Hypomagnesemia may be related to frailty, gait and balance problems, and basic activities of daily living in older adults.

OBJECTIVES: The study aims to investigate the relationship between hypomagnesemia, preclinical hypomagnesemia, and normomagnesemia as along with geriatric syndrome and comprehensive geriatric parameters(CGA). METHODS: 217 patients who applied to the geriatric clinic between November 2022 and December 2023 were included in the study. All patients underwent CGA. Patients were categorized into three groups: Magnesium (Mg) level ≤ 1.5 mg/dL, Mg level 1.5-1.8 mg/dL, and Mg level > 1.8 mg/dL. These three groups were compared in terms of demographic characteristics, comorbidities, CGA parameters, and geriatric syndromes. Regression analyses was conducted for significant parameters, adjusting for confounders. RESULTS: 74.9% of all participants were female, with an average age of 76.5 ± 6.6 years. The frequency of hypomagnesemia was 14.2%. Demographic characteristics and medication use, including proton pump inhibitors and diuretics, were similar in these three groups. While the FRIED frailty scale and the duration of the timed-up-and-go test were higher in the hypomagnesemia group, the Basic Activities Daily of Living (ADLs) and the Tinetti-POMA(performance-oriented mobility assessment) scores were lower in the hypomagnesemia group. When normomagnesemia was accepted as the reference category, FRIED frailty scale, Basic ADLs, and POMA score were more significant in the hypomagnesemia group (p = 0.025, p = 0.013 and p = 0.011,respectively), but there was no significance in the preclinical hypomagnesemia group regardless of the covariates. CONCLUSION: Hypomagnesemia, particularly serum Mg levels below 1.5 mg/dL, may be associated with frailty, basic ADLs, gait, and balance tests. In geriatric practice, patients with hypomagnesemia should be evaluated in terms of the risk of the mentioned disorders.

An alternative treatment option in older adults with knee osteoarthritis : Genicular nerve pulsed radiofrequency.

Osteoarthritis (OA), including knee OA (KOA), is an important cause of morbidity and disability in older adults. Pain management plays a major role in the treatment of KOA for pain relief and knee function improvement. Ultrasound-guided genicular nerve pulsed radiofrequency therapy is an effective, safe, nonradiative, and easily applicable treatment modality in older adults with KOA. It has a positive effect on geriatric syndromes, especially polypharmacy.

Muscle Strength Seems to be Related to The Functional Status and Severity of Dementia in Older Adults with Alzheimer's Disease.

AIM: This study aimed to determine the possible interrelationships between sarcopenia and Alzheimer's disease (AD). BACKGROUND: Sarcopenia and AD are two common geriatric syndromes; however, the relationship between AD and sarcopenia has not been evaluated in detail so far. OBJECTIVE: The objective is to evaluate the relationship between AD and sarcopenia. METHODS: This cross-sectional study was performed retrospectively on 128 patients with probable AD, with a mean age of 76.56±7.54 years. Comprehensive Geriatric Assessment, including the activities of daily living (ADLs), malnutrition, frailty, mini-mental state examination (MMSE), and orthostatic hypotension was performed. Sarcopenia was defined according to the revised EWGSOP-2 criteria. RESULTS: The frequency of probable sarcopenia and definitive sarcopenia was 54.7% and 18.7%, respectively. AD patients with probable sarcopenia had lower MMSE and ADLs scores and were frailer. Clinical dementia rating (CDR) score, MMSE, and basic and instrumental ADLs were independently related to probable sarcopenia in the patients (p=0.003, p<0.001, p=0.001, and p=0.001, respectively). The prevalence of probable sarcopenia in those with CDR 2 was higher than in those with CDR 0.5 and 1 (p=0.002). CONCLUSION: Our findings suggest that probable sarcopenia seems to be related to worse MMSE and ADLs scores and frailty in patients with AD and seems to be related to the severity of AD. Considering adverse health outcomes and the burden of sarcopenia on the patients and their caregivers, optimal care and treatment of sarcopenia in patients with AD are of great importance.

Predictivity of the comorbidity indices for geriatric syndromes.

BACKGROUND: The aging population and increasing chronic diseases make a tremendous burden on the health care system. The study evaluated the relationship between comorbidity indices and common geriatric syndromes. METHODS: A total of 366 patients who were hospitalized in a university geriatric inpatient service were included in the study. Sociodemographic characteristics, laboratory findings, and comprehensive geriatric assessment(CGA) parameters were recorded. Malnutrition, urinary incontinence, frailty, polypharmacy, falls, orthostatic hypotension, depression, and cognitive performance were evaluated. Comorbidities were ranked using the Charlson Comorbidity Index(CCI), Elixhauser Comorbidity Index(ECM), Geriatric Index of Comorbidity(GIC), and Medicine Comorbidity Index(MCI). Because, the CCI is a valid and reliable tool used in different clinical settings and diseases, patients with CCI score higher than four was accepted as multimorbid. Additionally, the relationship between geriatric syndromes and comorbidity indices was assessed with regression analysis. RESULTS: Patients' mean age was 76.2 ± 7.25 years(67.8% female). The age and sex of multimorbid patients according to the CCI were not different compared to others. The multimorbid group had a higher rate of dementia and polypharmacy among geriatric syndromes. All four indices were associated with frailty and polypharmacy(p < 0.05). CCI and ECM scores were related to dementia, polypharmacy, and frailty. Moreover, CCI was also associated with separately slow walking speed and low muscle strength. On the other hand, unlike CCI, ECM was associated with malnutrition. CONCLUSIONS: In the study comparing the four comorbidity indices, it is revealed that none of the indices is sufficient to use alone in geriatric practice. New indices should be developed considering the complexity of the geriatric cases and the limitations of the existing indices.

Improvement of nutritional status enhances cognitive and physical functions in older adults with orthostatic hypotension.

OBJECTIVES: Malnutrition may be an important risk factor for orthostatic hypotension (OH). The aim of this study was to investigate the relationship between malnutrition and OH, and the effect of nutritional improvement on cognitive functions and gait-balance parameters in patients with OH. METHODS: A total of 692 patients were included in the study. The Head-up Tilt Table Test and Mini Nutritional Assessment (MNA) were implemented for participants. Patients underwent a comprehensive geriatric assessment, including a neurocognitive evaluation and physical performance. After 6 mo, the participants who had OH were reevaluated. RESULTS: Women comprised 64.8% of the patients and the mean age was 74.98 ± 7.68 y. The frequencies of OH, malnutrition, and risk of malnutrition were 31.9%, 7.4%, and 13.3%, respectively. The rates of dementia, hypertension, sarcopenia, frailty, and a history of falls in the past year were higher in the OH-positive group. OH was associated with malnutrition (odds ratio: 2.48; confidence interval, 1.35‒4.54; P = 0.003) and risk of malnutrition (odds ratio: 1.64; CI, 1.03‒2.62; P = 0.035) in contrast with normal nutritional status. A higher MNA score during the follow-up period resulted in improved cognitive and gait-balance scores when confounding factors were adjusted (P < 0.05). Patients with OH whose MNA score improved during the follow up also had a significant decrease in the number of falls (P = 0.034). CONCLUSIONS: Optimization of nutritional status may improve global cognition and gait-balance functions, and prevent falls in older people with OH.

The evaluation of relationship between polypharmacy and anticholinergic burden scales.

OBJECTIVE: Polypharmacy and anticholinergic burden are the indicators for the evaluation of the quality of pharmacotherapy in older adults. The aim of this study was to consider which anticholinergic burden scales are more related with polypharmacy among older patients. METHODS: Four hundred and twenty older adults were evaluated retrospectively in this cross-sectional study. The patient's demographic data, comorbidities, the drugs, and number of drugs were recorded. Anticholinergic burden scales were calculated by a tool named anticholinergic burden calculator. RESULTS: The participants' mean age was 73.08±8.71. The prevalence of polypharmacy was 32.14%. The highest relationship with polypharmacy was observed for drug burden index (DBI) (odds ratio 10.87, p<0.001). CONCLUSION: Our study demonstrated that polypharmacy and DBI scores were more related than other anticholinergic burden scales in older adults.

Postural blood pressure changes in the elderly: orthostatic hypotension and hypertension.

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.

Relationship between sarcopenia and orthostatic hypotension.

BACKGROUND: The relationship between sarcopenia and orthostatic hypotension (OH) is unclear. OBJECTIVES: The aim of the present study was to investigate associations between sarcopenia/sarcopenia severity and OH. DESIGN: A total of 511 patients attending a geriatric outpatient clinic were included. OH was defined as a decrease in systolic and/or diastolic blood pressure of ≥ 20 mmHg and/or ≥ 10 mmHg, respectively, when one transitions from the supine to an upright position. OH was measured by the Head-up Tilt Table test at 1, 3 and 5 min (OH1, OH3 and OH5, respectively). Sarcopenia and its severity were defined according to the revised European consensus on definition and diagnosis. RESULTS: The mean age of the sample was 75.40 ± 7.35 years, and 69.9% were female. The prevalence of probable sarcopenia, sarcopenia and severe sarcopenia was 42.2%, 6.06% and 11.1%, respectively. After adjustment for all covariates, systolic OH1, OH1 and systolic OH5 were statistically significantly different between severe sarcopenia and the robust group (odds ratio [OR]: 3.26, confidence interval [CI] 0.98-10.84; P = 0.05 for systolic OH1; OR 4.31, CI 1.31-14.15; P = 0.016 for OH1; OR 4.09, CI 1.01-16.55; P = 0.048 for systolic OH5). Only systolic OH1 was statistically different between the sarcopenia and severe sarcopenia groups (OR 2.64, CI 1.87-8.73; P = 0.012). OH1 and OH5 were statistically significant different between severe sarcopenia and probable sarcopenia groups (P < 0.05); there was no relationship between the robust group and probable sarcopenia (P > 0.05). CONCLUSIONS: There is a close relationship between sarcopenia and severe sarcopenia and OH in older adults. Therefore, when a healthcare practitioner is evaluating an older patient with sarcopenia, OH should also be evaluated, and vice versa.

Cognitive and metabolic outcomes of vildagliptin addition to the therapy in patients with type 2 diabetes mellitus: 26 week follow-up study.

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 < 0.05). 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.

Validation of population-based cutoffs for low muscle mass and strength in a population of Turkish elderly adults.

BACKGROUND: Despite differences between the studies regarding methods for estimating low muscle mass, the European Working Group on Sarcopenia in Older People (EWGSOP) recommends use of two standard deviations (SDs) below the reference sex-specific means of healthy young adults. AIMS: The aim of this study was to determine the cutoff points of skeletal muscle mass index (SMI) and handgrip strength (HS) in Turkish population and to compare the power of different cutoff points to predict comprehensive geriatric assessment (CGA) parameters. METHODS: Two hundred and eight young healthy volunteers (104 women, 104 men) were included in the study to define SMI, HS cutoff values. 1150 older adults (784 women, 366 men) underwent CGA, including physical performance, activities of daily living (ADL), HS and frailty. Body composition was obtained from every participant by bioimpedance analysis (BIA). CGA parameters of sarcopenic patients according to EWGSOP and new Turkish cutoff points were compared. RESULTS: SMI cutoff points were defined 5.70 kg/m2 for women, 8.33 kg/m2 for men. HS thresholds were calculated as 14 kg for women, 28 kg for men using measurements of healthy young adult reference. Considering the new threshold values, the prevalence of sarcopenia was 10% (7% women, 17% men). When new sarcopenia criteria were applied and covariates were adjusted, sarcopenia was found to be more closely related to ADL impairment, balance, frailty in men, and balance, slow walking speed, ADL impairment, frailty in women (p < 0.05). DISCUSSION: Muscle mass and strength may vary between populations because of ethnicity and other related discrepancies. The evaluation of sarcopenia according to the present guidelines may cause overdiagnosis in some populations. CONCLUSION: Cutoff points specific to populations should be determined.

The Relationship between the Most Common Subtypes of Dementia and Orthostatic Hypotension in Older Adults.

BACKGROUND: It is crucial to evaluate the causes of morbidity and mortality in elderly patients with dementia, such as orthostatic hypotension (OH), which may affect their daily life activities, reduce the quality of life, and increase the caregiver burden. OBJECTIVE: We aimed to investigate the relationship between OH and the most common subtypes of dementia in detail. METHODS: A total of 268 older adults with dementia diagnosed with Alzheimer's disease (AD), dementia with Lewy bodies (DLB), vascular dementia (VaD), and behavioral variant frontotemporal dementia (bvFTD), and 539 older adults without dementia were included in this prospective study. Comprehensive geriatric assessment including comorbidity, medication evaluation, and the head-up tilt test was also performed. RESULTS: Of the participants, 13.8, 8.3, 6.4, and 4.8% had AD, DLB, bvFTD, and VaD, respectively. After adjusting for age, gender, the presence of comorbidities, and usage of OH-induced drugs; AD, DLB, and VaD were associated with OH (odds ratio [OR]: 2.23 confidence interval [CI] 95% 1.31-3.80; p = 0.003; OR: 3.68 CI 95% 1.98-6.83; p < 0.001, and OR: 3.56 CI 95% 1.46-8.69; p = 0.005, respectively). Furthermore, VaD was independently related to diastolic OH (OR: 4.19 CI 95% 1.66-10.57; p = 0.002), whereas AD and DLB were not. CONCLUSIONS: This study shows that elderly patients with DLB, AD, and VaD often have OH, a disabling autonomic dysfunction feature. Moreover, diastolic OH may play a role in the development of VaD. Therefore, considering potential complications of OH, it is essential to evaluate OH in the follow-up and management of those patients.

Factors that Increase Risk of Falling in Older Men according to Four Different Clinical Methods.

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.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.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 < .05): cerebrovascular disease, urinary incontinence, dizziness and imbalance, high Geriatric Depression Scale (GDS) scores, low Mini-Mental State Examination (MMSE), and The Lawton-Brody Instrumental Daily Living Activity Scale (IADL) and Barthel index (BI) for daily living activities scores, Significant correlations were found between all the assessment methods (p < .001).Conclusion: There is a strong relationship between fall risk and cerebrovascular disease, urinary incontinence, dizziness and imbalance, high GDS scores, low MMSE, BADL and IADL scores in older men. Therefore, older men should be screened for these risk factors to prevent falls.

A comparison of the prevalence of orthostatic hypotension between older patients with Alzheimer's Disease, Lewy body dementia, and without dementia.

Orthostatic hypotension (OH) is reported to be more prevalent particularly in patients with Dementia with Lewy bodies (DLB) because of the autonomic dysfunction, but prevalence of OH is not known in patients with Alzheimer Disease (AD). The aim of the present study was to determine whether OH can be used to distinguish DLB from AD. 38 patients with DLB, 88 patients with AD and 521 patients without dementia, underwent Comprehensive Geriatric Assessment. OH were evaluated for the 1st (OH1) and 3rd (OH3) minutes, taking the data in supine position as the basis, by Head-Up-Tilt Test. Prevalence of OH1 was 43.2% in AD, 44.7% in DLB and 17.9% in patients without dementia, and OH3 was 44.3% in AD, 47.4% in DLB and 17.9% in non-dementia group. The frequency of OH1 and OH3 was higher in the AD and DLB groups than in the patients without dementia (p < 0.001), but there was no significant difference between DLB and AD in terms of OH (p > 0.05). The percentage of asymptomatic patients with OH was 87.2% and 89.6% during 1st and 3rd minutes, respectively, and this percentage was similar in three groups (p > 0.05, for each). There was no significant difference between the two dementia groups in terms of comorbidities, drugs and laboratory values (p > 0.05). OH is more prevalent in patients with AD than controls and similar levels are observed in those with DLB. The prevalence of OH equally is greater with DLB or AD disease progression. Clinicians should be aware of OH and its related consequences in the management of the AD in older adults.

What is the relationship between frailty and orthostatic hypotension in older adults?

BACKGROUND: Frailty and orthostatic hypotension (OH), which is common in older adults, is associated with morbidity and mortality. The relationship between them remains unclear. The aim of the study is to determine whether there is a relationship between frailty and OH. METHODS: A total of 496 patients who were admitted to the geriatric clinic and underwent comprehensive geriatric assessment were retrospectively reviewed. In a cross-sectional and observational study, OH was measured by the Head-up Tilt Table test at 1, 3, and 5 min (respectively, OH1, OH3, and OH5) and the frailty was measured by the Fried's frailty scale. RESULTS: The mean age of all patients was 75.4 ± 7.38. The prevalence of females was 69.8%. When the frail people were compared with the pre-frail and the robust ones, the frailty was associated with OH1. There was no relationship between the groups in terms of OH1 when the pre-frail group was compared with the robust group. OH3 were higher in the frail group than in the pre-frail group (P < 0.05) and the OH5 were higher in the frail group than in the pre-frail and robust group (P < 0.05), but OH3 and OH5 were not associated with frailty status when they were adjusted for age (P > 0.05). Slowness and weakness were associated with OH1 (P < 0.05), whereas the other components of the Fried's test were not. CONCLUSIONS: Frailty may be a risk factor for OH1. The 1st min measurements of OH should be routinely evaluated in frail older adults to prevent OH-related poor outcomes.

Effect of Vitamin D on Cognitive Functions in Older Adults: 24-Week Follow-Up Study.

The purpose of this study is to assess the effect of vitamin D replacement on cognitive function in older adults. A total of 560 patients who underwent comprehensive geriatric assessment including Global cognitive assessment, Basic Activities of Daily Living (BADL), and Instrumental Activities of Daily Living (IADL) twice in 6-month period were retrospectively reviewed. Oral cholecalciferol was replaced to patients with vitamin D deficiency routinely. In baseline cognitive scores, BADL-IADL scores were lower in the severe deficiency group than in the deficiency and adequate groups (P < .05). With regard to the relation between changes in cognitive functions, BADL-IADL scores on the 6-month versus baseline, no difference was determined in patients with and without dementia (P > .05). Vitamin D replacement may not improve cognitive performance in older adults, even if vitamin D is raised to adequate level, suggesting that longer term replacement therapy may be needed to improve cognitive function.

Thiazide therapy is not related to any changes in cognitive function in older hypertensive patients with or without dementia: a 26-week follow-up study.

AIM: The study aimed to evaluate the effect of thiazide diuretics, a first-line antihypertensive therapy, on cognitive function in elderly hypertensive patients with or without cognitive impairment. METHODS: This retrospective and observational study assessed 286 elderly patients with hypertension. Patients were divided based on thiazide diuretic usage and then into dementia and non-dementia groups. The comprehensive geriatric assessment was performed for all patients. All participants were re-evaluated after a 26-week period. RESULTS: In total, 133 patients, including 62 with dementia, took thiazide. There were no significant differences between baseline and follow-up laboratory findings, comprehensive geriatric assessment parameters, including detailed neurocognitive assessment, or electrolytes in the thiazide group, the non-thiazide group, and the dementia group (P > 0.05). CONCLUSION: Thiazide therapy does not show any effect on cognitive function in older hypertensive adults regardless of dementia status.

Vitamin B12 deficiency might be related to sarcopenia in older adults.

Sarcopenia and dynapenia are related to repeated falls, mobility restriction, depression, frailty, increased mortality and morbidity. The aim of this study is to evaluate the relationship between vitamin B12 deficiency and sarcopenia in older adults. 403 patients, who attended to outpatient clinic and underwent comprehensive geriatric assessment, were included study. All cases' skeletal muscle mass (SMM), walking speed and hand grip strength were recorded by bioimpedance, 4meter walking test and hand dynamometer respectively. The diagnosis of sarcopenia was defined according to the criteria of the European Working Group on Sarcopenia in Older People. Sarcopenia was accepted low SMM with low handgrip strength or low physical performance. Dynapenia was defined as handgrip strength <30kg (men) and <20kg (women). The prevalence of sarcopenia and dynapenia was 24.8% and 32.0%, respectively. In the patients with sarcopenia, mean age, osteoporosis and frailty were higher, and MMSE, and instrumental ADL scores were lower than the patients without sarcopenia (p<0.05). The frequency of sarcopenia and dynapenia were 31.6% and 35.4%, respectively, in patients with vitamin B12 levels <400pg/mL. In addition lean body mass, total skeletal mass and skeletal muscle mass index were lower in the patients with vitamin B12 levels <400pg/mL compared to higher than 400pg/mL (p<0.05). Sarcopenia, which results in lots of negative clinical outcomes in older adults, might be related to vitamin B12 deficiency. Therefore, these patients should be periodically examined for vitamin B12 deficiency due to the potential negative clinical outcomes such as sarcopenia in older adults.