C. Kilic

Prevalence of potentially inappropriate prescribing among older adults: A comparison of the Beers 2012 and Screening Tool of Older Person's Prescriptions criteria version 2

To date, there is no study comparing the Beers 2012 and Screening Tool of Older Persons Prescriptions (STOPP) version 2 criteria, nor reporting a comparison of the prevalence of potentially inappropriate Prescribing (PIM) with STOPP version 2. We aimed to evaluate the prescriptions of patients admitted to a geriatric outpatient clinic with these tools, and to document the factors related to PIM use.

Reliability and Validity of Turkish Version of the Simplified Nutritional Appetite Questionnaire (SNAQ)

ObjectiveWe aimed to investigate reliability and validity of the Turkish version of the Simplified Nutritional Appetite Questionnaire (SNAQ) in geriatric outpatients.Design/SettingA cross-sectional study was designed through 2013–2016 years. At first, translation and back translation processes of the SNAQ from English to Turkish languages were done consecutively. Then construct validity was performed. Participants: They were recruited among the outpatients aged >=60 years that were consecutively admitted to the geriatric outpatient clinic of the Istanbul University hospital.MeasurementsDemographic data was recorded. SNAQ, Mini Nutritional Assessment (MNA), six-item Katz activities of daily living (ADL) and eight-item Lawton instrumental activities of daily living (IADL) scales were applied.Results442 participants consisted of 305 women and 137 men with a mean age of 77.1 ± 6.8 years. The SNAQ identified 21.5% (n=95) of the participants with poor appetite. Reliability analysis showed good inter-rater reliability (r=0.693, p<0.05) and test-retest stability (r=0.654, p<0.05). Cronbach’s alpha coefficient was 0.522. In terms of construct validity of SNAQ, Cohen’s kappa analysis showed fair to moderate agreement between SNAQ and MNA (κ=0,355, p<0.001). Female gender, being illiterate, functional dependency in IADL were significantly associated with poor appetite. The SNAQ score was weakly correlated with scores of MNA-SF and MNA-LF (r=0.392 and r=0.380, respectively, p<0.0001 for both). There was statistically significantbut negligible correlation between the SNAQ and Katz ADL index, Lawton IADL index, and age.ConclusionTurkish version of the SNAQ is a simple measurement with sufficient reliability and validity to screen poor appetite in community-dwelling older adults.

Performance of Sarc-F in Regard to Sarcopenia Definitions, Muscle Mass and Functional Measures

ObjectiveTo assess the reliability and validity of Turkish version of SARC-F in regard to screening with current definitions of sarcopenia, muscle mass and functional measures.DesignCross-sectional study.ParticipantsCommunity-dwelling older adults aged >=65 years admitting to a geriatric outpatient clinic.MeasurementsMuscle mass (bioimpedance analysis), handgrip strength, usual gait speed, chair sit-to-stand test, functional reach test, short physical performance battery, SARC-F questionnaire, FRAIL questionnaire Sarcopenia was evaluated with 4 current different definitions: European Working Group on Sarcopenia in Older People’s (EWGSOP); Foundation for the National Institutes of Health (FNIH), International Working Group on Sarcopenia (IWGS) and Society on Sarcopenia, Cachexia and Wasting Disorders (SCWD).ResultsAfter cross-cultural adaptation, 207 subjects were analysed in the clinical validation study. Mean age was 74.6±6.7 years, 67.6% were women. Against EWGSOP, FNIH, IWGS and SCWD definitions of sarcopenia, sensitivity of SARC-F were %25, 31.6%, 50% and 40%; specificity were 81.4%, 82.4%, 81.8% and 81.7%, respectively. Positive predictive values were between 5.1-15.4% and negative predictive values were 92.3-98.2%. Against parameters of low muscle mass, sensitivity were about 20% and specificity were about 81%. Against parameters of function; for low hand grip strength, sensitivity of SARC-F were 33.7% (for Turkish cut-off); 50% (for FNIH cut-off); specificity were 93.7% (for Turkish cut-off) and 85.8% (for FNIH cut-off). Against low UGS, poor performance in chair sit to stand test, functional reach test, SPPB and presence of positive frailty screening sensitivity were 58.3%, 39.2%, 59.1%, 55.2% and 52.1% while specificity were 97.3%, 97.8%, 88.1%, 99.3% and 91.2%, respectively.ConclusionThe psychometric performance of Turkish SARC-F was similar to the original SARC-F. It revealed low sensitivity but high specificity with all sarcopenia definitions. Sensitivity and specificity were higher for muscle function tests reflecting its inquiry and input on functional measures. Our findings suggest that SARC-F is an excellent test to exclude muscle function impairment and sarcopenia. SARC-F is relatively a good screening test for functional measures.

A new screening tool for self-neglect in community-dwelling older adults: IMSelf-neglect questionnaire

OBJECTIVE We aimed to develop a new screening tool for self-neglect in community-dwelling self-sufficient older adults. METHODS Istanbul Medical School Elder Self-Neglect questionnaire (IMSelf-neglect) was developed as a screening tool. Community-dwelling, self-sufficient older adults were recruited in a geriatric outpatient clinic (n = 226, 142 female, 84 male). Construct validity was based on social-workers interview as a gold-standard method. The cut-off threshold for IMSelf-neglect questionnaire was calculated from ROC-analysis using cut-off values that predicted social-workers opinion whether the older adult has self-neglect. RESULTS Mean age was 74 ± 6.5 years. The inter-rater and test-retest reliability were excellent (r = 0.887, p < .05; r = 0.942, p < .05, respectively). The internal consistency was good (Cronbachs alpha: 0.708). Cut-off threshold for IM Self-neglect questionnaire was calculated as 7 with 92.1% sensitivity and 70.7% specificity. Positive predictive value and negative predictive value of IMSelf-neglect questionnaire were 38.9% and 97.8%, respectively. There was significant moderate agreement between social workers assessment and results of IMSelf-neglect questionnaire (κ = 0.407, p < .001). The social worker confirmed 16.8% of the participants have self-neglect by the gold-standard clinical interview. Participants with self-neglect had decreased functionality, worse quality of life and tended to have more depression compared with participants without self-neglect. DISCUSSION/CONCLUSION We developed the IMSelf-neglect questionnaire as a valid and reliable tool to screen self-neglect in outpatient clinics complementary to comprehensive geriatric assessment.

Explicit versus implicit evaluation to detect inappropriate medication use in geriatric outpatients

Abstract Aim: The rates and reasons why clinicians decide not to follow recommendations from explicit-criteria have been studied scarce. We aimed to compare STOPP version 2 representing one of the most commonly used excplicit tool with the implicit comprehensive geriatric assessment mediated clinical evaluation considered as gold standard. Methods: Two hundred and six (n = 206) outpatients ≥65 years old were included. The study was designed as retrospective, cross-sectional, and randomised. STOPP version 2 criteria were systematically used to assess pre-admission treatments followed by implicit clinical evaluation regarding two questions: Were the STOPP criteria recommendations valid for the individual patient and were there any potentially inappropriate-prescription other than depicted by STOPP version 2 criteria? The underlying reason(s) and associated clinical-features were noted. Results: About 62.6% potentially inappropriate-prescriptions were identified (0.6 per-subject) according to systematic application of STOPP v2 while it was 53.4% (0.5 potentially inappropriate-prescriptions per subject) by clinician’s application of STOPP v2. Prevalence of non-compliance was 14.7% in 18 (21.7%) of 83 patients identified by systematic application. Suggestion to stop a drug was not accepted because of need of treatment despite likelihood of anticipated side-effects in about 2/3 and with no-anticipated side-effects in about 1/3 of non-compliances. Not following STOPP v2 was significantly associated with lower functional level. According to clinician’s implicit-evaluation, there were an extra 59.2% potentially inappropriate-prescriptions (0.6 per subject) in 80 (38.8%) patients yielding a total of 112.6% potentially inappropriate-prescription. Conclusions: Most of the STOPP v2 directed drug cessations are decided valid by the clinicians. In patients with higher functional dependency, it is likely that they are not followed due to palliation focussed care/patient–family preferences. There may be as much as STOPP v2 identified potentially inappropriate-prescriptions by implicit evaluation in a significant percent of geriatric patients signifying need for comprehensive geriatric evaluation in practice.

Prevalence of sarcopenia and its components in community-dwelling outpatient older adults and their relation with functionality

AIM Sarcopenia is recognized with its adverse functional outcomes. We aimed to report the prevalence of European Working Group on Sarcopenia in Older People (EWGSOP) defined sarcopenia and its individual components in community dwelling outpatient older adults and study the correlations of EWGSOP defined sarcopenia, muscle mass, muscle strength, and physical performance with functional status. MATERIAL AND METHODS The subjects were prospectively recruited from the geriatrics outpatient clinics of our university hospital. Body composition was assessed with bioimpedance analysis. Muscle strength was assessed by measurement of hand grip strength with hydraulic hand dynamometer, physical performance was assessed by 4 meter usual gait speed (UGS). Impaired muscle function was defined as presence of low muscle strength and or slow gait speed. As a measure of functionality, modified version of Katz activities of daily living (ADL) and Lawton instrumental activities of daily living (IADL) were assessed. RESULTS A total of 242 community dwelling outpatients with mean age of 79.4 ± 5.7 years were enrolled. 31.8% were male. Prevalence of low muscle mass was 2.1% and impaired muscle function was 71.1%. Prevalence of EWGSOP defined sarcopenia was 0.8% (1.3% in men and 0.6% in women). Most correlated parameter with ADL and IADL was the usual gait speed (r = 0.49, r = 0.63; p < .001, respectively). Grip strength was also correlated with ADL and IADL (r = 0.28, r = 0.35; p < .001). However, the skeletal muscle mass index (SMMI) was not correlated with ADL, IADL (p = .22, p = .22, respectively). In regression analysis, both ADL score and IADL scores were most related to UGS (beta = 0.5 and 0.6, p < .001), age (beta = -0.25 and -0.2, p < .001) and then sarcopenia (beta = 0.1 and 0.1, p < .05) but was not related to hand grip strength or SMMI. CONCLUSIONS The prevalence of sarcopenia was low as 0.8% albeit the presence of impaired muscle function in more than 2/3 of the cases. We have found that EWGSOP defined sarcopenia had association with ADL and IADL. The gait speed component of sarcopenia had the strongest associations with functional measures but SMMI component did not have any relation. We suggest that although low muscle mass may be a parameter related to worse functionality, it should not be regarded prerequisite for presence of sarcopenia analogous to low bone mineral density for osteoporosis.

Anorexia is Independently Associated with Decreased Muscle Mass and Strength in Community Dwelling Older Adults

ObjectivesWe aimed to investigate the association between anorexia and sarcopenia in community dwelling older adults.MethodAnorexia was assessed by Simplified Nutritional Appetite Questionnaire (SNAQ) and sarcopenia defined by EWSGOP criteria. Study participants consisted of 442 patients from Turkish validation study of the SNAQ. Study is designed as cross-sectional in community dwelling outpatients.MeasurementsMuscle mass was determined by using bioimpedance analysis. Skeletal muscle mass index (SMMI) was calculated as SMM (kg)/height (m)2. Muscle strength was evaluated by hand grip strength (HGS) with Jamar hydraulic hand dynamometer. Gait speed (GS) was assessed by usual 4 meters speed. Depression and quality of life were assessed by using Geriatric Depression Scale (GDS) and Euro-Quality of Life-5D(EQ-5D). Univariate analysis and multivariate regression analysis were run to evaluate the association between poor appetite and components of sarcopenia.ResultsPrevalences of low HGS, low gait speed and sarcopenia were higher in group with poor appetite (p=0.001, p<0.0001, p=0.036, respectively). Depression and constipation were more prevalent in participants with poor appetite (p<0.0001, p=0.033, respectively). SNAQ was correlated with SMMI and EQ-5D. Regression analysis showed that lower muscle mass, lower SMMI, and lower HGS were independently associated with poor appetite after adjustment for confounders. Neither gait speed nor diagnosis of sarcopenia was associated with poor appetite in regression analysis models.ConclusionWe observed poor appetite has independent association with lower skeletal muscle mass and decreased muscle strength. Prospective studies are needed to evaluate exact relationship between poor appetite and sarcopenia.

Comparing SARC-F with SARC-CalF to Screen Sarcopenia in Community Living Older Adults

ObjectiveTo compare the diagnostic value of the SARC-F combined with calf circumference (SARC-CalF) with the standard SARC-F to screen sarcopenia in community-dwelling older adults.DesignCross-sectional, diagnostic accuracy study.SettingGeriatric outpatient clinic of a university hospital.ParticipantsOlder adults >= 65 years.MeasurementsMuscle mass (bioimpedance analysis device), muscle strength (hand grip strength-Jamar hydraulic hand dynamometer), and physical performance (usual gait speed). Four currently used diagnostic criteria [European Working Group on Sarcopenia in Older People (EWGSOP), Foundation for the National Institutes of Health (FNIH), International Working Group on Sarcopenia (IWGS), and Society on Sarcopenia Cachexia and Wasting Disorders (SCWD) criteria] were applied. SARC-CalF was performed by using two different calf circumference threshold: standard cut-off 31 cm (SARC-CalF-31) and national cut-off 33 cm (SARC-CalF-33). The sensitivity/specificity analyses of the SARC-CalF and SARC-F tools were run. We used the receiver operating characteristics curves and the area under the receiver operating characteristics curves (AUC) to compare the diagnostic accuracy to identify sarcopenia.ResultsWe included 207 subjects; 67 male and 140 female with a mean age of 74.6±6.7 years. The prevalence of sarcopenia ranged from 1.9% to 9.2%. The sensitivity of SARC-F was between 25% (EWGSOP) and 50% (IWGS); specificity was about 82%. For SARC-CalF-31 and SARC-CalF-33 sensitivity was in general similar - between 25-50%-which pointed out that SARC-CalF was not superior to SARC-F for sensitivity in this sample. Corresponding specificities for SARCCalF-31 and SARC-CalF-33 were higher than SARC-F and were between 90-98%. Additionally, the AUC values, which indicates the diagnostic accuracy of a screening test, were in general higher for SARC-CalF-33 than the SARC-F and SARC-CalF-31.ConclusionsWe reported that addition of calf circumference item to SARC-F tool improved the specificity and diagnostic accuracy of SARC-F but it did not improve the sensitivity in a community-dwelling Turkish older adult population sample that had low prevalence of sarcopenia. The performance of SARC-CalF tool to screen sarcopenia is to be studied in different populations and living settings.

P322: Simplified Nutritional Appetite Questionnaire (SNAQ): an alternative test for geriatric nutritional assessment

Introduction: Nutrition is affected negatively in the old age due to physiological changes, acute-chronic diseases, oral-dental health problems, polypharmacy, economical factors, difficulties in food supply, difficulties in preparing and eating food. In this study we aim to evaluate nutritional status of community-dwelling older people by using Simplified Nutritional Appetite Questionnaire (SNAQ) and Mini Nutritional Assessment – Short Form (MNA-SF). Methods: Patients over 75 years of age admitted to outpatient clinic between 3 January 2013 and 31 December 2013 were enrolled. According to comprehensive geriatric assessment; height-weight measurements, weight loss, special diets and difficulty swallowing asked. The participants were evaluated with Katz Activities of Daily Living (ADL) and Lawton-Brody Instrumental Activities of Daily Living scores (IADL), Simplified Nutritional Appetite Questionnaire, Mini Nutritional Assessment Short-Form. Results: A total of 203 elders were included in the study. 33% were male and 67% were female. Mean age was 80.9 years. As a result of MNA-SF scores 5.4% had malnutrition and 22.7% had malnutrition risk. In our study group mean SNAQ score 15.5±2.4. Due to SNAQ scores total 20.7% (women 25.7%, men 10.4%) were at risk of weight loss (Table 1). We observed that a positive advanced correlation between SNAQ and functionality by ADL, IADL, the hand grip, physical activity and ambulation status (Table 2). Conclusions: Nutrition and appetite status of the elderly is an important part of a comprehensive geriatric assessment. It should be performed routinely. SNAQ form can be preferred as a alternative and a quick method for screening nutrition.