The role of geriatric assessment tests and anthropometric measurements in identifying the risk of falls in elderly nursing home residents.

OBJECTIVES: To determine the relation among the risk of falls, geriatric assessment, and anthropometric measurements, including the mini mental state examination, geriatric depression scale, handgrip test, and key pinch test. METHODS: This prospective study included 89 residents hospitalized between May 2014 and September 2015 in the geriatric care unit of the Istanbul Balikli Rum Hospital, Istanbul, Turkey. Patients were followed-up for one year, and their falls were recorded. Medical records of the included patients were retrieved and analyzed. RESULTS: A total of 89 patients, comprising 37 men and 52 women with an average age of 75.8 +/- 8.2 years were included in the study. The residents' annual falling averages were 1.0 +/- 1.5. The most significant factors were identified to be predicted muscle mass, skeletal muscle index, whole body bioimpedance, dominant arm muscle strength, dominant arm bioimpedance, and free fat mass.  CONCLUSIONS: The mini mental test, geriatric depression scale and lawton-brody scale combined with the handgrip, 6-meters walking, and bioimpedance tests are favorable for detecting the risk of falls and recurrent falls in vulnerable elderly nursing home residents.

The prevalence and the age at the onset of menopause in Turkish women in rural area.

OBJECTIVE: To find out the prevalence of natural menopause among Turkish women according to age and certain demographic variables in a specific rural area. METHODS: This cross sectional study was carried out in Silivri district of Istanbul, Turkey between January and May 2000. Included in the study were 845 women between the ages of 30-60 years, not undergoing any hormonal replacement, living in the villages of Silivri district, Istanbul, Turkey. The participants were asked for their ages, level of education, number of pregnancies, age at menarche, presence of menstruation, age at the onset of menopause, physical activity outside home and the use of oral contraceptives. Females declaring at least one year of amenorrhea were accepted as being in menopause. RESULTS: The median age for menopause was 47 years. Of the total 845 participants, 326 women were found to be in natural menopause. The prevalence of menopause was estimated as 8.6% for females younger than 40 years, 31.8% for females between the ages 40-45 years and 80.9% among females older than 45 years. Any of the variables questioned in our study have an effect on premature onset of menopause, but we found that never been pregnant (p=0.037, odd ratio (OR)=2.221, 95% confidence interval (CI)=1.048, 4.707) reduces the reproductive period, and the age at menarche younger than 13 prevents early menopause (p=0.000, OR=0.336, 95% CI=0.195, 0.579). Furthermore, both lead to early onset of menopause. Hazard ratios of the variables that have an effect on the onset of early menopause are calculated as 2:10 (95% CI=1.01, 4.39) for those who were never been pregnant and 1:10 for those with the menarche ages over 13 years (95% CI=0.68, 1.78). CONCLUSION: There was a noticeably high percentage of females (8.6%) younger than 40 years who were entering menopause. On the other hand, an early onset of natural menopause among Turkish women living in this rural area was found to be associated with never been pregnant and their age of menarche.

Relationship between insulin resistance and end-organ damage in white coat hypertension.

BACKGROUND: End-organ damage is seen in some patients suffering from white coat hypertension (WCH). It remains unclear which patients elude the risk of end-organ damage. A relationship between end-organ damage and insulin resistance was hypothesized. METHODS: This hypothesis was tested by comparing two groups of patients with WCH: those presenting with end-organ damage and those without end-organ damage. Both groups were tested for the presence of insulin resistance. The study was conducted in the outpatient clinics of the Internal and Family Medicine Departments of Cerrahpasa Medical School, Istanbul University. In this study 290 patients were screened for WCH, of which 75 were included in the study. The WCH was defined as an office blood pressure (BP) >/=140/90 mm Hg and mean daytime BP <135/85 mm Hg. The patients were divided into two groups according to the presence of end-organ damage. All patients received 24-h ambulatory BP monitoring. End-organ damage was diagnosed by revealing left ventricular hypertrophy on echocardiographic examination or retinopathy with fundoscopic examination. The homeostasis model assessment insulin resistance index (HOMA-IR) was used to assess insulin resistance. RESULTS: Among 75 patients with WCH, hypertensive retinopathy was detected in 25 patients, left ventricular hypertrophy in 15 patients, and both retinopathy and left ventricular hypertrophy simultanously in 6 patients. There were no significant differences between the groups regarding age, sex, lipid profile, and glucose levels. The HOMA-IR values in the patients with WCH and end-organ damage (4.2 +/- 1.7) were significantly higher (P < .0001) than those determined in patients with WCH but without end-organ damage (2.6 +/- 1.8). In patients with WCH with HOMA-IR values above 3 the risk of end-organ damage was found to be higher. CONCLUSIONS: A possible relationship between end-organ damage and insulin resistance in patients with WCH exists.