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Background: Although depression and anticholinergic drug use are common comorbidities that impair health status in later life, there are insufficient data on their relationship. This study aimed to investigate the relationship between depressive symptoms and anticholinergic use in older individuals. Methods: Community‐dwelling older adults (≥65 years) admitted to the tertiary referral geriatric outpatient clinic were included. Participants were evaluated for depressive symptoms using the Geriatric Depression Scale (GDS) with a cut‐off score of ≥6 for depression. Exposure to anticholinergic drugs was assessed using the anticholinergic cognitive burden (ACB) scale and three subgroups were created: ACB = 0, ACB = 1, and ACB ≥ 2. The relationship between these two parameters was assessed using multivariate logistic regression analysis considering other potential variables. Results: The study included 1232 participants (mean age 78.4 ± 7.2 years and 65.2% female) and the prevalence of depression was 24%. After adjusting for potential confounders, compared to ACB = 0, having ACB ≥ 2 was related to depression symptoms (odds ratio (OR): 1.56, 95% CI: 1.04–2.35, P = 0.034), whereas having ACB = 1 did not increase the risk (OR: 1.27, 95% CI: 0.88–1.83, P = 0.205). Conclusion: Our findings indicate that special attention should be paid to drug therapy in preventing depression in older adults, as exposure to a high anticholinergic load is negatively associated with psychological status. [ABSTRACT FROM AUTHOR]

Background: Transitional care is a key area of care provision to older people with chronic and complex health conditions and is associated with the quality of care delivered in the healthcare system. Aims: This study aimed to explore the perspectives of healthcare providers, including nurses and physicians, regarding transitional care from hospital to home in an urban area of Turkey. Methods: A qualitative study using a thematic analysis method was carried out. In‐depth semi‐structured interviews were held with eight clinical nurses and five general physicians involved in the provision of healthcare services to older patients in the transitional care process from hospital to home. Findings: The thematic analysis of in‐depth semi‐structured interviews with 13 healthcare professionals led to the development of the following themes: 'uninterrupted chain of care transfer', 'commitment to meet patient's needs' and 'support and removing ambiguities'. Conclusions: Key factors impacting on the quality and safety of transitional care and continuity of healthcare are communication and collaboration between healthcare staff and settings, and older patients' as well as family caregivers' awareness and their feelings of responsibility towards the continuity of care at home. [ABSTRACT FROM AUTHOR]

Background and Purpose: The need for high-quality long-term healthcare services is increasing across the globe as the population ages. Strategies for improving transitional care from hospital to home are needed. This study aimed to explore the perspectives of patients aged 65 years and over and their family caregivers transitioning from hospital to home in an urban area of Turkey. Methods: Thematic analysis of in-depth semi-structured interviews was conducted with older patients (n = 14), with at least one chronic disease and admitted to the hospital for a minimum of 3 days, and family caregivers (n = 11) who voluntarily participated. Results: Main themes were "confused feelings of safety and stress"; "worried about being left alone"; and "disrupted healthcare journey." The proactive rehabilitation model was used to elaborate on the study findings and interpret the perspectives and experiences of older patients and their family caregivers, which can be used for improving the quality of care after discharge from hospital. Implications for Practice: A high-quality transitional care program requires taking care of the feeling of safety in older patients and their family caregivers by the multidisciplinary team and their enhanced involvement in care initiatives after hospital discharge. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to examine bone mineral density (BMD) and osteoporosis in older adults with dementia compared to those with a normal cognitive status and to evaluate the type, severity, and duration of dementia. Patients and methods: Between May 2013 and May 2017, a total of 363 participants aged =65 years (136 males, 227 females; mean age 78.4±5.4 years; range 66 to 99 years) with and without Alzheimer's disease (AD), vascular dementia (VaD), or mixed dementia (AD-VaD) were included in this single-center, prospective, cross-sectional study. The dementia group included 93 patients with dementia and the control group included 270 age- and sex-matched healthy individuals. We used dual-energy X-ray absorptiometry (DXA) to measure BMD of the lumbar spine, total hip, and femoral neck. Results: Controlled for age and sex, demented and non-demented participants had a similar BMD (g/cm2) at lumbar spine [F (1, 358):0.83, p=363], but lower BMD values of total hip [F (1, 359):10.26, p=0.001] and femoral neck [F (1, 359):15.21, p<0.001] in the patients with dementia. Adjusted percentage of osteoporosis and low bone mass based on total hip and femoral neck T-scores were also significantly higher in the patient group. The mean BMD values, frequency of osteoporosis, and low bone mass did not significantly differ according to the subtype of dementia, sex, and disease duration or severity. Conclusion: Our study results show that demented elders have a lower BMD and higher frequency of osteoporosis at the hip, but not at the lumbar spine, irrespective of sex and type of dementia. Based on these results, we can speculate that not only AD, but also VaD and AD-VaD may be associated with bone loss at the hip. [ABSTRACT FROM AUTHOR]

The acute and post-acute care of the elderly is a process fraught with problems. Elderly patients at high risk are individuals who have to be admitted more frequently to a hospital due to developed complications, who are faced with a constant risk of hospitalization, and who have increased risks of functional decline, nursing home admittance, and death. These adverse outcomes cause discrepancies and problems in the implementation and regulation of treatment and coordination between health entities. Factors increasing these risks vary among these individuals, but existing chronic diseases and geriatric syndromes are the most important underlying causes. The identification of elderly patients at high risk for complications is difficult because of the complex syndromes, chronic diseases, care and socioeconomic problems. Also, these patients are at risk for unplanned hospital admissions. One of every 4 or 5 elderly patients discharged at high risk is re-admitted to a hospital within the first month. In these patients, early diagnosis, followed by a multi-disciplinary team, enhanced discharge planning, medication reconciliation and out of hospital care could contribute to improving the quality of care and more efficient use of the resources. In Turkey there is a need for patient-centered programs on this issue. [ABSTRACT FROM AUTHOR]

Caregiver burden in patients with dementia is a condition that impairs both patients and caregivers health. We aimed to compare the caregiver burden between Lewy body dementia (LBD) and Alzheimer's dementia (AD) groups. Subjects, admitted to the geriatric outpatient clinic of Gulhane Medical Faculty, were assessed in this analysis. AD patients (n=30) and LBD patients (n=29) with caregiver were considered as patient groups. Older people with normal cognitive function (n=32) with caregiver were included as control group. Zarit Burden Interview was used to evaluate caregiver's depression. The mean caregiving periods (year) in AD, LBD, and control groups were 5.0±3.0, 3.5±1.2, and 5.2±3.3, respectively. Depression was prevalent in caregivers of AD group (50%, p=0.04). Depression level in dementia was higher in LBD group (mean=16.2±6.0) and significantly higher than AD group (mean=12.1±5.2) (p=0.007). Zarit Burden Interview score was the highest in LCD group (mean=18.5±10.3) and significantly higher than control group (mean=7,4±6,4) (p<0.001). In our study, perceived stress and exhaustion were more among caregivers of LBD than those of AD. Interventions aimed to decrease caregiver burden are needed to implement in patients with dementia, especially with LCD, and in their caregivers. [ABSTRACT FROM AUTHOR]

The older adult at high risk safety problem during transitions between care settings has become a huge public health problem. The care needs of this population are required to be assessed with a multifactorial approach due to increasing comorbidities, physical and physiological changes, environmental risks, social and lifestyle factors, and nutrition. Safe Transitions for at risk Patients (STAR) program has been developed to address patient's safety problem of potentially preventable hospital readmissions among older adults who are at high risk for complications during transitions. There is a growing older population in Turkey which is in the process of demographic transition and it has to be taken steps toward to meet this challenge by building "Program Culture". STAR program for Turkey, which aims at meeting future needs in the care of older patients at high risk, has been created by modifying STAR program. This adapted program has been prepared in accordance with health system requirements in Turkey. Testing of this patient-centered intervention can increase the quality of geriatric care while adverse outcomes and potentially preventable readmissions decrease and provide econo mic benefits. [ABSTRACT FROM AUTHOR]

Osteoporosis is a disorder that affects commonly the people above 65 years, impairs the functional status, decreases the life quality, and increases mortality and cost. Lateral screening of vertebra or displaying of proximal femur with DEXA is gold standard method for the evaluation of diagnosis and fracture risk in elderly subjects. Physical examination for the analysis of risk factors of falling and laboratory methods for the diagnosis of secondary osteporosis were used. While increasing muscle strength and balance, exercise programs, calcium and vitamin D supplement are helpful in the prevention of falling. As anti-osteoporotic drugs, aleandronat, risedronat, and strontium ranelat have anti-fracture efficiencies for both hip and vertebra fracture. It is considered that the making of periodically routine health examination is important for early diagnosis and treatment in elderly people. In routine examination of elderly subject, it would be helpful that declaring of actions to be done for the prevention of osteoporosis development, if occured, the stopping of progression, and the prevention of falling as part of health training. [ABSTRACT FROM AUTHOR]

Vitamin D is thought to have a probable helpful effect on the action of insulin. There is little information regarding this relationship in prediabetic elderly subjects in the literature. The aim of this study was to investigate differences in insulin sensitivity and metabolic parameters according to vitamin D levels in prediabetic elderly subjects. Seventy nine elderly subjects (31 male, 48 female; mean age: 75.8±6.04 years) who admitted to the Department of Geriatry of Gulhane Military Medical Faculty were included in the study. According to plasma concentrations of 25(OH)D, the subjects were categorized in 2 groups: those with a level lower than 20 ng/mL (vitamin D deficiency: Group I) and those with a level higher than 20 ng/mL (vitamin D insufficiency [20-30 ng/mL] or vitamin D normal [>30 ng/mL]; Grup II). Serum insulin and HOMA-IR levels in Group I were significantly higher than those in Group II (p=0.025 and p=0.021, respectively). In all the subjects there was a statistically significant negative correlation between plasma 25(OH)D levels and HOMA-IR and insulin levels (r=-0.287 and r=-0.302, respectively). Our results indicate that insulin sensitivity may decrease in prediabetic elderly subjects with vitamin D deficiency. Further randomized, controlled, and prospective studies are necessary to investigate the relationship between vitamin D and these parameters in prediabetic elderly subjects. [ABSTRACT FROM AUTHOR]

There is little information regarding the risk factors of osteoporosis in older men. The aim of this study was to examine the risk factors in older men with osteoporosis. Medical records of 209 older men (mean age: 77.1±6.0 years) who admitted to the Geriatric Clinics of Gulhane Military Medical Academy were examined prospectively. The measurement of bone mineral density was made at the lumbar spine and femur by the DEXA method. Osteoporosis and osteopeny were observed in 64 (30.6%) and 92 (44.0%) of the 209 cases, respectively. Bone mineral density was normal in 53 (25.4%) cases. The last ten-year history revealed fracture in 25 (11.6%) osteoporotic and 14 (6.7%) osteopenic cases. Osteoporosis was more common in those with lower body mass index scores (p<0.05). The incidence of osteoporosis was higher in those who were not making exercise (p<0.05). Age, waist circumference, erythrocyte sedimentation rate, and the levels of ionized calcium, magnesium, phosphor and thyroid stimulating hormone were not related with osteoporosis (p>0.05). In our study it was detected that osteoporosis was less prevalent in older men who had higher body weight index scores and regular physical activity. The results indicate that the primary prevention with exercise and good nourishment is an important factor in preserving bone mineral density in men older than 65 years just as in adults and young subjects. [ABSTRACT FROM AUTHOR]

Falls are one of the geriatric syndromes which occur commonly and significantly increase morbidity and mortality rates in elderly. The incidence of falls increases with age. Falls usually occur when impairments in cognitive, behavioral, and executive function begin. The incidence of fall is between 30 and 40 percent of community-dwelling people and approximately 50 percent of individuals in the long-term care setting over the age of 65 years. Fracture (hip, arm, wrist, pelvis), head trauma or major lacerations, as defined serious wounding, occur 10-25% of elderly cases. Fall is overlooked in clinical examination due to various reasons; the patient never mentions the event to a doctor; there is no injury at the time of the fall; the doctor fails to ask the patient about a history of falls; or either doctor or patient erroneously believes that falls are an inevitable part of the aging process. Elderly give not usually any self-information about fall, for this reason, all older patients should be asked at least once per year about falls and should be assessed in terms of balance and gait disorders. There are many distinct causes for falls in old people. Falls in older individuals occur when a threat to the normal homeostatic mechanisms that maintain postural stability is superimposed on underlying age-related declines in balance, ambulation, and cardiovascular function. This factor may be an acute illness (eg, fever, water loss, arrhythmia), a new medication, an environmental stress (eg, unfamiliar surrounding), or an unsafe walking surface. The elderly person can not cope with happened additional stress. To prevent and decrease the frequency of falls, effective approaches are medical interventions, environmental modifications, education-exercise programs, and assisted device. Detection and amelioration of risk factors can significantly reduce the rate of future falls. The assessment of fall, causing mobility restriction, use of nursing home, and treating independent live in elderly, are very important. and needs further studies. [ABSTRACT FROM AUTHOR]

Background: Data on adverse prognostic factors for mortality in patients with dementia with Lewy bodies (DLB) are limited. The objective of this study was to evaluate two-year mortality predictors in patients with DLB., Methods: : Individuals aged ≥ 60 years with a diagnosis of DLB, followed by a tertiary-referral geriatric outpatient clinic from 2006 to 2021, were assessed retrospectively using medical or patient records. The mortality status of the patients in the second year after diagnosis was determined. Demographic and clinical characteristics were reviewed to determine their impact on mortality prediction., Results: A total of 108 patients with DLB participated in this study. The mean age was 78.9 ± 6.6 years, and 49.1% were females. At the end of the two-year follow-up, 23 patients (21.3%) died and 85 patients (78.7%) were still alive. Malnutrition, and cognitive and functional impairments were significantly more common in the mortality group. Age, female sex, functional impairment, moderateto-severe clinical dementia rating, and malnutrition were associated with an increased mortality risk. On the multivariable analysis, malnutrition (HR = 5.00; 95% CI: 1.64-15.24; p: 0.005) was the only independent predictor of two-year-mortality., Discussion: Patients with DLB had an unfavorable survival outcomes. Approaches to prevent malnutrition can improve prognosis and reduce early mortality in this vulnerable group. However, further studies are needed to determine mortality risk factors in this population.

Background: Elder abuse is among the most important ethical issue during the management of older population. The elder abuse suspicion index (EASI) was developed for evaluating abuse in older adults. We aimed to assess the reliability and validity of the Turkish version EASI-Türkiye (TR) among older adults., Methods: This study included 89 community-dwelling older adults. The EASI-TR and other scales, including HwalekSengstock Elder Abuse Screening Test-Türkiye (HS/EAST-TR), YGDS, Yesavage Geriatric Depression Scale (YGDS), Instrumental Activities of Daily Living (IADL), and Activities of Daily Living (ADL) were administered to all participants. Internal consistency and external validity were assessed., Results: EASI-TR revealed an excellent test-retest reliability and acceptable level of internal consistency (Cronbach's α = 0.711). The item-total correlations ranged between 0.296 and 0.701, except for the second item. This test showed significant correlations with the HS/EAST-TR and IADL (p < 0.05), demonstrating good external validity., Discussion: The EASI-TR appears to have acceptable reliability and validity in screening for abuse in older adults. This tool may recognize cases that require additional evaluation in managing of ethical issues.

Background/aim: This study aimed to assess validity and reliability of the Turkish version of Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC-T)., Materials and Methods: The individuals who met inclusion criteria of the study were in patients of a hospital and a long-term care facility. Mini Mental Status Exam (MMSE), Cornell Dementia Depression Scale (CDDS), Global Deterioration Scale (GDS), visual analogue scale (VAS), and PACSLAC-T were administered to all subjects. The scales were repeated with an interval of two weeks for test–retest reliability., Results: A total of 112 patients with dementia were included in the study. The intraclass correlation coefficient ICC for test–retest reliability of the PACSLAC-T was 0.713 with a 95% confidence interval of 0.486–0.843. The Cronbach’s α coefficient for total PACSLAC-T was 0.842 for test and 0.888 for retest, which indicated substantial internal consistency. In convergent validity, there were significant correlations between PACSLAC-T total score VAS (r = 0.684, P < 0.001), while no correlation was found between PACSLAC-T total score and CDDS (r = 0.127, P = 0.094), and GDS (r = 0.096, P = 0.167). Also, significant correlations were found between PACSLAC-T total score and MMSE (r = –0.468, P = 0.016)., Conclusion: This study showed that PACSLAC-T could be a promising tool for the management of pain in older adults with limited communication skills.