Publications by authors named "Gulistan Bahat"

127 Publications

Atrial fibrillation: a geriatric perspective on the 2020 ESC guidelines.

Eur Geriatr Med 2021 Nov 2. Epub 2021 Nov 2.

Section of Geriatrics, Department of Medical Sciences, University of Turin, A.O.U. Città della Salute e della Scienza, Molinette, Corso Bramante 88, 10126, Turin, Italy.

Background: The Task Force for the diagnosis and management of atrial fibrillation (AF) of the European Society of Cardiology (ESC) published in 2020 the updated Guidelines for the Diagnosis and Management of Atrial Fibrillation with the contribution of the European Heart Rhythm Association (EHRA) of the ESC and the European Association for Cardiothoracic Surgery (EACTS).

Methods And Results: In this narrative viewpoint, we approach AF from the perspective of aging medicine and try to provide the readers with information usually neglected in clinical routine, mainly due to the fact that while the large majority of AF patients in real life are older, frail and cognitively impaired, these are mostly excluded from clinical trials, and physicians' attitudes often prevail over standardized algorithms.

Conclusions: On the basis of existing evidence, (1) opportunistic AF screening by pulse palpation or ECG rhythm strip is cost-effective, and (2) whereas advanced chronological age by itself is not a contraindication to AF treatment, a Comprehensive Geriatric Assessment (CGA) including frailty, cognitive impairment, falls and bleeding risk may assist in clinical decision making to provide the best individualized treatment.
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http://dx.doi.org/10.1007/s41999-021-00537-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8562074PMC
November 2021

Ishii test for screening sarcopenia: performance in community-dwelling older adults.

Aging Clin Exp Res 2021 Oct 15. Epub 2021 Oct 15.

Division of Geriatrics, Department of Internal Medicine, Istanbul Medical School, Istanbul University, Fatih, 34093, İstanbul, Turkey.

Background: Sarcopenia is associated with an increased likelihood of major adverse health outcomes. Therefore, screening and early and timely identification of sarcopenia are essential. EWGSOP2 (European Working Group on Sarcopenia in Older People2) suggests Ishii screening test for formal-case findings. We aimed to define the diagnostic value of the Ishii screening test, which estimates the probability of sarcopenia using an equation-derived score based on three variables (age, grip strength, and calf circumference) in Turkish older adults.

Methods: Older adults aged >  = 60 who applied to a geriatric outpatient clinic were included in the study. The recommendation of the EWGSOP2 for the definition of sarcopenia was followed. The probability of sarcopenia was estimated by using a score chart of Ishii. Performance of Ishii screening test was analyzed by using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). The receiver-operating characteristic (ROC) analysis was performed to determine the area under the curve (AUC).

Results: We included 1635 patients with the mean age of 74.7 ± 7.0. The prevalence of probable sarcopenia was 11.9%. The prevalence of confirmed sarcopenia according to height was 0.7%. The prevalence of severe sarcopenia was 0.3% in total. Against diagnoses of probable sarcopenia, confirmed sarcopenia, and severe sarcopenia, the sensitivity values of the Ishii screening test were 84%, 100%, and 100%; the specificity values were 86.1%, 83.9%, and 84.6%, respectively. PPV values were 44.9%, 4.2%, 2.1%; NPV were 97.6%, 100%, 100%, and the AUC values were 0.933, 0.961, and 0.959, respectively.

Conclusion: Our results suggest that the Ishii screening test is a successful screening and maybe a candidate diagnostic test for sarcopenia.
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http://dx.doi.org/10.1007/s40520-021-01998-6DOI Listing
October 2021

Associations between polypharmacy and physical performance measures in older adults.

Arch Gerontol Geriatr 2021 Oct 9;98:104553. Epub 2021 Oct 9.

Department of Internal Medicine, Division of Geriatrics, Istanbul Medical School, Istanbul University, Capa, 34390, Istanbul, Turkey.

Objectives: A preserved ambulation is one of the keypoints for functionality and polypharmacy, a common problem in older adults, is associated with worse functional status. Our aim was to examine the associations of polypharmacy with certain physical performance measures used to evaluate ambulation.

Methods: This retrospective, cross-sectional study was conducted in a geriatric outpatient clinic. Using ≥5 medications was accepted as polypharmacy. Usual gait speed (UGS), chair sit-to-stand test (CSST), timed up and go test (TUG) and short physical performance battery (SPPB) were performed to assess physical performance status. We created two models for logistic regression analyses: Model 1 was adjusted for age, sex and body mass index (BMI). We added comorbidities to Model 1 and further created Model 2.

Results: There were 392 participants (69.1% were female, mean age: 73.9±6.2 years). Polypharmacy was seen in 62.5%. Participants with polypharmacy presented with a poor physical performance compared to the no-polypharmacy group (p<0.001, for each). In multivariate analyses, polypharmacy was independently associated with poor SPPB (Odds Ratio (OR)=2.5; 95% Confidence Interval (CI)=1.3-4.7 and OR=2.4; 95% CI=1.2-4.8 for Model 1 and 2, respectively) and long CSST (OR= 2.6; 95% CI=1.3-5.2 and OR=3.7; 95% CI=1.7-8.2 for Model 1 and 2, respectively). There was a significant association between polypharmacy and slow UGS in Model 1 (OR=1.9; 95% CI=1.0-3.5); but relationship did not persist after adding comorbidities into the first model (OR=1.6; 95% CI= 0.8-3.1). There was no significant association between long TUG and polypharmacy in any of the models.

Conclusion: Polypharmacy is well-known with its association with falls and fractures in older adults and this might be explained by its association with poor physical performance. Whether polypharmacy causes a deterioration in physical performance is an issue needs to be enlightened by further longitudinal studies.
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http://dx.doi.org/10.1016/j.archger.2021.104553DOI Listing
October 2021

Acute sarcopenia changes following hospitalization: influence of pre-admission care dependency level.

Age Ageing 2021 11;50(6):2140-2146

Department of Geriatrics, Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium.

Introduction: Hospitalization is associated with acute changes in sarcopenia status in older people, but the influencing factors are not fully understood. Pre-admission care dependency level as a risk factor has not yet been investigated.

Objective: Evaluate if pre-admission care dependency level is an independent predictor of sarcopenia changes following hospitalization.

Setting And Subjects: Data came from the Sarcopenia 9+ EAMA Project, a European prospective multi-centre study. For this study, 227 hospitalised older people were included from four different hospitals in Belgium, Spain and Poland, between 18 February 2019 and 5 September 2020.

Methods: Sarcopenia status at admission and discharge were calculated using a combined score (desirability value) based on muscle mass (calf circumference), strength (grip) and function (walking speed). Ratio of admission to discharge status was the outcome (desirability ratio; 1.00 meaning no difference). Predictor variable was the pre-admission care dependency level, classified into three groups: independent older people living at home, dependent older people living at home and older people living in a care home. Linear regression models were applied, considering potential confounders.

Results: Mean desirability ratio for dependent older people living at home ('middle dependent group') was lower (0.89) compared to independent older people (0.98; regression coefficient -0.09 [95% CI -0.16, -0.02]) and care home patients (1.05; -0.16 [95% CI -0.01, -0.31]). Adjusting for potential confounders or using another statistical approach did not affect the main results.

Conclusion: Dependent older people living at home were at higher risk of deterioration in sarcopenia status following hospitalization. In-depth studies investigating causes and potential interventions of these findings are needed.
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http://dx.doi.org/10.1093/ageing/afab163DOI Listing
November 2021

Sarcopenia in patients following stroke: an overlooked problem.

Int J Rehabil Res 2021 Sep;44(3):269-275

Division of Geriatrics, Department of Internal Medicine.

Our aim was to investigate the prevalence of sarcopenia in stroke patients, the relationship between sarcopenia detected with different low muscle mass (LMM) adjustment methods, and between stroke-related parameters. Eighty-one patients with chronic stroke who underwent inpatient rehabilitation were included. Spasticity was evaluated by modified Ashworth scale, Brunnstrom staging approach was used for motor function evaluation, physical independence was evaluated using Barthel Index, quality-of-life was evaluated by EQ-5D-3L, and the Cumulative Illness Rating Scale was used to measure multimorbidity. Muscle strength was evaluated by handgrip strength, muscle quantity through a bioelectric impedance analysis, and physical performance by gait speed and short physical performance battery. LMM was calculated through two different methods: Skeletal muscle mass (SMM)/height2, and SMM/BMI. For the definition of sarcopenia, we followed the EWGSOP2 recommendation. Associated sarcopenia factors were predicted by multivariate binary logistic regression analysis. The prevalence of probable sarcopenia was 32.1%. The prevalence of confirmed/sarcopenia when LMM was adjusted for BMI was higher than when adjusted for height2 (16 and 1.2%, respectively). Age was significantly higher in those with probable sarcopenia (P = 0.006). Stroke duration was shorter in those with probable or confirmed sarcopenia (P = 0.004, P < 0.001, respectively). EQ-5D-3L scores were significantly lower in those with confirmed sarcopenia (P = 0.050). The strongest associated factor with confirmed sarcopenia was stroke duration (OR: 0.77; 95% CI, 0.618-0.965). This study suggests that prevalence of sarcopenia after a stroke is significantly high. LMM adjusted for BMI comes in front as the adjustment method for LMM after a stroke.
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http://dx.doi.org/10.1097/MRR.0000000000000487DOI Listing
September 2021

Management of type 2 diabetes mellitus in older adults: eight case studies with focus SGLT-2 inhibitors and metformin.

Acta Clin Belg 2021 Jul 12:1-8. Epub 2021 Jul 12.

Department of Internal Medicine and Paediatrics, Section of Geriatrics, Ghent University, Ghent, Belgium.

: Sodium-glucose co-transporter-2 (SGLT-2) inhibitors have been recently introduced for type 2 diabetes treatment with significant cardiovascular, renal benefits. Yet, they have frequently been refrained in older adults. Metformin is regarded the first-line diabetes therapy for all ages; still it is associated with weight loss and frailty in older adults. We aimed to outline our experience with three oldest-old patients with high cardiovascular risk managed with SGLT-2 inhibitors, and five patients with anorexia/weight loss managed by metformin cessation. : We outlined demographics, comorbidities, geriatric syndromes, functional status, and diabetes duration, and presented the changes in frailty by noting pre-intervention and post-intervention frailty scores. We outlined benefits and side effects related to SGLT-2 inhibitors, and the deprescription reasons and represcription practices of metformin therapy. We gave details on baseline and current diabetes treatment, overall medication regimen, and current status of the patients. : Among the case studies with SGLT-2 inhibitors, two patients were frail and reversed to pre-frailty status after SGLT-2 intervention, while the third patient was and remained robust. All patients had clinical improvements with better blood pressure and glucose control. Among the case studies treated with metformin, all were frail before the cessation of metformin. Four reversed to pre-frailty and one became robust after intervention. : The findings of our case studies suggest considering SGLT-2 inhibitors in patients with accompanying heart failure/high cardiovascular risk factors and cessation of metformin in those with malnutrition/malnutrition risk. These approaches have potential to improve frailty and inappropriate medication use in diabetic older adults.
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http://dx.doi.org/10.1080/17843286.2021.1952379DOI Listing
July 2021

Skeletal muscle mass assessment to detect low muscle mass: Regional or total?

Clin Nutr 2021 07 17;40(7):4642-4643. Epub 2021 Jun 17.

Istanbul University, Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics, Capa, 34093, Istanbul, Turkey.

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http://dx.doi.org/10.1016/j.clnu.2021.06.014DOI Listing
July 2021

Orthogeriatrics: a vital requirement for improving fragility fracture patient care internationally with particular reference to Turkey.

Arch Osteoporos 2021 06 26;16(1):103. Epub 2021 Jun 26.

Department of Public Health, Epidemiology and Health Economics, Liège Medical School, University of Liège, Liège, Belgium.

Purpose: Orthogeriatrics is a team approach that aims to provide adequate and timely intervention for individuals suffering from fragility fractures, particularly hip fractures. These patients are mostly the frailest older adults. The aim of orthogeriatrics is to re-gain functionality as early as possible and to decrease disability and mortality. Some developed countries have established orthogeriatric services, while many others, including Turkey, have so far not. Here, to identify areas for improvement, we outline the status of the orthogeriatrics in older adults in Turkey.

Methods: We present clear calls for action, emphasizing possible and noteworthy areas for improvement.

Results: Our proposals include the need for an easily applied, short version of comprehensive geriatric assessment; appropriate laboratory testing on admission; paracetamol with a special emphasis in its dosings and clues for state-of-the-art analgesic management; the essential need to introduce oral nutritional supplementation, irrespective of nutritional status; the need for vitamin D commencement, in almost all patients; and starting osteoporosis treatment in fracture hospitalization, whenever appropriate. Last but not least, the ever-increasing prerequisite to establish "fracture liaison services" is stipulated.

Conclusion: We suggest that our recommendations offer great potential in Turkey, for the improvement of frail fracture patients' care. We call the other countries that do not have established orthogeriatric lines to model our approach to improve the management of fracture patients globally.
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http://dx.doi.org/10.1007/s11657-021-00967-wDOI Listing
June 2021

Clarifying the relationship between sarcopenia and depression in geriatric outpatients.

Aging Male 2021 Dec;24(1):29-36

Department of Internal Medicine, Division of Geriatrics, Istanbul Medical School, Istanbul University, Istanbul, Turkey.

Objective: We investigate the relationship between sarcopenia components and depression in geriatric outpatients, considering the effects of potential confounding factors.

Methods: Adults ≥60 years of age were selected from outpatient clinics. Muscle strength was assessed using handgrip strength (HGS) measured using a hydraulic hand dynamometer and chair stand test (CSST). Physical performance was evaluated by usual gait speed (UGS), nutritional status, and frailty were screened by mini-nutritional assessment (MNA) questionnaire and FRAIL scale. Depression was diagnosed through a psychiatric interview and the administration of the Geriatric Depression Scale (GDS).

Results: Participants with depression were similar to participants without depression regarding age ( = .055), education ( = .095), frailty ( = .857), and HGS scores ( = .053). The group with depression had longer CSST duration ( = .023), slower UGS ( =  .027), and more malnutrition ( = .001). Multivariate regression analysis revealed that only the malnutrition was independently associated factor with depression after adjusting for confounding factors.

Conclusions: Depression is associated with malnutrition and some components of sarcopenia in geriatric outpatients. Our results revealed that sarcopenia might be associated with depression through malnutrition. If malnutrition lasts for a long time, sarcopenia may become evident in the later stages of depression.
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http://dx.doi.org/10.1080/13685538.2021.1936482DOI Listing
December 2021

SARC-F can detect sarcopenia with a high sensitivity.

Aging Clin Exp Res 2021 07 16;33(7):2017. Epub 2021 Jun 16.

Division of Geriatrics, Department of Internal Medicine, Istanbul Medical School, Istanbul University, Capa, 34390, Istanbul, Turkey.

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http://dx.doi.org/10.1007/s40520-021-01909-9DOI Listing
July 2021

Protecting older patients with cardiovascular diseases from COVID-19 complications using current medications.

Eur Geriatr Med 2021 08 25;12(4):725-739. Epub 2021 May 25.

Helsinki University and Helsinki University Hospital, Haartmaninkatu 4, PO Box 340, N00029, Helsinki, Finland.

Purpose: In the pathogenesis of severe COVID-19 complications, derangements of renin-angiotensin-aldosterone system (RAAS), vascular endothelial dysfunction leading to inflammation and coagulopathy, and arrhythmias play an important role. Therefore, it is worth considering the use of currently available drugs to protect COVID-19 patients with cardiovascular diseases.

Methods: We review the current experience of conventional cardiovascular drugs [angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers, anticoagulants, acetosalicylic acid, antiarrhythmic drugs, statins] as well as some other drug classes (antidiabetic drugs, vitamin D and NSAIDs) frequently used by older patients with cardiovascular diseases. Data were sought from clinical databases for COVID-19 and appropriate key words. Conclusions and recommendations are based on a consensus among all authors.

Results: Several cardiovascular drugs have a potential to protect patients with COVID-19, although evidence is largely based on retrospective, observational studies. Despite propensity score adjustments used in many analyses observational studies are not equivalent to randomised controlled trials (RCTs). Ongoing RCTs include treatment with antithrombotics, pulmonary vasodilators, RAAS-related drugs, and colchicine. RCTs in the acute phase of COVID-19 may not, however, recognise the benefits of long term anti-atherogenic therapies, such as statins.

Conclusions: Most current cardiovascular drugs can be safely continued during COVID-19. Some drug classes may even be protective. Age-specific data are scarce, though, and conditions which are common in older patients (frailty, comorbidities, polypharmacy) must be individually considered for each drug group.
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http://dx.doi.org/10.1007/s41999-021-00504-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8143992PMC
August 2021

Associations of sarcopenic obesity versus sarcopenia alone with functionality.

Clin Nutr 2021 05 12;40(5):2851-2859. Epub 2021 Apr 12.

Department of Internal Medicine, Division of Geriatrics, Istanbul Medical School, Istanbul University, Capa, 34390, Istanbul, Turkey.

Background & Aims: There have been several attempts to come up with a global operational definition of sarcopenia (S), and consequently, a definition of S has been established, to some extent. That said, the definition of sarcopenic obesity (SO), which is defined as the presence of obesity + sarcopenia, remains obscure, hindering evaluations of the prevalence and relevance of SO. It has yet to be elucidated whether SO is associated with worse functionality when compared to S alone (S without obesity). In the present study, we compare SO and S alone in terms of their associations with functional measures through the application of alternative definitions of SO. As a secondary output, we document the prevalence of SO based on alternative definitions.

Methods: This retrospective cross-sectional study included community-dwelling adults over 60 years of age who presented as outpatients to a university hospital between 2012 and 2020. All were evaluated for body composition (bioimpedance analysis), handgrip strength (Jamar hand dynamometer) and functional health status [activities of daily living (ADL), instrumental activities of daily living (IADL)]. The fat percentile method was used to define the obesity component of SO. Low muscle mass (LMM) was defined using two different adjustment methods of skeletal muscle mass (LMM adjusted by height or LMM adjusted by BMI). S was defined based on the EWGSOP2 definition, as probable S (low muscle strength) or confirmed S (low muscle strength + LMM). Accordingly, three alternative definitions of SO were applied based on three alternative definitions of S, i.e., "obesity + sarcopenia (probable)", "obesity + sarcopenia (confirmed, LMM adjusted by height)" and "obesity + sarcopenia (confirmed, LMM adjusted by BMI)". The associations of SO and S alone with functional measures were examined with univariate analyses and adjusted multivariate analyses.

Results: Included in the study were 1468 older adults (median age 75; 68.8% female). The prevalence of SO was very low (0.2%) based on the SO definition "obesity + sarcopenia (confirmed, LMM adjusted by height), but it was present at a considerable and comparable rate based on SO definition "obesity + sarcopenia (probable)" and SO definition "obesity + sarcopenia (confirmed, LMM adjusted by BMI)" (4.1%, 4.0%; respectively). As SO by "obesity + sarcopenia (confirmed, LMM adjusted by height)" had an ignorable prevalence, this definition of SO was excluded from further analyses. Multivariate analyses revealed that, when compared to the Non-S Non-Obese group, S alone definitions had odds ratio (OR) of 5.4 and 3.4 while SO definitions had an OR of 3.2 and 2.7 for impaired ADL, and an OR of 7.9 and 6.4, while SO definitions had an OR of 3.0 and 2.7 for impaired IADL. SO was thus found to be associated with a lower prevalence of impaired functional measures than that of S alone.

Conclusions: Our results suggest that the SO definition confirmed, LMM adjusted by height has an ignorable prevalence in populations in which underweight or malnutrition is uncommon. Among sarcopenic older individuals, obesity may have a protective effect against the limitations of some functional measures, providing evidence of the possible protective effect of obesity in sarcopenic individuals.
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http://dx.doi.org/10.1016/j.clnu.2021.04.002DOI Listing
May 2021

Measuring calf circumference: a practical tool to predict skeletal muscle mass via adjustment with BMI.

Authors:
Gülistan Bahat

Am J Clin Nutr 2021 06;113(6):1398-1399

Division of Geriatrics, Department of Internal Medicine, Istanbul Medical School, Istanbul University, Capa, Istanbul, Turkey.

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http://dx.doi.org/10.1093/ajcn/nqab107DOI Listing
June 2021

Hypotension in Nursing Home Residents on Antihypertensive Treatment: Is it Associated with Mortality?

J Am Med Dir Assoc 2021 Nov 10;22(11):2319-2324.e4. Epub 2021 Apr 10.

Department of Geriatrics, FHU CARTAGE, Centre hospitalier régional et universitaire de Nancy, and INSERM 1116, Université de Lorraine, Nancy, France.

Objective: To assess whether low systolic blood pressure (SBP) or diastolic blood pressure (DBP) due to antihypertensive medications might be related to mortality among nursing home (NH) residents.

Design: Observational, longitudinal.

Setting: Nursing home.

Participants: Age ≥60 years, receiving antihypertensive medications.

Measurements: Demographic characteristics, mobility status, number of chronic diseases and drugs, nutritional status, and antihypertensive medications were noted. At the first visit, we recorded blood pressure (BP) measurements of last 1 year, which were measured regularly at 2-week intervals and considered their mean values. SBP and DBP thresholds were analyzed for mortality by ROC analysis. Multivariate Cox regression analyses were performed to determine factors related to mortality.

Results: The sample included 253 residents with a mean age of 75.7 ± 8.7 years, and 66% were male. Residents were evaluated at a mean follow-up time of 14.3 ± 5.2 months (median: 15) for short-term mortality and 31.6 ± 14.3 months (median: 40) for long-term mortality. The prevalence of low SBP (≤110 mm Hg) and low DBP (≤65 mm Hg) was 34.8% and 15.8%, respectively. In follow-up, the short-term mortality rate was 21.7% (n = 55) and the long-term mortality rate was 42.2% (n = 107). Low SBP (≤110 mm Hg) was related to mortality in short- and long-term follow-ups [short-term follow-up: hazard ratio (HR) 3.7, 95% confidence interval (CI) 1.5-8.6, P = .01; long-term follow-up: HR 1.8, 95% CI 1.1-3.0, P = .02], adjusted for age, mobility status, nutritional state, and total number of diseases and drugs. Low DBP (≤65 mm Hg) was related to mortality in short- and long-term follow-ups [short-term follow-up: HR 3.0, 95% CI 1.2-7.8, P = .02, long-term follow-up: HR 2.8, 95% CI 1.5-5.2, P = .001], adjusted for age, mobility status, nutritional state, and total number of diseases and drugs.

Conclusions And Implications: Systolic hypotension was found in more than one-third of the NH residents receiving antihypertensive treatment. Low SBP and DBP were significant factors associated with mortality. Particular attention should be paid to prevent low SBP and DBP in NH residents on antihypertensive treatment.
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http://dx.doi.org/10.1016/j.jamda.2021.03.004DOI Listing
November 2021

International Validation of the Turkish Inappropriate Medication Use in the Elderly (TIME) Criteria Set: A Delphi Panel Study.

Drugs Aging 2021 06 13;38(6):513-521. Epub 2021 Apr 13.

Section of Geriatrics, Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium.

Objective: Explicit screening tools and implicit evaluation methods have been developed to assist healthcare professionals in the management of pharmacotherapy in older adults. As prescribing habits and locally available medications vary considerably between countries, guides tailored to the needs of specific regions may be required. We aimed to report the results of the international Delphi validation study for the Turkish Inappropriate Medication use in the Elderly (TIME) criteria set, which aims to detect inappropriate prescribing in older adults in Eastern Europe.

Methods: The study was conducted between June 2019 and March 2020. Delphi rounds were conducted by the TIME international working group, which included 11 internationally recognized experts in geriatric pharmacotherapy as Delphi panelists. They were asked to indicate to what extent they agreed or disagreed with each TIME criterion, taking into account both the available evidence and their own experience. We used a five-point Likert scale from 1 (strongly agree) to 5 (strongly disagree) and an online software program (SurveyMonkey) to grade the level of agreement. Criteria with a median value of 1 or 2 and a 75th centile value of 1 or 2 were accepted, and criteria with a median value > 2 were rejected. Those with a median value of 1 or 2 but a 75th centile value > 2 were retained, to be assessed in the following round. The initial list of Delphi criteria comprised 153 TIME items.

Results: After three Delphi rounds, 134 criteria were accepted and seven criteria were rejected, while 12 criteria did not achieve consensus, and so were not included in the final validated set of TIME criteria.

Conclusion: We developed the internationally validated TIME criteria set based on a Delphi process involving international experts. The validation study suggests that the TIME criteria set can be applied in both central and Eastern European settings. Further studies are needed to assess the utility and benefit of the TIME criteria in reducing inappropriate drug use and improving clinical outcomes.
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http://dx.doi.org/10.1007/s40266-021-00855-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8041618PMC
June 2021

Best Practice Recommendations for Stroke Patients with Dysphagia: A Delphi-Based Consensus Study of Experts in Turkey-Part I: Management, Diagnosis, and Follow-up.

Dysphagia 2021 Mar 9. Epub 2021 Mar 9.

Department of Physical Medicine and Rehabilitation, University of Health Sciences Turkey, Ankara Training and Research Hospital, Ankara, Turkey.

Dysphagia is one of the most common and important complications of stroke. It is an independent marker of poor outcome after acute stroke and may become chronic after the acute period and continues to affect all aspects of the patient's life. Patients with stroke may encounter any of the medical branches in the emergency room or outpatient clinic, and as in our country, there may not be specialists specific for dysphagia, such as speech-language pathologists (SLP), in every hospital. This study aimed to raise awareness and create a common opinion of medical specialists for stroke patients with dysphagia. This recommendation paper has been written by a multidisciplinary team and offers 45 recommendations for stroke patients with dysphagia. It was created using the eight-step Delphi round via e-mail. This study is mostly specific to Turkey. However, since it contains detailed recommendations from the perspective of various disciplines associated with stroke, this consensus-based recommendation paper is not only a useful guide to address clinical questions in practice for the clinical management of dysphagia in terms of management, diagnosis, and follow-up, but also includes detailed comments for these topics.
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http://dx.doi.org/10.1007/s00455-021-10273-9DOI Listing
March 2021

Sarcopenia quality-of-life questionnaire (SarQoL)®: translation, cross-cultural adaptation and validation in Turkish.

Aging Clin Exp Res 2021 Nov 4;33(11):2979-2988. Epub 2021 Feb 4.

Division of Geriatrics, Department of Internal Medicine, Istanbul Medical School, Istanbul University, Istanbul, Turkey.

Background: The sarcopenia quality-of-life (SarQoL)® questionnaire is a multidimensional sarcopenia specific tool designed for community dwelling older adults.

Aims: The aim of this study was to translate, to cross-culturally adapt and validate the SarQoL® questionnaire to assess sarcopenia-related quality of life in Turkish older adults.

Methods: The validation process was performed in two sections: the first section constituted the translation with cross-cultural adaptation of SarQoL® into Turkish. Second section constituted the clinical validation study. To validate the Turkish version of the SarQoL®, we assessed its validity (discriminative power, construct validity), reliability (internal consistency, test-retest reliability) and floor/ceiling effects.

Results: One hundred community-dwelling subjects (mean age: 74.7 ± 6.1 years) were evaluated. The EWGSOP2 consensus diagnostic criteria were used to diagnose probable sarcopenia. A database including 1437 older adults, with complete evaluation of sarcopenia parameters, served to define low global muscle function. Results revealed a good discriminative power: subjects with probable sarcopenia had higher total scores compared to non-sarcopenic subjects (50 ± 16 vs. 68.9 ± 16.9, p < 0.001) a high internal consistency (Cronbach's alpha: 0.88), consistent construct validity and excellent test-retest reliability (intraclass correlation coefficient: 0.97, 95% confidence interval: 0.94-0.98). There was no floor/ceiling effect.

Conclusion: The Turkish version of the SaQoL® questionnaire was found to be reliable and valid for the measurement of quality of life of sarcopenic patients and is, therefore, available for use in clinical research and practice. This validation could enable use of the SarQoL® tool in the eastern populations more confidently.
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http://dx.doi.org/10.1007/s40520-020-01780-0DOI Listing
November 2021

Non-vitamin K antagonist oral anticoagulant use at doses inappropriately lower than recommended in outpatient older adults: a real-life data.

Eur Geriatr Med 2021 08 30;12(4):809-816. Epub 2021 Jan 30.

Division of Geriatrics, Department of Internal Medicine, Istanbul University, Istanbul Medical School, Istanbul, Turkey.

Background/purpose: There has been a rapid increase in the use of non-vitamin K-antagonist oral anticoagulants (NOAC). Current guidelines recommend dose adjustments be made in accordance with certain criteria for each NOAC. This study is aimed at determining whether or not NOAC were prescribed for non-valvular atrial fibrillation (AF) in guideline-recommended doses in community-dwelling older adults.

Methods: Older adults taking NOAC for non-valvular AF presenting to a cardiology outpatient clinic for the first time were included in the study. The NOAC dose for each patient was assessed based on the recommendations of the European Society of Cardiology and were categorized as appropriate or inappropriate (low or high dose). The patients were also evaluated for demographic data, diseases, CHA2DS2-VASc score, HASBLED score, frailty and falls in the previous year.

Results: A total of 302 older adults were included in the study, with a mean age of 75.5 ± 7.5 years. One hundred eighty-four patients (60.9%) were found to be on appropriate doses of NOAC, while 109 (36.1%) were on inappropriately low doses and nine (2.98%) were on inappropriately high doses. Accordingly, 39.1% of the AF patients were found to be on inappropriate doses of NOAC, 92.4% of which were inappropriately low. A multivariate logistic regression analysis revealed that the only factor associated with inappropriate low-dose NOAC use was patient age (OR = 1.061, 95% CI = 1.009-1.116, p = 0.022).

Conclusion: Our study suggests that the inappropriate use of lower dose NOAC may emerge as a significant problem in outpatient older adults. This inappropriate practice seems to be associated with older age rather than the diseases, CHA2DS2-VASc/HASBLED scores, frailty and presence of falls.
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http://dx.doi.org/10.1007/s41999-021-00452-0DOI Listing
August 2021

Cut-off values of skeletal muscle index and psoas muscle index at L3 vertebra level by computerized tomography to assess low muscle mass.

Clin Nutr 2021 06 16;40(6):4360-4365. Epub 2021 Jan 16.

Istanbul University, Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics, Istanbul, Turkey.

Background & Aims: Computerized tomography (CT) is considered the gold standard for the evaluation of total skeletal muscle quantity. Skeletal muscle assessments at the L3 vertebra level revealed significantly correlated with total body muscle measurements. Clinicians need cut-offs to evaluate low muscle mass in various patients who already had CT imaging without any additional cost. This assessment is important to help the physicians to stratify the patients for mortality and other complications. It may also enable the diagnosis of malnutrition by the GLIM criteria. Few studies reported cut-offs in different populations. We aimed to provide cut-off values for total skeletal muscle index (SMI) and psoas muscle mass index (PMI) at the L3 vertebra level in the Turkish population.

Methods: We assessed the preoperative plain CT images of living adult liver donors who were admitted to a single transplantation center between June 2010 and April 2018. We derived cut-off values with two alternative methods, the 5th percentile value or mean minus two standard deviations and from two groups of study participants, i.e. the total study population and the younger subgroup aged between 18 and 40.

Results: The study population involved 601 subjects with a mean age of 32.5 ± 9 (range: 18-59 years) and 326 (54.2%) was male. The younger subgroup was composed of 482 individuals with a mean age of 28.8 ± 5.9 and 55.6% male. In patients aged between 18 and 40, PMI and SMI cut-offs by using the 5th percentile were 5.40 cm/m, 41.42 cm/m for males; and 3.56 cm/m, 30.70 cm/m for females; respectively. The cut-offs of PMI and SMI by using mean minus two standard deviations were 4.62 cm/m, 38.67 cm/m for males; and 2.66 cm/m, 27.8 cm/m for females; respectively. These cut-offs were comparable to the other populations.

Conclusions: Our study provided cut-offs to be used in CT images for PMI and SMI. There is a need for further longitudinal studies to verify whether these cut-offs are successful in predicting mortality or other adverse outcomes associated with low muscle mass.
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http://dx.doi.org/10.1016/j.clnu.2021.01.010DOI Listing
June 2021

Mannose binding lectin gene 2 (rs1800450) missense variant may contribute to development and severity of COVID-19 infection.

Infect Genet Evol 2021 04 27;89:104717. Epub 2021 Jan 27.

Department of Medical Biology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.

Background/objectives: COVID-19 followed a mortal course in some young patients without any underlying factors, however, it followed a very benign course in some very older individuals with multiple comorbidities. These observations question if some genetic factors may be related to the vulnerability and poor prognosis of the disease. In this study, we aimed to investigate whether MBL2 gene B variant at codon 54 (rs1800450) were related to the variabilities in clinical course of this infection.

Methods: 284 PCR-confirmed COVID-19 patients and 100 healthy controls were included in the study. COVID-19 patients were subdivided according to the clinical features and clinical characteristics were analyzed. DNAs of all patients and controls were examined for the codon 54 A/B (gly54asp: rs1800450) variation in exon 1 of the MBL2 gene.

Results: In univariate analysis, BB genotype of MBL2 gene was more common among COVID-19 cases compared with controls (10.9% vs 1.0%, respectively; OR = 12.1, 95%CI = 1.6-90.1, p = 0.001). Multivariate analyses, adjusted for age, sex and MBL genetic variants, revealed that when compared with the COVID-19 patients that had AA genotype (reference), the patients that had BB or AB genotypes suffered from a higher risk for severe disease (for BB genotype, odds ratio (OR) = 5.3, p < 0.001; for AB genotype, OR = 2.9, p = 0.001) and for ICU need (for BB genotype, OR = 19.6, p < 0.001; for AB genotype, OR = 6.9, p = 0.001). On the other hand, there was not any significant difference between the genotype variants in terms of mortality at 28 days or development of secondary bacterial infection.

Conclusion: The B variants of MBL2 gene at codon 54, which were associated with lower MBL2 levels, were related to a higher risk for a more severe clinical course of COVID-19 infection in some respects. Our findings may have potential future implications, e.g. for use of MBL protein as potential therapeutics or prioritize the individuals with B variants during vaccination strategies.
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http://dx.doi.org/10.1016/j.meegid.2021.104717DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7838598PMC
April 2021

Muscle strength cutoff values calculated from the young reference population to evaluate sarcopenia in Turkish population.

Aging Clin Exp Res 2021 Oct 27;33(10):2879-2882. Epub 2021 Jan 27.

Division of Geriatrics, University of Ramon Y Cajal, Madrid, Spain.

Sarcopenia is defined as a progressive and generalized skeletal muscle disorder that is associated with an increased likelihood of adverse outcomes, including mobility problems and mortality. To reach a global consensus for its standard definition and diagnosis, more recently, a revised EWGSOP consensus (EWGSOP2) has been published. In EWGSOP2 definition, sarcopenia has been regarded as skeletal muscle failure and low muscle strength has been put forward as its key defining characteristics. EWGSOP2 suggested the use of handgrip strength cutoff values calculated by mean minus 2.5 standard deviations of the young healthy population. In this report, following EWGSOP2's suggestion, we aimed to outline the handgrip strength cutoffs derived from a young Turkish reference population, and compare them with the other population-specific reports.
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http://dx.doi.org/10.1007/s40520-021-01785-3DOI Listing
October 2021

Comparison of standard population-specific handgrip strength cut-off points in the detection of probable sarcopenia after launch of EWGSOP2.

Aging Male 2020 Dec 12;23(5):1564-1569. Epub 2021 Jan 12.

Division of Geriatrics, Department of Internal Medicine, Istanbul Medical School, Istanbul University, Istanbul, Turkey.

Objective: We aimed to compare European Working Group on Sarcopenia in Older People (EWGSOP2)-suggested and population-specific handgrip strength (HGS) thresholds to detect probable sarcopenia and their associations with physical-performance measures and frailty.

Methods: A retrospective cross-sectional observational-study included geriatrics outpatients applied to a university-hospital. HGS, timed up and go test (TUG), and usual gait speed (UGS) were assessed. Frailty was screened by FRAIL-scale.

Results: A total of 1825 older adults were included (mean age, 74.5 + 7.0 years; 68.8% female). Prevalence of low-HGS were 12.2% by the EWGSOP2-recommended (27/16 kg) cut-offs and 37.5% by population-specific cut-offs (35/20 kg) (<.001). When low-HGS was defined by EWGSOP2 suggested cut-offs, low-HGS was associated with impaired UGS, (odds ratio [OR] = 3.8, 95% confidence interval [CI]: 2.0-6.9, <.001); impaired TUG, (OR = 4.6, 95% CI: 2.4-8.8, <.001); and frailty (OR = 20.9, 95% CI: 8.3-53.0, <.001). Similarly, low HGS determined by population-specific cut-off points was associated with impaired UGS (OR = 3.1, 95% CI: 2.1-6.9, <.001); impaired TUG (OR = 6.0, 95% CI: 3.0-11.8, <.001); and frailty (OR = 7.3, 95% CI: 4.1-13.0, <.001).

Conclusions: Application of EWGSOP2-recommended standard HGS-cut-offs showed successful application in-practice. However, use of standard HGS cut-offs may result in underdiagnosis of probable sarcopenia. Therefore, we suggest that, whenever available, use of population-specific cut-offs for HGS may be better for correctly identifying older adults at risk.
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http://dx.doi.org/10.1080/13685538.2020.1870038DOI Listing
December 2020

Best Practice Recommendations for Stroke Patients with Dysphagia: A Delphi-Based Consensus Study of Experts in Turkey-Part II: Rehabilitation.

Dysphagia 2021 10 5;36(5):800-820. Epub 2021 Jan 5.

Department of Physical Medicine and Rehabilitation, Ankara Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey.

Dysphagia is one of the most common and important complications of stroke. It is an independent marker of poor outcome following acute stroke and it continues to be effective for many years. This consensus-based guideline is not only a good address to clinical questions in practice for the clinical management of dysphagia including management, diagnosis, follow-up, and rehabilitation methods, but also includes detailed algorithms for these topics. The recommendation paper has been written by a multidisciplinary team and offers 117 recommendations for stroke patients with dysphagia. While focusing on management principles, diagnosis, and follow-up in the 1st part (45 items), rehabilitation details were evaluated in the 2nd part (72 items).
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http://dx.doi.org/10.1007/s00455-020-10218-8DOI Listing
October 2021

STOPPFall (Screening Tool of Older Persons Prescriptions in older adults with high fall risk): a Delphi study by the EuGMS Task and Finish Group on Fall-Risk-Increasing Drugs.

Age Ageing 2021 06;50(4):1189-1199

Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.

Background: Healthcare professionals are often reluctant to deprescribe fall-risk-increasing drugs (FRIDs). Lack of knowledge and skills form a significant barrier and furthermore, there is no consensus on which medications are considered as FRIDs despite several systematic reviews. To support clinicians in the management of FRIDs and to facilitate the deprescribing process, STOPPFall (Screening Tool of Older Persons Prescriptions in older adults with high fall risk) and a deprescribing tool were developed by a European expert group.

Methods: STOPPFall was created by two facilitators based on evidence from recent meta-analyses and national fall prevention guidelines in Europe. Twenty-four panellists chose their level of agreement on a Likert scale with the items in the STOPPFall in three Delphi panel rounds. A threshold of 70% was selected for consensus a priori. The panellists were asked whether some agents are more fall-risk-increasing than others within the same pharmacological class. In an additional questionnaire, panellists were asked in which cases deprescribing of FRIDs should be considered and how it should be performed.

Results: The panellists agreed on 14 medication classes to be included in the STOPPFall. They were mostly psychotropic medications. The panellists indicated 18 differences between pharmacological subclasses with regard to fall-risk-increasing properties. Practical deprescribing guidance was developed for STOPPFall medication classes.

Conclusion: STOPPFall was created using an expert Delphi consensus process and combined with a practical deprescribing tool designed to optimise medication review. The effectiveness of these tools in falls prevention should be further evaluated in intervention studies.
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http://dx.doi.org/10.1093/ageing/afaa249DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8244563PMC
June 2021

The thresholds for components of sarcopenia: need for an objective approach.

Eur Geriatr Med 2021 02 29;12(1):215-216. Epub 2020 Nov 29.

Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics, Istanbul University, Capa, 34390, Istanbul, Turkey.

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http://dx.doi.org/10.1007/s41999-020-00407-xDOI Listing
February 2021

Geriatric care in European countries where geriatric medicine is still emerging.

Eur Geriatr Med 2021 02 25;12(1):205-211. Epub 2020 Nov 25.

Department of Geriatrics and FHU CARTAGE, CHU de Nancy and INSERM 1116, Université de Lorraine, Nancy, France.

Purpose: Practicing geriatric medicine is a challenging task since it involves working together with other medical doctors while coordinating a multidisciplinary team. Global Europe Initiative (GEI) group within the European Geriatric Medicine Society gathers geriatricians from different regions where geriatrics is underrepresented or still developing to promote initiatives for the advancement of geriatric medicine within these countries.

Methods: Here we present a first effort to describe several aspects that affect practicing geriatric medicine in five different countries: Greece, Portugal, Russia, Turkey, and Tunisia.

Results: We can notice discrepancies between countries concerning all dimensions of geriatrics (recognition, training, educational and professional standards, academic representation, working context).

Conclusions: These differences correspond to the specificities of each country and set the frame where geriatric medicine is going to be developed across Europe. EuGMS with GEI group can provide useful support.
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http://dx.doi.org/10.1007/s41999-020-00419-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7685957PMC
February 2021

Handgrip strength cut-offs to define sarcopenia in Turkish population.

Aging Clin Exp Res 2021 01 28;33(1):207-208. Epub 2020 Sep 28.

Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics, Istanbul University, Capa, 34390, Istanbul, Turkey.

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http://dx.doi.org/10.1007/s40520-020-01704-yDOI Listing
January 2021

Important Points to Consider During Practical Application and in the Validation Studies of SARC-F Tool to Screen Sarcopenia [Letter].

Clin Interv Aging 2020 10;15:877-878. Epub 2020 Jun 10.

Department of Internal Medicine, Division of Geriatrics, Istanbul University School of Medicine, Istanbul 34093, Turkey.

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http://dx.doi.org/10.2147/CIA.S262334DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7294043PMC
July 2020

Start low, go slow, but look far: the case of geriatric medicine in Balkan countries.

Eur Geriatr Med 2020 10 25;11(5):869-878. Epub 2020 Jun 25.

Université de Lorraine, CHRU-Nancy, Pôle « Maladies du Vieillissement, Gérontologie et Soins Palliatifs », 54000, Nancy, France.

Purpose: To present an insight of the situation of geriatric medicine in Balkan countries, as it was presented in the context of the 2nd pre-congress seminar of the 16th European Geriatric Medicine Society (EuGMS) Congress Athens 2021.

Methods: Representatives from 8 Balkan countries (Albania, Croatia, Greece, Republic of North Macedonia, Romania, Serbia, Slovenia, Turkey) answered 3 questions to reflect the state of geriatric medicine in their country: education on geriatrics; systems/methods for assessment of functional status and frailty; pre-operative risk assessment. An open discussion followed.

Results: Undergraduate education in geriatric medicine seems underestimated in medical faculties of Balkan countries, whereas a high heterogeneity is observed at a post-graduate level. Only a few Balkan countries have geriatric medicine as a recognized medical specialty or subspecialty. Functional status and frailty are only sporadically assessed, and pre-operative risk assessment is very rarely performed with a geriatric focus. Scarcity of expertise and structures relevant to geriatric medicine seems to be common. Developing a training curriculum and geriatrics-related structures are two interconnected aspects. Cooperation among physicians and multidisciplinary teams are essential for the practice of geriatric medicine. A functional geriatric network is eventually necessary and ambulatory geriatric expertise is probably a feasible and clinically relevant starting point. Providing pragmatic solutions to the pressing challenges in variable clinical settings, supplementing and working in harmony with existing components of each health system, is probably the most convincing strategy to gain political support in developing geriatric medicine.

Conclusion: Balkan countries share common experiences and challenges in developing geriatrics. Whilst the principles of geriatric medicine are perhaps universal, proposed solutions should be adapted to each country's specific circumstances. Cooperation of the Balkan countries could promote in each the development of geriatric medicine. EuGMS is willing to foster relevant actions.
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http://dx.doi.org/10.1007/s41999-020-00350-xDOI Listing
October 2020

Reference Cutoff Values for Muscle Strength in Different Nations.

Nutr Clin Pract 2020 08 24;35(4):755. Epub 2020 Jun 24.

Division of Geriatrics, Department of Internal Medicine, Marmara University Hospital, Pendik, Istanbul, Turkey.

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http://dx.doi.org/10.1002/ncp.10544DOI Listing
August 2020
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