Process of allogeneic hematopoietic cell transplantation decision making for older adults.

Allogeneic hematopoietic cell transplantation (alloHCT) may be the only curative option for some older adults with hematologic malignancies, and its associated risks of significant morbidity and mortality warrant a clear, informed decision-making process. As older adults have not been transplanted routinely until recent years, younger people have been the prototypical group around whom the current process has developed. Yet, this process is applied to older adults who have different considerations than younger patients when making their transplant decision. Older adults do not have the open-ended lives of younger patients and are entitled to consider how to spend their remaining time. They also possess maturity and experience, and with proper knowledge, they can make informed choices rather than moving forward in the transplant process unaware. Notably, older patients face similar problems with the informed decision-making process in nephrology. Strategies such as providing education about alloHCT gradually and repeatedly during induction, presenting recent knowledge from the literature in plain language, and utilizing a team approach to patient education may help older adults make the best decision about transplant in light of their situation and values. Understanding when and how older adults decide on alloHCT is an important first step to further exploring this problem.

How to measure snoring? A comparison of the microphone, cannula and piezoelectric sensor.

The objective of this study was to compare to each other the methods currently recommended by the American Academy of Sleep Medicine (AASM) to measure snoring: an acoustic sensor, a piezoelectric sensor and a nasal pressure transducer (cannula). Ten subjects reporting habitual snoring were included in the study, performed at Landspitali-University Hospital, Iceland. Snoring was assessed by listening to the air medium microphone located on a patient's chest, compared to listening to two overhead air medium microphones (stereo) and manual scoring of a piezoelectric sensor and nasal cannula vibrations. The chest audio picked up the highest number of snore events of the different snore sensors. The sensitivity and positive predictive value of scoring snore events from the different sensors was compared to the chest audio: overhead audio (0.78, 0.98), cannula (0.55, 0.67) and piezoelectric sensor (0.78, 0.92), respectively. The chest audio was capable of detecting snore events with lower volume and higher fundamental frequency than the other sensors. The 200 Hz sampling rate of the cannula and piezoelectric sensor was one of their limitations for detecting snore events. The different snore sensors do not measure snore events in the same manner. This lack of consistency will affect future research on the clinical significance of snoring. Standardization of objective snore measurements is therefore needed. Based on this paper, snore measurements should be audio-based and the use of the cannula as a snore sensor be discontinued, but the piezoelectric sensor could possibly be modified for improvement.

Sarcopenia assessment project in the nursing homes in Turkey.

BACKGROUND/OBJECTIVES: Sarcopenia and sarcopenic obesity (SO) are geriatric syndromes leading to physical disability, poor quality of life and death. The aim of this study was to investigate the prevalence of sarcopenia and SO in nursing homes in Turkey and to define local disparities for diagnosing sarcopenia and SO. SUBJECTS/METHODS: This cross-sectional multicenter study was performed in 711 patients in 14 nursing homes. Comprehensive geriatric assessment tests, handgrip strength and calf circumference (CC) measurements were carried out. Sarcopenia was both defined by handgrip strength and CC criteria. RESULTS: According to handgrip strength measurement, 483 (68%) of patients were sarcopenic (male: 72%, female: 63.8%), 228 were non-sarcopenic. The prevalence of SO was 22% (13.7% in men, 30.2% in women). Patients (82.5%) who were diagnosed as sarcopenic by the handgrip strength test were not sarcopenic according to CC sarcopenia criteria. Therefore, we tried to determine the optimal CC value for diagnosing sarcopenia in our population. CONCLUSIONS: Both sarcopenia and SO were prevalent among Turkish nursing home elderly residents. Most of the patients with sarcopenia were obese or overweight. We showed that diagnosing sarcopenia with CC measurement underestimated the sarcopenia prevalence assessed by handgrip strength. So we concluded that, although different assessment methods are recommended for the diagnosis of sarcopenia local disparities should be considered.

Prevalence of aging population in the Middle East and its implications on cancer incidence and care.

The Middle Eastern population is aging rapidly, and as aging is the main risk factor for cancer, the incidence and prevalence of that disease are increasing among all the populations in the region. These developments represent huge challenges to national and community-based health services. At the current state of affairs, most Middle Eastern countries require the cooperation of international agencies in order to cope with such new challenges to their health systems. The focus and emphasis in facing these changing circumstances lie in the education and training of professionals, mainly physicians and nurses, at the primary, secondary and tertiary levels of health services. It is imperative that these training initiatives include clinical practice, with priority given to the creation of multidisciplinary teams both at the cancer centers and for home-based services.

Orthostatic hypotension in the healthy elderly.

Orthostatic hypotension (OH) is a common problem in elderly people causing several complications such as falls and fractures. In recent years, it was noticed that OH seems to have an association with cardiovascular risk factors including cerebrovascular events, higher nocturnal blood pressure levels, and arterial stiffness. In this study, we aimed to evaluate the prevalence of OH in our healthy elderly people and its association with blood pressures, left ventricular mass, plasma insulin, age, and autonomic tests including heart rate response (HRR) to valsalva maneuver, heart rate variation (HRV) during deep breathing, HRR to standing. A total of 61 subjects (35 male/26 female) were enrolled and completed the study. Nine out of 61 (14.7%) were found to have OH. When demographic features and study parameters were compared in both groups (subjects with OH: 9 and non-OH: 52), no difference in blood glucose, sodium, potassium, calcium, body mass index, systolic and diastolic blood pressures, HRR to valsalva maneuver, HRV during deep breathing, HRR to standing were found between the groups. While fasting plasma insulin level was significantly higher in non-OH group than those in OH group (p<0.05), left ventricular mass index was significantly higher in subjects with OH (p<0.05). In conclusion, OH is a prevalent condition in healthy elderly people and its relation with cardiovascular risk factors like increased left ventricular mass index and impaired blood pressure control need more studies to demonstrate such an association and responsible mechanisms.

The prevalence of Vitamin D deficiency and effects of ultraviolet light on Vitamin D levels in elderly Turkish population.

Vitamin D deficiency is commonly found in the elderly and is associated with osteoporosis and hip fractures. In this study, Vitamin D status of 138 female and 87 male subjects living in old age homes (OAH) and 171 female and 24 male subjects living in own homes (OH) from Central Anatolia were assessed. A questionnaire was applied to collect information about wearing features and degree of sunlight exposure and benefiting from ultraviolet index calculated (BFUI). We have found Vitamin D deficiency in 33.4% among our subjects. Also, 40.1% of subjects living in OAH (54.1% of females and 18.4% of males) and 24.4% of subjects living in OH (27.9% of females and 4.2% of males) were Vitamin D deficient. Vitamin D deficiency was significantly higher in subjects living in OAH than subjects living in OH (P = 0.001) and also higher in females than males (40.7% versus 15.3%, P < 0.001). Subjects with Vitamin D deficiency were older (P < 0.001), BFUI was lower (P < 0.001) and parathyroid hormone (PTH) was higher (P < 0.001) than those having normal level of 25(OH)D. There was a significant negative correlation between 25(OH)D levels and age (P < 0.001, r = -0.248) PTH and 25(OH)D (P = 0.004, r = -0.340), and positive correlation between 25(OH)D and BFUI (P < 0.001, r = 0.340). Vitamin D deficiency is very common in Turkish elderly subjects especially living in OAH and there is a significant low exposure to sunlight among them. Simply by asking clothing habits and exposure to sunlight, we can able to identify risk of Vitamin D insufficiency in elderly subjects.

Recognition of neurocognitive dysfunction in chronic hemodialysis patients.

We sought to determine the prevalence, recognition, and consequences of mental impairment among chronic hemodialysis patients. We administered the Mini Mental Status Exam (MMSE), a brief validated method for assessing cognitive mental status that is commonly used by clinicians, to 84 patients from our dialysis units. To determine the clinical implications of mental impairment, we obtained Kt/V, albumin, protein catabolic rate, blood pressure, and hematocrit values. We found that 21% of subjects had mild mental impairment (MMSE 18 to 23) and that 11% had moderate-severe mental impairment (MMSE 0 to 17). We found no relationship between MMSE score and years on dialysis, Kt/V value, hematocrit value, or erythropoietin use. On univariate analysis, MMSE score was associated with albumin, protein catabolic rate, inter-dialytic weight gain, number of co-morbid conditions, number of hospitalizations. Outcomes on univariate analysis were further analyzed by multivariate analysis. There was an independent relationship between decrement in MMSE score and lower protein catabolic rate and increased hospitalization number and number of co-morbid conditions. Based on our findings, we recommend that clinicians routinely screen hemodialysis patients for mental impairment and target impaired patients for interventions to improve mental status and associated adverse outcomes.