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Objectives: To examine changes in serum levels of the bone remodelling molecules dickkopf-1 (Dkk-1), sclerostin, wingless-type protein-3a (Wnt-3a), and bone morphogenetic protein-7 (BMP-7) during 6 months of anti-tumour necrosis factor (anti-TNF) treatment in ankylosing spondylitis (AS) patients with high disease activity. Method: We included 40 patients with axial AS: 20 patients with high disease activity were assigned to treatment with TNF inhibitor and 20 with low disease activity were assigned to non-steroidal anti-inflammatory drug (NSAID) treatment. Markers of bone remodelling and inflammation were assessed at baseline and after 6 months. Results: In the TNF inhibitor-treated group Dkk-1 decreased significantly from 196.8 pg/mL [95% confidence interval (CI) 94.1-399.0] to 116.3 pg/mL (95% CI 38.0-301.6) and BMP-7 increased significantly from 1.4 pg/mL (95% CI 0-23.0) to 20.3 pg/mL (95% CI 4.9-41.3). There was a significant negative correlation between Dkk-1 and BMP-7 at 6 months (r = -0.64, p = 0.004) in this group. Non-parametric regression analysis adjusted for disease duration, age, sex, baseline modified Stoke's Ankylosing Spondylitis Spine Score (mSASSS), and baseline C-reactive protein (CRP) confirmed a statistically significant effect of treatment on time-related changes of Dkk-1 and BMP-7. Erythrocyte sedimentation rate (ESR), CRP, and also the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score decreased significantly in the anti-TNF-treated group. Conclusions: Among the potential biomarkers of bone remodelling in AS, Dkk-1 and BMP-7 displayed significant time alterations and correlative interactions during anti-TNF treatment. [ABSTRACT FROM AUTHOR]

Appetite is a strong determinant of nutritional status. As cognitive impairment is usually linked to alterations in eating behaviour, people with dementia might experience changes in appetite with the loss of ability to express their needs, including dietary choices and preferences. The aim of the study was to develop an appetite loss screening tool for older adults, inclusive for those with mild to moderate cognitive impairment. The study questionnaire, consisting of 44 binary items related to appetite, was employed among 127 hospitalized older patients (55.9% women, mean age 79.4 ± 7.1 years) with and without cognitive impairment (31.5% categorized as suspected mild dementia, 26.0% as suspected moderate dementia). An exploratory factor analysis was performed to identify items that constitute the final scale, with a Cronbach's alpha coefficient of 0.81. The final tool consists of seven questions, with a sensitivity of 80% and specificity of 80.6%, using the Council on Nutrition Appetite Questionnaire score as reference. Acceptability post-test was performed in 20 patients (70% women, mean age 79.6 ± 5.3 years) to test the clinical feasibility of the scale. The customized design of the scale, according to the recommendation for written materials for individuals with dementia, empowers older adults, supports diagnosis and encourages their proactivity in the treatment process. The scale was found to perform similarly in older persons with and without cognitive impairment, which renders it a versatile assessment tool., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Purpose: Intracerebral hemorrhage is the deadliest form of stroke. This study aimed to enhance the prediction of 30-day mortality in intracerebral hemorrhage patients by integrating computational parameters., Methods: This study retrospectively analyzed 435 patients with spontaneous intracerebral hemorrhage (ICH). Utilizing the acquired computed tomography (CT) images, we extracted the contour and visual representation of ICH. For the extracted contour, the analysis encompassed factors including compactness, fractal dimension, Fourier factor, and circle factor. For the images depicting ICH, we calculated various factors related to density distribution including mean, coefficient of variance, skewness and kurtosis, as well as texture parameters, such as energy, entropy, contrast and homogeneity. To assess the impact of surgical treatment on 30-day mortality, logistic regression analysis was used., Results: A total of 126 patients (29.09%) died within 30 days. A total of 62 (14.25%) patients underwent surgical treatment. Multivariate logistic regression analysis revealed that surgical treatment was independently associated with a lower risk of 30-day mortality (odds ratio, OR 0.226, 95% confidence interval, CI 0.049-0.85; p = 0.039). Based on the moderated analysis, we found that the volume of ICH (OR 0.905, 95% CI 0.902-0.908; p < 0.001) and ICH energy (OR 1.389, 95%CI 0.884-0.988; p = 0.010) had positive moderating effect on such associations while the presence of intraventricular blood had negative moderating effect (OR 1.154, 95% CI 1.034-1.628; p = 0.010)., Conclusion: Patients exhibiting a higher volume and energy of ICH might benefit from surgical treatment; however, this efficacy was found to be diminished in cases involving the presence of intraventricular blood., (© 2024. The Author(s).)

Purpose: To measure changes in quantitative tortuosity descriptors of the internal carotid artery (ICA) after intracranial aneurysm embolization, and to determine possible factors associated with changes in tortuosity., Materials and Methods: An analysis of 52 patients with embolized intracranial aneurysms was performed. ICA tortuosity was assessed by digital subtraction angiograms obtained prior to the embolization and after the first follow-up examination. For each patient, tortuosity descriptors were calculated: relative length (RL), sum of angle metrics (SOAM), triangular index, product of angle distance (PAD), and inflection count metric (ICM). To represent changes in tortuosity for each descriptor, delta (Δ) value was defined as value of the descriptor prior to embolization minus value of the descriptor on follow-up examination., Results: In a median follow-up of 14 months, no statistically significant changes in tortuosity were observed on the nonembolized side. On the embolized side, SOAM (2.89 [SD ± 0.92] vs 2.38 [SD ± 0.94]; P < .001), PAD (5.01 [SD ± 1.83] vs 3.95 [SD ± 1.72]; P < .001), and ICM (12.18 [SD ± 4.55] vs 9.76 [SD ± 4.04]; P = .006) were significantly higher after embolization than before embolization. Median ΔRL (-0.02 [-0.045 to 0.002] vs -0.01 [-0.02 to 0.003]; P = .003), ΔPAD (0.84 [0.30-1.82] vs 0.10 [-0.001 to 1.10]; P < .001), and ΔICM (2.05 [0.42-3.50] vs 0.27 [0.02-2.16]; P = .004) were significantly higher on the embolized side. Tortuosity correlated with elapsed time after embolization., Conclusions: Tortuosity of the ipsilateral ICA increased after intracranial aneurysm embolization., (Copyright © 2024. Published by Elsevier Inc.)

Objective: One symptom commonly associated with the presence of unruptured intracranial aneurysms is headache. In this study, the authors aimed to analyze factors associated with headaches among patients with intracranial aneurysms, with special consideration of hemodynamic parameters., Methods: The authors prospectively included 96 patients with 122 unruptured intracranial aneurysms. The authors obtained detailed medical history including current diseases and medications, as well as blood pressure values taken during hospitalization from the patients' medical records. The short-form McGill Pain Questionnaire was administered to each patient at admission and 3-6 months after the procedure to assess type and severity of headache. Based on imaging data, the authors obtained 3D reconstruction of each patients' aneurysm dome with feeding artery. The authors performed computational fluid dynamics analysis of blood flow through prepared models using OpenFOAM. Blood was modeled as Newtonian fluid, using the incompressible transient solver. Patient-specific internal carotid artery (ICA) blood velocity waves obtained with Doppler ultrasound were set as inlet boundary conditions. After performing simulation, the authors calculated the hemodynamic parameters of the aneurysm dome., Results: A total of 30 patients (31.25%) reported having headaches. In multivariate logistic regression analysis, female sex (OR 2.81, 95% CI 2.51-4.86; p < 0.01), ICA aneurysm location (OR 7.93, 95% CI 5.51-8.52; p < 0.01), multiple aneurysms (OR 6.05, 95% CI 1.83-11.83; p = 0.02), mean dome blood velocity (OR 3.10, 95% CI 2.01-3.30; p < 0.01) and time-averaged wall shear stress (OR 1.18, 95% CI 1.47-2.72; p = 0.04) were independently associated with the presence of headache. Additionally, 17 patients (56.67%) reported complete relief of symptoms after the procedure. In multivariate logistic regression analysis, the mean blood flow in the ICA was independently associated with complete resolution of headaches after aneurysm treatment (OR 2.32, 95% CI 1.57-3.28; p < 0.01)., Conclusions: Hemodynamic parameters of intracranial aneurysms might be associated with headaches and their relief after aneurysm treatment.

Aim: Hypertension is a risk factor for intracranial aneurysm rupture. We analyzed whether the intake of drugs from specific classes of anti-hypertensive medications affects hemodynamic parameters of intracranial aneurysm dome., Methods and Results: We recorded medical history including medications and the in-hospital blood pressure values. We then obtained 3D reconstruction of each patients' aneurysm dome and the feeding artery. Using OpenFOAM software we performed Computational Fluid Dynamics analysis of blood flow through the modeled structures. Blood was modeled as Newtonian fluid, using the incompressible transient solver. As the inlet boundary condition we used the patient-specific Internal Carotid Artery blood velocity waves obtained with Doppler ultrasound. We calculated haemodynamic parameters of the aneurysm dome. All presented analyses are cross-sectional.We included 72 patients with a total of 91 unruptured intracranial aneurysms. The history of β-blocker intake significantly influenced hemodynamic parameters of aneurysm dome. The patients on β-blockers had significantly smaller aneurysm domes (5.09 ± 2.11 mm vs. 7.41 ± 5.89 mm; p = 0.03) and did not have aneurysms larger than 10 mm (0% vs 17.0%; p = 0.01). In the Computational Fluid Dynamics analysis, walls of aneurysms in patients who took β-blockers were characterized by lower Wall Shear Stress Gradient (1.67 ± 1.85 Pa vs. 4.3 ± 6.06 Pa; p = 0.03), Oscillatory Shear Index (0.03 ± 0.02 vs. 0.07 ± 0.10; p = 0.04) and Surface Vortex Fraction (16.2% ± 5.2% vs. 20.0% ± 6.8%; p<0.01). After controlling for covariates, we demonstrated difference of Surface Vortex Fraction (F[1, 48] = 4.36; p = 0.04) and Oscillatory Shear Index (F[1, 48] = 6.51; p = 0.01) between patients taking and not taking β-blockers, respectively., Conclusion: Intake of β-blockers might contribute to more favorable hemodynamics inside aneurysmal sac. Other antihypertensive medication classes were not associated with differences in intracranial aneurysm parameters., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

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.

Purpose: We aimed to analyse the characteristics of geriatric courses offered to undergraduate medical students in higher educational institutions (HEIs) in Poland., Methods: We searched the official websites of the HEIs offering the medical degree programmes and directly contacted the dean's offices and HEIs representatives to retrieve the relevant information. The documents were analysed for course content, teaching methods, duration, and recommended texts. We also checked the obtained curricula for the reference to of the learning objectives related to geriatric medicine, selected from the currently endorsed Polish educational standards (ES) provided by the Ministry of Science and Higher Education., Results: Geriatric medicine courses were obligatory at all included HEIs (n = 19), but the courses differed in structure and content. The courses varied in duration from 11 to 60 h and were primarily lecture based. Simulation was utilized at only one HEI and e-learning at two institutions. Out of 315 learning objectives, we acknowledged only 9 as geriatric. They were not always found in all curricula. Two HEIs included self-described learning objectives in their curricula. Across all HEIs, a total of 29 recommended texts (published between 1995 and 2021) were identified, including 2 English-language texts., Conclusion: Geriatric medicine was a mandatory subject for medical students of the included HEIs. However, there was a lack of uniformity in the offered courses. This leaves room for the development of a unified undergraduate geriatrics curriculum to effectively address diverse geriatric issues across Europe. The importance of this matter is highlighted by demographic trends and workforce challenges., (© 2024. The Author(s).)

Purpose: Reduced appetite is a common issue among older adults. However, its formal assessment is rarely undertaken in clinical practice. The aim of the study was to check the frequency of reporting of appetite status in hospitalized older adults and to analyze the terms documented by physicians when reporting reduced appetite., Methods: A retrospective analysis of electronic medical records of hospitalized patients aged 65 and older was conducted. To determine patients' appetite status structured appetite assessment or any references related to appetite were considered., Results: We included 1291 individual patients' medical records, of which 13.3% contained any reference to appetite. We showed that in our setting, appetite was not assessed according to standardized questionnaires. In addition, appetite status was documented with inconsistent terminology., Conclusions: Appetite status was rarely noted in electronic medical records. The lack of a structured assessment of reduced appetite in older patients was found., (© 2024. The Author(s).)

Introduction: Interprofessional education (IPE) is an integrative approach that enables collaboration of students of two or more different health professions in aim to acquire skills and competencies related not only to their field of study but also to ensure the standard of care based on collaborative practice. IPE has not yet been explored in relation to collaboration between dietetics-nutrition and pharmacy students, while there is evidence that in many cases nutrition is complementary to pharmacotherapy in the treatment process., Aim: The aim of this scoping review was to gather, describe and discuss all relevant literature regarding joint interprofessional training of pharmacy and dietetics-nutrition undergraduates., Methods: We performed a literature search for studies where IPE between dietetics-nutrition and pharmacy students was described. 2204 articles on this topic were identified. After eligibility assessment, 8 articles were included in the review., Results: Eight studies were included in the review. Two of these described IPE activities between dietetics and pharmacy students only. The included studies varied in setting, methodology and outcome measures and covered a wide range of topics relevant to clinical practice, such as management of inflammatory bowel diseases, care of the older adults or counselling skills. The most common teaching method was the use of case studies. Some of the included studies did not identify specific learning objectives. The most common way of gathering feedback from participants was through questionnaires and interviews., Conclusions: IPE of pharmacy and dietetics-nutrition students is feasible and may be beneficial in many aspects related to learning. However, there is no well-established model or standard that would facilitate the implementation of such activities in individual educational institutions., (© 2024. The Author(s).)

Purpose: To present the two-day Delirium Awareness Day-related event held at the University Hospital, Kraków, Poland., Methods: Activities included a lecture, a multimedia presentation, meetings with healthcare workers at their respective wards, and distribution of information posters about delirium. Local news outlets were also engaged., Results: We reached out to approximately 300 persons in the hospital itself and several thousand via TV and radio broadcasts. We prompted interdisciplinary discussions about delirium, especially concerning preventive measures. The most common questions were how to alleviate symptoms as soon as possible, with the expectation of straightforward solutions for the non-geriatrician staff. Patient distress and burden on caregivers were important topics brought-up in the discussions., Conclusion: We demonstrated that our educational initiative was feasible and well-accepted among medical staff. Local media helped in building public understanding of delirium. Education about the syndrome should be one of the key societal tasks of geriatricians., (© 2024. The Author(s), under exclusive licence to European Geriatric Medicine Society.)

Introduction: Aneurysmal subarachnoid hemorrhage is a devastating type of stroke, associated with high mortality and morbidity. One of modifiable risk factors of aneurysm rupture is hypertension, however, it is still not clear whether any particular antihypertensive drugs play a significant role in the prevention of aneurysm rupture., Objectives: We decided to investigate whether there is any association between acetylsalicylic acid, α-blockers, β‑blockers, angiotensin‑converting enzyme inhibitors, angiotensin II receptor blockers, calcium channel blockers, diuretics, statins, and anticoagulants and a risk of intracranial aneurysm rupture., Patients and Methods: We retrospectively analyzed 334 patients with ruptured and unruptured intracranial aneurysm. Based on logistic regression models, we obtained unadjusted and adjusted odds ratios (ORs) of subarachnoid hemorrhage associated with the use of vasoactive medications and with indices of tortuosity., Results: We found that β‑blocker intake was significantly related to higher tortuosity of the cerebral arteries. Also, the intake of β‑blockers (OR, 0.41; 95% CI, 0.21-0.77; P = 0.01) and statins (OR, 0.23; 95% CI, 0.05-0.68; P = 0.01) significantly decreased the risk of aneurysm rupture, a result driven by a decreased rupture risk of anterior circulation aneurysms. No such association was found for the posterior part of the cerebral circulation., Conclusions: Aneurysm located in the anterior cerebral circulation might be less likely to rupture if patients receive β‑blockers or statins.

Background: The purpose of this study was to investigate the efficacy and safety of the NADA (National Acupuncture Detoxification Association)-standardized ear acupuncture protocol in comparison to medical acupuncture (MA) in the treatment of chronic nonspecific low back pain (LBP) in older adults., Methods: This was a prospective, clinical, single center, open label, comparative study. A total of 60 older patients with chronic nonspecific LBP were enrolled in the study. The patients were divided into two groups. The MA group received treatment with medical acupuncture (MA), while the NADA group received NADA ear acupuncture once a day for 20 min, for a total of 10 sessions. The co-primary outcome measures were the reduction in pain intensity evaluated by the Numeric Rating Scale (NRS) compared to baseline and improvement in patients' quality of life (QOL) assessed in the SF-36 questionnaire before and after treatment; this was compared between the two groups., Results: After two weeks of treatment, a significant reduction compared to baseline was observed in the NRS scores following treatment with medical acupuncture as well as after the utilization of NADA ear acupuncture protocol: NRS score for average pain experienced by the patients over the previous week (NRSa) MA: p = 0.002; NADA: p < 0.001, maximum NRS score in the past week (NRSm) MA: p < 0.001; NADA: p < 0.001, and NRS score at the time of examination (NRSe) MA: p = 0.001; NADA: p < 0.001. Reduction of the NRSa score compared to baseline was significantly greater in the NADA group ( p = 0.034). Significant improvements in the QOL of patients according to the SF-36 questionnaire compared to baseline were observed in the MA group in the following domains: PF ( p = 0.003), RP ( p = 0.002), SF ( p = 0.041), RE ( p = 0.005), MH (p = 0.043), HT ( p = 0.013), PCS ( p = 0.004), and MCS ( p = 0.025); and in the NADA group, in the following domains: PF ( p = 0.004), RP ( p = 0.048), BP ( p = 0.001), VT ( p = 0.035), RE ( p = 0.006), MH ( p < 0.001), HT ( p = 0.003), PCS ( p < 0.001), and MCS ( p < 0.001). There were minor complications observed in 35% of patients (total of 20 participants); 31% (9 patients) in the MA group and 39% (11 patients) in the NADA group. These were minor and quickly resolved, including insertion point pain, minor bleeding after needle removal, and one instance of fainting. No patients in either group reported worsening of LBP. These complications occurred in 4.14% of MA sessions (12 times/290 sessions) and in 6.07% of NADA acupuncture sessions (16 times/280 sessions)., Conclusion: The outcomes of this study suggest that both MA and NADA ear acupuncture could be a valuable and personalized component of a comprehensive approach to managing chronic nonspecific LBP in older patients. Incorporation of MA and NADA ear acupuncture into the clinical management of chronic nonspecific LBP in elderly patients has the potential to reduce pain intensity and improve the overall quality of life of affected individuals. However, further studies are needed to confirm our findings.

Background: Numerous studies based on assessment of lithium clearance demonstrated higher sodium reabsorption in renal proximal tubules in individuals with hypertension, overweight, obesity, metabolic syndrome, or diabetes., Aims: We aimed to assess the influence of angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin-II-receptor antagonists (ARB) treatment on sodium handling., Methods: In a sample of 351Caucasian subjects without diuretic treatment with prevailing sodium consumption, we studied associations between renal sodium reabsorption in proximal (FPRNa) and distal (FDRNa) tubules assessed by endogenous lithium clearance and daily sodium intake measured by 24-hour excretion of sodium (UNaV), in the context of obesity and long-term treatment with ACE-I or ARB., Results: In the entire study population, we found a strong negative association between FPRNa and ACE-I/ARB treatment (b = -19.5; SE = 4.9; P <0.001). Subjects with FPRNa above the median value showed a significant adverse association between FPRNa and age (b = -0.06; SE = 0.02; P = 0.003), with no association with ACE-I/ARB treatment (P = 0.68). In contrast, in subjects with FPRNa below the median value, we found a strongly significant adverse relationship between FPRNa and ACE-I/ARB treatment (b = -30.4; SE = 8.60; P <0.001), with no association with age (P = 0.32)., Conclusions: ACE-I/ARB long-term treatment modulates FPRNa in the group with lower reabsorption, but not in that with higher than median value for the entire study population.

Background: Tortuosity of intracranial arteries has been proven to be associated with the risk of intracranial aneurysm development. We decided to analyze which aspects of tortuosity are correlated with hemodynamics parameters promoting intracranial aneurysm development., Methods: We constructed 73 idealized models of tortuous artery (length: 25 mm, diameter: 2.5 mm) with single bifurcation. For each model, on the course of segment before bifurcation, we placed 1-3 angles with measures 15, 30, 45, 60, or 75 degrees and arc lengths 2, 5, 7, 10, or 15 mm. We performed computational fluid dynamics analysis. Blood was modeled as Newtonian fluid. We have set velocity wave of 2 cardiac cycles. After performing simulation we calculated following hemodynamic parameters at the bifurcation: time average wall shear stress (TAWSS), time average wall shear stress gradient (TAWSSG), oscillatory shear index (OSI), and relative residence time (RRT)., Results: We found a significant positive correlation with number of angles and TAWSS (R = 0.329; P < 0.01), TAWSSG (R = 0.317; P < 0.01), and negative with RRT (R = -0.335; P < 0.0.01). Similar results were obtained in terms of arcs lengths. On the other hand, mean angle measure was negatively correlated to TAWSS (R = -0.333; P < 0.01), TAWSSG (R = -0.473 P < 0.01), OSI (R = -0.463; P < 0.01), and positively to RRT (R = 0.332; P < 0.01). On the basis of the obtained results, we developed new tortuosity descriptor, which considered angle measures normalized to its arc length and distance from bifurcation. For such descriptor we found strong negative correlation with TAWSS (R = -0.701; P < 0.01), TAWSSG (R = 0.778; P < 0.01), OSI (R = -0.776; P < 0.01), and positive with RRT (R = 0.747; P < 0.01)., Conclusions: Hemodynamic parameters promoting aneurysm development are correlated with larger number of smaller angles located on larger arcs., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Acute viral respiratory infections have proven to be a major health threat, even after the Corona Virus Disease 2019 (COVID-19) pandemic. We aimed to check whether the presence or absence of an acute respiratory infection such as COVID-19 can influence the physical activity of older hospitalised patients. We cross-sectionally studied patients aged ≥60 years, hospitalized during the pandemic in the non-COVID-19 and COVID-19 ward at the University Hospital, Kraków, Poland. Using activPAL3 ® technology, we assessed physical activity for 24 h upon admission and discharge. In addition, we applied the sarcopenia screening tool (SARC-F); measured the hand grip strength and calf circumference; and assessed the Modified Early Warning Score (MEWS), age-adjusted Charlson Index, SpO2%, and length of stay (LoS). Data were analysed using SAS 9.4. The mean (min, max) age of the 31 (58% women, eight with COVID-19) consecutive patients was 79.0 (62, 101, respectively) years. The daily time (activPAL3 ® , median [p5, p95], in hours) spent sitting or reclining was 23.7 [17.2, 24] upon admission and 23.5 [17.8, 24] at discharge. The time spent standing was 0.23 [0.0, 5.0] upon admission and 0.4 [0.0, 4.6] at discharge. The corresponding values for walking were 0.0 [0.0, 0.4] and 0.1 [0.0, 0.5]. SARC-F, admission hand grip strength, calf circumference, and LoS were correlated with physical activity upon admission and discharge (all p < 0.04). For every unit increase in SARC-F, there was a 0.07 h shorter walking time upon discharge. None of the above results differed between patients with and without COVID-19. The level of physical activity in older patients hospitalised during the pandemic was low, and was dependent on muscular function upon admission but not on COVID-19 status. This has ramifications for scenarios other than pandemic clinical scenarios.

Anorexia of aging is a common problem in older adults. Depending on the setting, its prevalence varies from about 10% (among community-dwelling older adults) to over 30% in acute wards and nursing homes. The objective of this systematic review was to establish the prevalence of poor appetite in frail persons ≥60 years of age. We performed a literature search for studies where the prevalence of anorexia of aging among frail and pre-frail old adults was reported. 957 articles on this topic were identified. After eligibility assessment, three articles were included in the review. The studies included 4657 community-dwelling older adults. The weighted total prevalence of anorexia of aging in all the included studies was 11.3%. Among frail and pre-frail participants, loss of appetite was reported in 20.5% (weighted estimate). Overall, robust status was associated with a 63% lower probability of concomitant anorexia of ageing (OR 0.37, 95%CI 0.21-0.65, p = 0.0005). Frailty or risk of frailty are associated with more prevalent anorexia of ageing. This has potential practical implications; however, more research, especially to elucidate the direction of the relation, is needed.

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).

A significant proportion of the population aged 75 and over experiences an episode of major depression. Symptoms of depression manifested by elderly patients are sometimes treated as a natural element of the aging process, leaving elderly patients undiagnosed or misdiagnosed. It is postulated that the use of the Mediterranean diet may counteract the development of depression and alleviate depressive symptoms due to the anti-inflammatory properties of this diet. The aim of the systematic review was to assess whether the degree of adherence to the Mediterranean diet is related to the occurrence and severity of depressive symptoms in people over 65 years of age. We included 9 studies out of 317 identified manuscripts. The results of the studies included in the review indicate that adherence to the principles of the Mediterranean diet by elderly people may bring beneficial results in the prevention of depressive symptoms and justify further search for the relationship between this diet and its individual components with the mental well-being of old patients.

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., (© 2023. The Author(s).)

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).)