some protective benefits.