Hacer Dogan Varan

Validation of Katz index of independence in activities of daily living in Turkish older adults

OBJECTIVE Katz Index of Independence in Activities of Daily Living Scale (Katz ADL) is a widely used tool to assess the level of independency in older adults. The objective of this study was to assess the validity and reliability of the Turkish version of the six item Katz ADL in geriatric patients aged 65 years and older. METHODS The participants were recruited in a geriatric medicine outpatient clinic (n=211). The Katz ADL was translated to Turkish and it was administered with the Barthel index (BI) and SF-36 physical functioning subscale (SF-36 PF) which are already validated in Turkish. Reliability was assessed by internal consistency, interrater and test-retest analysis. Construct validity was assessed by Spearman correlations between the Katz ADL and other functional status indices. RESULTS The internal consistency was high (Cronbachs α=0.838). The test-retest reliability and inter-rater reliability were excellent (ICC 0.999 [0.999-1.000 95% CI]). Regarding the convergent validity strong associations between Katz ADL, BI and SF-36 PF were demonstrated (rs=0.988, p<0.001 and rs=0.674, p<0.001). CONCLUSION Validating an instrument, which has originally been developed in a different culture, is a complex but neccessary task. It provides an opportunity for comparison of information across different cultures. To our knowledge, this is the only study to demonstrate reliability and validity of the Katz ADL-six item version in the geriatric population living in Turkey. Turkish version of the Katz ADL is a valid and reliable scale to detect the disability status in the basic activities of daily living in older adults.

Validation of the Turkish Version of the Quick Mild Cognitive Impairment Screen

Background: The objective of this study was to validate the Turkish version of the Quick Mild Cognitive Impairment (Qmci-TR) screen. Methods: In total, 100 patients aged ≥65 years referred to a geriatric outpatient clinic with memory loss were included. The Qmci was compared to the Turkish versions of the standardized Mini-Mental State Examination and the Montreal Cognitive Assessment (MoCA). Results: The Qmci-TR had higher accuracy than the MoCA in discriminating subjective memory complaints (SMCs) from cognitive impairment (mild cognitive impairment [MCI] or dementia), of borderline significance after adjusting for age and education (P = .06). The Qmci-TR also had higher accuracy than the MoCA in differentiating MCI from SMC, which became nonsignificant after adjustment (P = .15). A similar pattern was shown for distinguishing MCI from dementia. Test reliability for the Qmci-TR was strong. Conclusion: The Qmci-TR is a reliable and useful screening tool for discriminating MCI from SMC and dementia in a Turkish population.

Association of Bioelectrical Impedance Analysis–Derived Phase Angle and Sarcopenia in Older Adults

Background: Sarcopenia is an important problem for older adults, leading to morbidity and mortality; therefore, early detection with a precise method is essential. We aimed to investigate the role of bioelectrical impedance analysis–derived phase angle as a determinant of sarcopenia. Materials and Methods: A cross section of 263 community-dwelling and hospitalized older adults (>65 years) were assessed in terms of sarcopenia with bioelectrical indices and anthropometric measurements. Sarcopenic and nonsarcopenic groups were compared, and significant determinants of sarcopenia were further analyzed with multivariate logistic regression analysis. Results: Forty patients were diagnosed with sarcopenia. The following were significant correlates of sarcopenia: female sex, low weight/height, low body mass index, decreased muscle strength, low calf circumference, low skeletal muscle mass/index, high impedance at 50 kHz, a history of hypertension, worse nutrition status, and low phase angle. Diagnostic parameters with well-known association were omitted, and sex, height, weight, body mass index, creatinine, nutrition status, phase angle, impedance at 50 kHz, and hypertension category were included in regression analysis. The following were independent associated factors with sarcopenia: phase angle (odds ratio [OR]: 0.59, 95% confidence interval [95% CI]: 0.40–0.87, P = .008), body mass index (OR: 0.84, 95% CI: 0.77–0.93, P = .001) impedance at 50 kHz (OR: 1.010, 95% CI: 1.006–1.015, P < .001), and height (OR: 0.93, 95% CI: 0.88–0.97, P = .001). Receiver operating characteristic analysis revealed that the optimal phase angle cutoff value to detect sarcopenia was ⩽4.55º. Conclusions: Bioelectrical phase angle can be useful for diagnosis of sarcopenia.

Survival After Percutaneous Endoscopic Gastrostomy in Older Adults With Neurologic Disorders.

BACKGROUND Percutaneous endoscopic gastrostomy (PEG) tube placement is a common procedure performed to provide a route for enteral feeding. We aimed to examine the survival after PEG in older adults with neurologic disease and to demonstrate the factors associated with mortality. METHODS We analyzed the data of 500 patients who underwent PEG placement between 2005 and 2015 at a university hospital. The data included age, sex, follow-up duration, comorbidities, medications, indications for PEG, complications, and laboratory results. Related risk factors and mortality rates were analyzed. RESULTS Median age was 77 years. Median survival time after PEG placement was 13.9 months. The 30-day, 3-month, 1-year, 2-year, 3-year, and 5-year mortality rates were 11.3%, 28.3%, 46.8%, 56.3 %, 63.0%, and 67.8%, respectively. Stroke was independently correlated with mortality (odds ratio [OR], 2.20; 95% confidence interval [CI], 1.52-3.19; P < .001). Overall survival time after PEG placement was shorter in patients with stroke than without stroke (11.4 vs 27.1 months, P = .014). In multivariate logistic regression analyses, preprocedural neutrophil percentage (OR, 1.10; 95% CI, 1.02-1.17, P = .015) and late complications (OR, 9.2; 95% CI, 1.80-46.90; P = .008) were independent risk factors for mortality in the stroke subgroup. Prophylactic antibiotic usage (OR, 0.07; 95% CI, 0.17-0.29; P < .001) and hyperlipidemia (OR, 0.30; 95% CI, 0.86-1.00; P = .048) were independently and inversely correlated with mortality in stroke patients. CONCLUSIONS Stroke patients had higher mortality rates than other neurological indications for PEG. In stroke patients with PEG, neutrophil percentage was independently correlated with mortality, while hyperlipidemia and preprocedural antibiotic usage were independently related with survival.

Hypovitaminosis D is an independent associated factor of overactive bladder in older adults

AIM OF THE STUDY Urinary incontinence and vitamin D deficiency are common problems encountered in geriatric population. We aimed to investigate if there is a relationship between these conditions. SUBJECTS AND METHOD Among 2281 patients who were admitted to our geriatric medicine outpatient clinic spanning the last three years, 705 patients with known vitamin D status, urinary incontinence and subtype, and calcium plus vitamin D therapy data were included in statistical analysis. Patients who are using calcium plus vitamin D therapy were excluded. SPSS (Statistical Package for Social Sciences) version 15.0 for Windows was used for statistical analysis and p<0.05 was considered as statistically significant. RESULTS Mean age of the study population was 72.3±6.4years and 62.8% were female. Plasma vitamin D level (OR: 0.968, 95%CI: 0.943-0.993, p=0.013), MMSE (Mini Mental State Examination) score (OR: 0.944, 95%CI: 0.902-0.989, p=0.014), and serum ALP (Alkaline Phosphatase) level (OR: 0.995, 95%CI: 0.992-0.998, p=0.001) were found to be inversely correlated factors, and serum calcium level (OR: 1.772, 95%CI: 1.008-2.888, p=0.022) was found to be a positively correlated factor of overactive bladder. Considering the different clinical subtypes of urinary incontinence, only urgency incontinence was associated with lower plasma vitamin D level (p=0.013). CONCLUSIONS Vitamin D deficiency and insufficiency are independent associated factors for overactive bladder in older adults. This is explicable by effects of vitamin D on muscle growth and function.

Masked Hypertension is Associated With Cognitive Decline in Geriatric Age–Geriatric MASked Hypertension and Cognition (G-MASH-cog) Study

Background Masked hypertension is described as high ambulatory blood pressure measurements (ABPM) where office blood pressure measurements are normal. Effect of hypertension on cognitive functions is well known. However, the effect of masked hypertension on cognitive functions is unclear. The aim of this study is to examine the relationship between masked hypertension and cognitive functions. Methods One hundred-two normotensive patients admitted to the Geriatric Medicine outpatient clinic were included. Exclusion criteria were hypertension, dementia, major depression, and usage of antihypertensive medication. All patients underwent ABPM procedures and average daytime blood pressure, mean blood pressure at night and the 24-hour average blood pressure measurements were recorded. Comprehensive geriatric assessment tests and neuropsychological tests were administered. The diagnosis of masked hypertension was based on the definitions in the 2013 guideline of the European Society of Cardiology. Results Forty-four patients (43%) were diagnosed with masked hypertension. Patients with masked hypertension had significantly lower scores on Mini-Mental State Examination (MMSE) test, Quick Mild Cognitive Impairment Test (QMCI), and Categorical Fluency Test than the normotensive patients (p = .011; p = .046; and p = .004; respectively). Montreal Cognitive Assessment Scale test score was lower in masked hypertension, although this was not statistically significant. Conclusion This study may indicate that geriatric patients with masked hypertension, compared to normotensive patients have decreased cognitive functions. Masked hypertension should be kept in mind while assessing older adults. When masked hypertension is detected, cognitive assessment is essential to diagnose possible cognitive dysfunction at early stage.

Comment on: Sarcopenia is a risk factor for falling in independently-living Japanese older adults: A 2-year prospective cohort study of the GAINA study: Sarcopenia and fall risk

reported in the late 1980s continues today among older Japanese adults inHawaii, in 2014we carried out a preliminary survey of four adult day care centers in the state and found that approximately 51% of the elderly service users were ethnic Japanese, despite this ethnic group accounting for approximately 40% of Hawaii’s older adults. These preliminary findings, in addition to anecdotal evidence of some ethnic utilization patterns, prompted the present study. Our premise was that ethnicity and its values toward family support and health might affect the type and quantity of homecare services selected for older adults. Regarding the relationship between ethnicity and homecare services received, a study in the UK reported that ethnicity influenced where patients with cancer died. Ethnic disparities have also been seen in the types and patterns of home healthcare services delivered toMedicare beneficiaries with diabetes mellitus in the USA. The reasons behind these disparities are unclear though, and researchers have proposed a number of contributing factors, including patient preferences, culture, accessibility to healthcare and other service-related factors. In terms of ethnic Japanese, few studies have investigated their preference toward homecare services. However, in Hawaii, the older generation is dominated by ethnic Japanese. Therefore, investigating their preferences toward homecare services and providing such services might improve their quality of life and reduce healthcare costs. In addition, as the aforementioned examples of adult day care centers imply, ethnic Japanese older adults might disproportionately use particular types of services. Therefore, to examine their desire to utilize homecare services, in the present study we focused on a single medical alert company in Hawaii where 51% of its subscribers were ethnic Japanese, and we examined the reasons why ethnic Japanese older adults, comparedwith non-Japanese older adults, disproportionately used personal emergency response system (PERS) services.

Higher Serum Endocan Level Is Associated with Alzheimer Disease

Background: The novel molecule endocan, which is released by endothelium and is regulated by proangiogenic and proinflammatory cytokines, may have a role in the pathophysiology of Alzheimer disease (AD). The aim of this study was to evaluate the relationship between serum endocan levels and AD. Methods: A total of 134 patients (47 AD, 42 amnestic mild cognitive impairment [aMCI], and 45 control patients) 65 years of age and older were recruited in this study. Cognitive status of the patients was evaluated by performing the Montreal Cognitive Assessment (MOCA) and the Mini-Mental State Examination (MMSE). Serum endocan levels were measured with an enzyme-linked immunosorbent assay kit. Results: Median serum endocan level was significantly higher in AD patients (380.1 ng/mL) than in both aMCI patients (247.7 ng/mL) and controls (277.6 ng/mL; p < 0.01). Serum endocan level had a weak but significant correlation with MMSE and MOCA scores (r = –0.219 and r = –0.232; p = 0.012 and p = 0.01, respectively). Serum endocan level was detected as a factor independently associated with AD. The cutoff serum level of endocan predicting AD was >288.94 ng/mL in receiver operating characteristic curve analysis (area under the curve 0.71, 95% CI 66.7–90.9, sensitivity 80.9%, specificity 59.8%; p < 0.01). Conclusion: Higher serum endocan levels may be associated with the pathogenesis of AD.

A Challenging Decision to Anticoagulate in an Older Adult with Rheumatoid Arthritis

neurodegenerative conditions such as Parkinson’s disease and Alzheimer’s disease, and thrombin inhibition has been proposed as a potential therapeutic target in the latter condition. Although this case report is contrary to these proposed hypotheses, there is no conclusive evidence of the role of thrombin inhibition in human neurological function. This association between thrombin inhibition and cognitive impairment highlights the need for further exploration of the various roles of thrombin in the human brain. This case report describes a rare association between dabigatran and cognitive impairment that is reversible upon cessation. Although the pathogenesis is unclear, clinicians should consider cessation of dabigatran if there is insidious onset of unexplained cognitive decline. Further evaluation of the role of thrombin in the brain may be warranted.