A different outlook to consequences of anemia in older adults.

OBJECTIVES: Anemia is a common health issue in older adults with crucial consequences. We aimed to investigate the relationship of anemia with various components of geriatric syndromes. METHODS: A total of 486 older individuals aged 65 and over admitted to a university hospital were included in this cross-sectional study. According to WHO criteria, we defined anemia as hemoglobin concentration lower than 13 g/dL in men and 12 g/dL in women. The Working Group on Sarcopenia in Older People (EWGSOP2) criteria were used to diagnose sarcopenia. Handgrip strength (HGS) was measured by a hand dynamometer. Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) questionnaires were used to evaluate functionality. Geriatric Depression Scale (GDS), Mini Nutritional Assessment (MNA), Mini-Mental State Examination (MMSE), and European Quality of Life-5 Dimensions (EQ-5D) questionnaires were also used. RESULTS: Participants' mean age was 72.2 ± 6.4 years and 58.8% of them were female. Ninety-two of 486 patients were anemic and 64.1% of anemic patients were female. Anemic group had lower IADL, EQ-5D, HGS scores, and higher GDS scores. According to multivariate logistic regression analysis, age, and anemia were found to be independent risk factors for dependency in IADL in both genders. Anemia, age, and depression were found to be independent risk factors for low HGS in women. CONCLUSION: Anemia and depression are independent factors for low HGS in women, and anemia and age are independent factors for dependency on instrumental daily activities in older persons. Treating depression and raising Hb to optimal levels may be critical interventions to improve the health and life quality of people aged 65 and over, particularly in the female gender.

Bone mineral density response to antiosteoporotic drugs in older depressed adults.

Until now, studies did not evaluate the efficacy of antiosteoporotic agents in depressed patients. We demonstrate that the presence of depression and/or serotonergic antidepressant use was associated with non-response to osteoporosis treatment in older adults. PURPOSE: This study aimed to evaluate the effects of depression and antidepressants on bone mineral density (BMD) and response to antiosteoporotic agents in older adults. METHODS: A total of 198 participants with osteoporosis, aged 65 and over, were included in this retrospective study. BMD was measured by dual-energy x-ray absorptiometry scanning at baseline and month 24. RESULTS: Eighty-three of the 198 patients had a diagnosis of depression, and all were serotonergic antidepressant users. Baseline BMD was similar in depressed and non-depressed patients. Lumbar spine BMD change was significantly lower in depressed patients than non-depressed patients (2.89% and 4.85%, respectively, p < 0.001). In addition, of those receiving denosumab treatment, depressed ones had lower lumbar spine BMD changes. Depression and/or antidepressant use was an independent variable for non-response to osteoporosis treatment in both the femoral neck (p = 0.008, OR = 2.61) and lumbar spine (p = 0.015, OR = 6.87), while alendronate and zoledronic acid were independent variables for non-response in the femoral neck and total femur compared to denosumab. CONCLUSIONS: Our study has shown that the presence of depression and/or serotonergic antidepressant use was associated with non-response to osteoporosis treatment in older adults. The results of our study may guide physicians to make treatment decisions in older individuals with depression.

Changes in sexual behaviour of male physicians during the COVID-19 pandemic.

Healthcare workers have been affected both physically and mentally during the COVID-19 pandemic. This study aimed to investigate the impacts of COVID-19 on the mental health and sexual behaviour of male physicians working during the pandemic. A survey was carried out on male physicians working in Turkey during the pandemic. Participants' sexual behaviours, anxiety symptoms, and depressive symptoms were assessed. The frequency of anxiety and depressive symptoms was 55.9% and 44.1%, respectively. Among the 102 participants, 35.3% reported decreased sexual desire, and 41.2% reported decreased sexual intercourse. Working more, caring for COVID-19 patients, having higher scores for anxiety and depressive symptoms were related to changes in sexual behaviour. High prevalences of anxiety and depressive symptoms and sexual behaviour changes were found among male physicians during the COVID-19 pandemic. This study points out the importance of psychosocial support in health professionals during the pandemic period.

The role of comprehensive geriatric assessment in predicting fall risk.

BACKGROUND: The prevention of falls among older adults is one of the most important public health issues in today's aging society. There are many factors significantly affecting the risk of falls. AIMS: This study aimed to investigate the factors on fall risk in older adults. METHODS: A total of 335 elderly outpatients aged 65 and over were included in this cross-sectional study. Comprehensive geriatric assessment was performed on the participants. Tinetti Balance and Gait Assessment Tool (TBGA) and Mini-Mental State Examination (MMSE) were used to assess fall risk and cognitive functions, respectively. RESULTS: The mean age of 335 participants was 72.1 ± 6.0 years and 55.2% was female. Of the participants, 40.6% had a moderate-high fall risk according to TBGA and 31.6% had a history of falls within the last year. Although there was no significant difference in MMSE results between the medium-high fall risk group and the low fall risk group, higher MMSE attention and calculation domain score was found to be an independent variable for decreased fall risk and sarcopenia for increased fall risk (p = 0.039, OR = 0.70 and p = 0.037, OR = 3.43, respectively). CONCLUSION: The role of sarcopenia in fall risk is well established. In this study, we also showed that attention and calculation play important roles in fall risk. Elderly individuals with low scores in attention and calculation domains need a more detailed assessment in terms of fall risk, even if cognitive functions are considered normal according to the MMSE.

A simple method for clinical implications of pain; comprehensive geriatric assessment.

OBJECTIVE: The effect of chronic pain on the elderly population is enormous in terms of both human suffering and cost. This study aimed to investigate the factors associated with chronic low back pain in older adults by performing a comprehensive geriatric assessment. METHODS: This cross-sectional study included 225 elderly patients admitted to a geriatric outpatient clinic. All participants underwent a comprehensive geriatric assessment, and factors related to chronic low back pain were assessed. Participants were grouped as those with and without chronic pain. RESULTS: The mean age of the participants was 72.9±6.9 years, and 149 (66.2%) of them had chronic pain complaints. The number of chronic diseases and medications, depressive symptom scores, and sleep quality scores were higher, and quality of life (European Quality of Life-5 Dimensions index and European Quality of Life-5 Dimensions visual analog scale) and nutritional status scores were lower in the chronic pain group. The pain visual analog scale score had a statistically significant moderate negative correlation with the European Quality of Life-5 Dimensions index (r=-0.440, p=0.000) and European Quality of Life-5 Dimensions visual analog scale (r=-0.398, p=0.000) scores. The male gender was associated with a reduced risk of chronic pain, while poor sleep quality and number of comorbidities were associated with an increased risk of chronic pain (p=0.000, OR 0.20, p=0.021, OR 2.54, and p=0.010, OR 1.40, respectively). CONCLUSION: Chronic pain is common and independently associated with poor sleep quality, an increased number of diseases, and female gender. The results of our study may guide pain management in older individuals.

A retrospective study of diabetes treatment in older adults: what should we AIM for?

OBJECTIVES: Management of diabetes in elderly individuals requires a complex approach, considering the negative consequences. Glycemic overtreatment and undertreatment are relatively common conditions among this population. This study aimed to determine the potential overtreatment and undertreatment frequencies in older adults and the factors associated with these conditions. METHODS: This retrospective study included 405 diabetic older adults aged >65 years. Sociodemographic characteristics, additional comorbidities, medications, HbA1c and fasting glucose levels of the patients have been recorded. RESULTS: The median age of the patients was 71 years. The frequency of potential overtreatment and undertreatment has been found to be 20.2% and 17.8%, respectively. Insulin and sulfonylureas were found to be associated with increased risk of potential overtreatment (p = 0.000, OR = 14.91 and p = 0.000, OR = 8.48, respectively) and reduced risk of potential undertreatment (p = 0.001, OR = 0.16 and p = 0.000, OR = 0.05, respectively), while DPP-4 inhibitors were found to be associated with reduced risk of potential undertreatment (p = 0.000, OR = 0.12). CONCLUSION: Our study has shown that potential glycemic overtreatment and undertreatment are common problems in diabetic older adults. It was found that agents with a high risk of hypoglycemia, such as insulin and sulfonylureas, were more closely associated with potential overtreatment. In the management of diabetes in the elderly, it should be aimed to choose treatment agents that lead to less negative consequences and to follow up the patients more closely.

An inconvenient status in anti-osteoporotic treatment process: corticosteroid use.

OBJECTIVE: There are limited studies investigating the comparison of the efficacy of anti-osteoporotic drugs in different conditions resulting in osteoporosis in older adults. This study aimed to compare the effectiveness of anti-osteoporotic agents in older adults with or without glucocorticoid-induced osteoporosis. METHODS: This retrospective study included 364 patients with osteoporosis, aged 65 years and older. Bone mineral density measurement was performed, and the percent change from baseline was calculated at month 24. RESULTS: Of the 364 patients, 80 were glucocorticoid users. Similar changes in the bone mineral density of the lumbar spine and femoral neck and fracture risk were found in patients with or without glucocorticoid-induced osteoporosis. There was no significant difference in bone mineral density changes between the groups in terms of anti-osteoporotic agents used. CONCLUSIONS: This study demonstrated that the response to anti-osteoporotic agents was similar in older adults with glucocorticoid-induced osteoporosis and those without glucocorticoid-induced osteoporosis. The results of our study may guide osteoporosis treatment in older individuals with glucocorticoid-induced osteoporosis.

Different reflections of the face mask: sleepiness, headache and psychological symptoms.

Objectives. The COVID-19 pandemic has had significant physical and mental effects on healthcare workers. This study aims to evaluate the relationship between wearing face masks and headache, sleepiness, mood and anxiety symptoms in healthcare workers. Methods. A survey was administered to 365 healthcare workers working during the pandemic. The Beck depression inventory, the Beck anxiety inventory and the Epworth sleepiness scale were used to assess depressive symptoms, anxiety symptoms and daytime sleepiness, respectively. Participants were also asked about new-onset headaches. Results. Almost half of the participants (47.6%) reported new-onset headaches, and 23.2% reported excessive daytime sleepiness. The frequencies of depressive and anxiety symptoms were 43.7 and 59.2%, respectively. Sleepiness scores and new-onset headache frequency were higher in women and those using filtering facepiece respirators. A statistically significant positive correlation was found between mask-wearing duration, depressive and anxiety symptom scores, and sleepiness score. Conclusions. The present study has shown that many healthcare workers wearing face masks suffered from sleepiness, headaches and psychological symptoms during the COVID-19 pandemic. These findings indicate the importance of improving working conditions and planning psychological interventions for healthcare workers.

Malnutrition and Depressive Symptoms in Elderly Palliative Care Patients.

Objective: The aim of this study is to determine the prevalence of and relationship between malnutrition and depressive symptoms in older palliative care inpatients. Methods: One hundred and thirty-six older adults were included in the study. The Geriatric Depression Scale, Mini Nutritional Assessment Short Form, Mini Mental State Examination, Barthel index, and Lawton & Brody index were used to evaluate the mood, nutrition status, mental status, and activities of daily living of the patients. Results: The mean age of the patients was 74.88 ± 8.82 years, and 63.2% of the patients were female. According to the nutritional assessment, 39.7% of the patients suffered from malnutrition, while 47.1% were at risk for it, and depressive symptoms were detected in 79.4% of the patients. A strong negative correlation was found between the scores for nutritional and depressive symptoms (r = -.750, 95% CI = -.834 to -.668). Conclusion: Malnutrition, risk of malnutrition, and depressive symptoms were found to occur often among the patients, and the relationship between them was statistically significant. Our results highlight that the quality of life of palliative care patients could be improved by providing adequate nutrition and psychological support.

How have older adults reacted to coronavirus disease 2019?

AIM: Outbreaks have a wide spectrum of psychosocial impact on individuals. This study aimed to investigate the psychosocial effects of measures to prevent the spread of the novel coronavirus disease on older adults in Turkey. METHODS: A survey was conducted of 104 adults who had to stay at home during the pandemic. Participants' depressive symptoms, anxiety symptoms, nutritional status, health-related quality of life, and sleep quality were assessed. RESULTS: The frequency of depressive and anxiety symptoms was 37.5% and 29.8%, respectively. The frequency of depressive symptoms was higher in women, individuals age ≥85 years, and those with less education and low monthly income. Anxiety symptom frequency was also higher in women and those with less education and low monthly income. Quality of life and sleep were worse in those with depressive symptoms and anxiety symptoms. CONCLUSION: To our knowledge, this is the first published study to investigate the effect of a pandemic on the mood, anxiety symptoms, nutrition status, quality of life, and sleep of older adults during the pandemic period. Our findings indicate the importance of psychosocial support in older individuals during and after the pandemic period.

Correlation between Rho-kinase pathway gene expressions and development and progression of glioblastoma multiforme.

Glioblastoma multiforme (GBM) is the most common and the most aggressive primary malignant tumor of the brain. Prognostic factors in GBM can be sorted as age, tumor localization, tumor diameter, symptom period and type, the extent of surgery, postoperative tumor volume, and adjuvant radiotherapy and/or chemotherapy status. Besides the interactions between actin microfilaments, microtubules, and intermediate filaments, environmental factors and intracellular signals which regulate them affect the cell invasion. Rho proteins and therefore Rho-kinase activation play important role at these changes. The aim of this study is to evaluate the relationship between the Rho-kinase pathway gene expressions and prognosis in GBM. Ninety-eight patients diagnosed as GBM between 2001 and 2010 were enrolled into the study. RNA was obtained from the paraffinized tumor tissue of the patients with formalin-fixed, paraffin-embedded RNA isolation kit and the mRNA expressions of 26 genes were investigated. There was a statistically significant negative correlation between the ages at the diagnosis and survival. There was a significant relationship between the overexpression of Rho-kinase pathway-related genes LIMK1, CFL1, CFL2, and BCL2 and low expression of MAPK1 gene and the survival of the patients. These results demonstrate for the first time that there is a marked contribution of Rho-kinase pathway-related genes to the progression and survival of the GBM. The expression of these genes may be related to response of multimodal therapy or these parameters could be used to determine possible unresponsive patients before treatment.