Publications by authors named "Pinar Soysal"

169 Publications

Weight loss in Alzheimer's disease, vascular dementia and dementia with Lewy bodies: Impact on mortality and hospitalization by dementia subtype.

Int J Geriatr Psychiatry 2021 Nov 22. Epub 2021 Nov 22.

South London and Maudsley NHS Foundation Trust, London, UK.

Objectives: Loss of weight is associated with cognitive decline as well as several adverse outcomes in dementia. The aim of this study was to assess whether weight loss is associated with mortality and hospitalization in dementia subtypes.

Methods: A cohort of 11,607 patients with dementia in Alzheimer's disease (AD), vascular dementia (VD), or dementia with Lewy bodies (DLB) was assembled from a large dementia care health records database in Southeast London. A natural language processing algorithm was developed to established whether loss of weight was recorded around the time of dementia diagnosis. Cox proportional hazard models were applied to examine the associations of reported weight loss with mortality and emergency hospitalization.

Results: Weight loss around the time of dementia was recorded in 25.5% of the whole sample and was most common in patients with DLB. A weight loss-related increased risk for mortality was detected after adjustment for confounders (Hazard ratio (HR):1.07; 95% confidence interval (CI):1.02-1.15) and in patients with AD (HR: 1.11; 95% CI: 1.04-1.20), but not in DLB and VD. Weight loss was associated with a significantly increased emergency hospitalization risk (HR: 1.14; 95% CI: 1.08-1.20) and in all three subtypes.

Conclusions: While there were associations with increased hospitalization risk for all three subtype diagnoses, weight loss was only associated with increased mortality in AD. Weight loss should be considered as an accompanying symptom in dementia and interventions should be considered to ameliorate risk of adverse outcomes.
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http://dx.doi.org/10.1002/gps.5659DOI Listing
November 2021

Comment on 'The relationship between the severity of insomnia and falls in the elderly'.

Psychogeriatrics 2021 Nov 18. Epub 2021 Nov 18.

Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey.

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http://dx.doi.org/10.1111/psyg.12788DOI Listing
November 2021

Anxiety symptoms among informal caregivers in 47 low- and middle-income countries: A cross-sectional analysis of community-based surveys.

J Affect Disord 2022 Feb 14;298(Pt A):532-539. Epub 2021 Nov 14.

Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona 08830, Barcelona, Spain; ICREA, Pg, Lluis Companys 23, 08010 Barcelona, Spain.

Background: There are no multi-country studies on the association between informal caregiving and anxiety from low- and middle-income countries (LMICs). Therefore, we investigated this relationship in a large predominantly nationally representative sample from 47 LMICs.

Methods: Cross sectional data from the World Health Survey were analyzed. Anxiety symptoms referred to severe or extreme problems with worries or anxiety in the past 30 days. Information on caregiving in the past 12 months was obtained. Multivariable logistic regression analysis adjusting for age, sex, marital status, education, household size, employment, disability, and country was conducted. Data on 237,952 individuals aged ≥18 years [mean (SD) age 38.4 (16.0) years; 50.8% female] were analyzed.

Results: After adjustment for potential confounders, caregiving was positively associated with anxiety symptoms (OR = 1.52; 95%CI = 1.40, 1.65). Greater number of caregiving activities was associated with higher odds for anxiety symptoms dose-dependently, with the OR (95%CI) for engagement in 5 activities (vs. no caregiving) being 2.19 (1.86-2.58).

Conclusion: Caregiving is associated with higher odds for anxiety symptoms among adults in LMICs. Given the increasing importance of informal caregivers in long-term care provision and the fact that good health of caregivers is vital to sustain this system, interventions to address mental health of caregivers in LMICs are urgently needed.
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http://dx.doi.org/10.1016/j.jad.2021.11.029DOI Listing
February 2022

A comparison of anticholinergic burden in older patients with and without cancer.

Future Oncol 2021 Dec 27;17(36):5067-5075. Epub 2021 Oct 27.

Department of Geriatrics, Bezmialem Vakıf University, Istanbul 34093, Turkey.

To compare anticholinergic burden (ACB) in older patients with and without cancer and evaluate the effects of ACB on geriatric syndromes. A total of 291 patients from the geriatric clinic and 301 patients from the oncology clinic were evaluated. ACB <2 was categorized as low ACB and ACB ≥2 was categorized as high ACB. A comprehensive geriatric assessment was performed on patients from the geriatric clinic. ACB scores were significantly higher in patients without cancer compared with those with cancer (p < 0.005). Number of falls and Geriatric Depression Scale 15 scores were higher and Mini-Nutritional Assessment and Barthel/Lawton activities of daily living scores were lower in geriatric patients with high ACB scores compared with those with low ACB scores (p < 0.005). It is crucial to understand the potential effects of ACB for rational drug use and optimum cancer management in older patients with cancer.
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http://dx.doi.org/10.2217/fon-2021-0469DOI Listing
December 2021

Body mass index categories and anxiety symptoms among adults aged ≥ 50 years from low and middle income countries.

Wien Klin Wochenschr 2021 Oct 18. Epub 2021 Oct 18.

Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, 08830, Barcelona, Spain.

Background: Body weight may be a risk factor for anxiety; however, there is a scarcity of studies on this association in older adults especially from low and middle income countries (LMICs). Therefore, we investigated the association between body mass index (BMI) and anxiety symptoms among adults aged ≥ 50 years from 6 LMICs.

Methods: Cross-sectional, community-based, nationally representative data from the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) were analyzed. The BMI was based on measured weight and height and was categorized as: < 18.5 kg/m (underweight), 18.5-24.9 kg/m (normal weight), 25.0-29.9 kg/m (overweight), 30.0-34.9 kg/m (obesity class I), 35.0-39.9 kg/m (obesity class II), and ≥ 40 kg/m (obesity class III). Anxiety symptoms referred to severe/extreme problems with worry or anxiety in the past 30 days. Multivariable logistic regression analysis was conducted.

Results: Data on 34,129 individuals aged ≥ 50 years (mean age 62.4 years, SD 16.0 years; 52.1% female) were analyzed. Overall, compared to normal weight, only underweight was significantly associated with anxiety symptoms (odds ratio, OR = 1.56; 95% confidence interval, CI = 1.26-1.95). Obesity class III (vs. normal weight) was associated with significantly increased odds for anxiety symptoms (OR = 4.15; 95%CI = 1.49-11.59) only among males.

Conclusion: In this large representative sample of older adults from LMICs, underweight was associated with anxiety symptoms in males and females. Class III obesity was associated with anxiety symptoms only in males. Future studies to shed light on the reason why severe obesity was associated with anxiety symptoms only among males in LMICs are needed.
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http://dx.doi.org/10.1007/s00508-021-01954-4DOI Listing
October 2021

Comment on "Association between habitual coffee consumption and skeletal muscle mass in middle-aged and older Japanese people".

Geriatr Gerontol Int 2021 11 27;21(11):1071-1072. Epub 2021 Sep 27.

Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey.

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http://dx.doi.org/10.1111/ggi.14282DOI Listing
November 2021

Associations between nutritional factors and excessive daytime sleepiness in older patients with chronic kidney disease.

Aging Clin Exp Res 2021 Aug 27. Epub 2021 Aug 27.

Division of Nephrology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey.

Background: Excessive daytime sleepiness (EDS) is prevalent in not only older adults, but also patients with chronic kidney disease (CKD), and is associated with higher risks of morbidity and mortality.

Aims: The aim of the present study is to determine associations between EDS and nutritional status and serum nutrient levels in older patients with CKD.

Methods: This cross-sectional study included 367 patients (aged ≥ 65 years) with CKD (eGFR < 60 ml/min/1.73 m and/or > 30 mg/day of albuminuria for > 3 months). EDS was recorded using the Epworth Sleepiness Scale (a score of ≥ 11). Malnutrition was diagnosed according to the Mini Nutritional Assessment (MNA) tool (a score of < 17).

Results: The mean age was 81 ± 7 years, and 248 (67%) were female. EDS was seen in 99 (26.9%) patients. Those with EDS had significantly lower MNA scores and more frequent malnutrition than those without EDS (p < 0.05). In multivariable analysis adjusted for age, sex, cerebrovascular disease, dementia, number of drugs, and number of urinations at night, and the Charlson Comorbidity Index the relationship between malnutrition and EDS persisted (OR 2.58, 95% CI 1.38-4.83, p = 0.003). There was no significant difference between the presence of EDS and serum levels or deficiencies of vitamin D, vitamin B, and folate (p > 0.05).

Conclusions: EDS is associated with malnutrition in older patients with CKD. Therefore, EDS and nutritional status should be evaluated together in clinical practice. However, future studies are needed to determine the direction of the association between malnutrition and EDS and to evaluate if dietary intervention can improve EDS.
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http://dx.doi.org/10.1007/s40520-021-01966-0DOI Listing
August 2021

Sleep problems and mild cognitive impairment among adults aged ≥50 years from low- and middle-income countries.

Exp Gerontol 2021 10 10;154:111513. Epub 2021 Aug 10.

Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona 08830, Spain; ICREA, Pg, Lluis Companys 23, 08010 Barcelona, Spain.

Background: The limited available literature suggests that sleep problems are linked to an increased risk of mild cognitive impairment (MCI). However, this association has been little studied to date in low-income settings.

Objective: To investigate the association between sleep problems and MCI in a large sample of adults from six low-and middle-income countries (LMICs).

Design: Cross-sectional.

Setting: Study on Global Ageing and Adult Health (SAGE).

Subjects: 32,715 individuals aged ≥50 years with preservation in functional abilities [age range 50-114 years; 51.7% females].

Methods: MCI was defined using the National Institute on Aging-Alzheimer's Association criteria. Sleep problems were assessed by the question "Overall in the last 30 days, how much of a problem did you have with sleeping, such as falling asleep, waking up frequently during the night or waking up too early in the morning?" and categorized as "None", "Mild", "Moderate", "Severe/Extreme". Multivariable logistic regression analysis and meta-analysis were conducted.

Results: Compared to no sleep problems, mild, moderate, and severe/extreme sleep problems were associated with significant 1.40, 1.83, and 2.69 times higher odds for MCI with similar associations being observed between age groups and sex. Severe/extreme sleep problems were positively associated with MCI (i.e., OR > 1) in the six countries studied with the overall estimate being OR = 1.80 (95% CI = 1.50-2.16), and a low level of between-country heterogeneity was observed (I = 28.2%).

Conclusions: Sleep problems were associated with higher odds for MCI. Interventions to improve sleep quality among middle-aged and older adults in LMICs may be an effective strategy in reducing risk of MCI and dementia.
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http://dx.doi.org/10.1016/j.exger.2021.111513DOI Listing
October 2021

Ejaculation Disorders in Male Patients with Cancer: A Systematic Review and Meta-Analysis of Prevalence.

J Urol 2021 Dec 21;206(6):1361-1372. Epub 2021 Jul 21.

The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK.

Purpose: Ejaculatory dysfunction (EjD) and erectile dysfunction after cancer treatment are clinically important complications, but their exact prevalence by various kinds of cancer site and type of treatment is unknown. The aim of this systematic review and meta-analysis was to examine the available evidence and provide pooled estimates for prevalence of EjD and erectile dysfunction in relation to all cancer sites and identify characteristics associated with EjD in cancer patients.

Materials And Methods: We performed a systematic review and meta-analysis of cross-sectional and case-control studies. We searched 4 electronic databases (Medline®, CINAHL, PsychInfo and Embase®) until July 22, 2020. All retrospective or prospective studies reporting the prevalence of EjD in male patients with cancer were included in this review. A random effects meta-analysis was conducted calculating prevalence proportions with 95% confidence intervals. Prevalence proportions were calculated for the incidences of EjD by cancer site and type of treatment.

Results: A total of 64 studies (a total of 10,057 participants) were included for analysis. The most common cancer sites were bladder, colon, testis and rectum. The prevalence rates of EjD after surgical intervention ranged from 14.5% (95% CI 2.2-56.3) in colon cancer to 53.0% (95% CI 23.3-80.7) in bladder cancer. The prevalence rates of erectile dysfunction ranged from 6.8% (95% CI 0.8-39.1) in bladder cancer to 68.7% (95% CI 55.2-79.6) in cancer of the rectum.

Conclusions: In a large study-level meta-analysis, we looked at a high prevalence of EjD and erectile dysfunction at various cancer sites and across different treatment types. Prospective studies of EjD and erectile dysfunction after various kinds of cancer treatments are warranted.
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http://dx.doi.org/10.1097/JU.0000000000002136DOI Listing
December 2021

Comparative Evaluation of Orthostatic Hypotension in Patients with Diabetic Nephropathy.

Kidney Blood Press Res 2021 20;46(5):574-580. Epub 2021 Jul 20.

Department of Medical Education, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey.

Introduction: Orthostatic hypotension (OH) affects 5-20% of the population. Our study investigates the presence of OH in diabetic nephropathy (DNP) patients and the factors affecting OH in comparison with nondiabetic chronic kidney disease (NDCKD) patients.

Method: Patients presented to the nephrology clinic, and those who consented were included in the study. DNP was defined by kidney biopsy and/or clinical criteria. NDCKD patients of the same sex, age, and eGFR were matched to DNP patients. Demographic parameters and medications were obtained from the records. OH was determined by Mayo clinic criteria. The same researcher used an electronic device to measure blood pressure (BP). All samples were taken and analyzed the same day for biochemical and hematologic parameters and albuminuria.

Results: 112 (51 F, 61 M, mean age: 62.56 ± 9.35 years) DNP and 94 (40 F, 54 M, mean age: 62.23 ± 10.08 years) NDCKD patients were included. There was no significant difference between DNP and NDCKD groups in terms of OH prevalence (70.5 vs. 61.7%, p = 0.181). Male patients had significantly higher OH prevalence than female patients (74.7 vs. 60.0%, p = 0.026). There was no significant difference in change in systolic BP between the groups (24.00 [10.00-32.00] mm Hg vs. 24.00 [13.75-30.25] mm Hg, p = 0.797), but the change in diastolic BP was significantly higher in the DNP group (8.00 [2.00-13.00] mm Hg vs. 6.00 [2.00-9.00] mm Hg, p = 0.025). In the DNP group, patients with OH had significantly higher uric acid levels than those without OH (7.18 ± 1.55 vs. 6.36 ± 1.65 mg/dL, p = 0.017). And, 73.7% of patients on calcium channel blockers developed OH (p = 0.015), and OH developed in 80.6% of 36 patients on alpha-blockers (p = 0.049).

Conclusion: OH prevalence is very high in CKD, and etiology of CKD does not have a statistically significant effect on the frequency of OH, despite a difference that could be meaningful clinically. Therefore, patients with CKD are checked for OH, with or without concurrent diabetes mellitus. Evaluation of postural BP changes should be a part of nephrology practice.
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http://dx.doi.org/10.1159/000517316DOI Listing
July 2021

Physical multimorbidity and incident urinary incontinence among community-dwelling adults aged ≥50 years: findings from a prospective analysis of the Irish Longitudinal Study on Ageing.

Age Ageing 2021 11;50(6):2038-2046

Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, 08830 Barcelona, Spain.

Background: There are no prospective studies on the association between multimorbidity and urinary incontinence (UI), while mediators in this association are unknown. Thus, we aimed to (i) investigate the longitudinal association between multimorbidity and UI in a large sample of Irish adults aged ≥50 years and (ii) investigate to what extent physical activity, polypharmacy, cognitive function, sleep problems, handgrip strength and disability mediate the association.

Methods: Data on 5,946 adults aged ≥50 years old from the Irish Longitudinal Study on Aging were analysed. The baseline survey was conducted between 2009 and 2011 and follow-up after 2 years was conducted. Information on self-reported occurrence of UI in the past 12 months and lifetime diagnosis of 14 chronic conditions were obtained. Multivariable logistic regression and mediation analysis were conducted.

Results: After adjustment for potential confounders, compared to having no chronic conditions at baseline, having three (odds ratio [OR] = 1.79; 95% confidence interval [CI] = 1.30-2.48) and four or more (OR = 1.86; 95% CI = 1.32-2.60), chronic conditions were significantly associated with incident UI. Mediation analysis showed that polypharmacy, sleep problems and disability explained 22.7, 17.8 and 14.7% of the association between multimorbidity (i.e. two or more chronic conditions) and incident UI, respectively.

Conclusion: A greater number of chronic conditions at baseline were associated with a higher risk for incident UI at 2-year follow-up among adults aged ≥50 years in Ireland. Considering the effects of different medications on UI and improving sleep quality and disability among people aged ≥50 years with multimorbidity may reduce the incidence of UI.
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http://dx.doi.org/10.1093/ageing/afab151DOI Listing
November 2021

Associations between recently diagnosed conditions and hospitalization due to COVID-19 in patients aged 50 years and older- A SHARE-based analysis.

J Gerontol A Biol Sci Med Sci 2021 Jul 12. Epub 2021 Jul 12.

National Research Centre for the Working Environment, Copenhagen, Denmark.

Background: Only a few studies have been carried out with a large sample size on the relationship between chronic conditions and hospitalization for COVID-19, and there is no research examining recently diagnosed conditions. Our purpose was to evaluate this association in a large sample including the older population from Europe and Israel.

Methods: Data from the SHARE COVID-19 Survey, a representative survey of individuals aged 50 or over residing in 27 European countries and Israel, were retrieved. Associations between recently diagnosed chronic conditions (i.e., conditions detected over the last three years) (exposure) and hospitalization due to COVID-19 (outcome) were assessed using multivariable logistic regression.

Results: 51,514 participants on average 71.0 (SD = 9.2) years old were included. Participants with multimorbidity (i.e., two or more recently diagnosed conditions) had significantly higher odds for COVID-19 hospitalization (AOR = 3.91 [95%CI = 2.14-7.12]). Independent conditions such as lung disease (AOR = 16.94 [95%CI = 9.27-30.95]), heart disease (AOR = 3.29 [95%CI =1.50-7.21]), or cancer (AOR = 3.45 [95%CI = 1.26-9.48]), showed particularly high odds for hospitalization due to COVID-19 disease.

Conclusions: People with recently diagnosed diseases, and in particular those having lung disease, heart disease, or cancer were significantly more likely to be hospitalized for COVID-19.
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http://dx.doi.org/10.1093/gerona/glab199DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8344421PMC
July 2021

Excessive Daytime Sleepiness is Associated With Malnutrition, Dysphagia, and Vitamin D Deficiency in Older Adults.

J Am Med Dir Assoc 2021 10 25;22(10):2134-2139. Epub 2021 Jun 25.

Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey. Electronic address:

Objectives: Both excessive daytime sleepiness (EDS) and nutritional deficiencies are common and can cause similar negative consequences, such as falls, and cognitive impairment in older adults, but there is no study investigating the relationship between the two. The aim of this study is to investigate the relationship between malnutrition/micronutrient deficiency and EDS in patients with and without dementia.

Design: Cross-sectional study.

Setting And Participants: A total of 800 outpatients (243 of whom had dementia), aged ≥65 years, were included.

Methods: All patients underwent comprehensive geriatric assessment. Mini Nutritional Assessment (MNA) scores >23.5, 17-23.5, or <17 were categorized as well-nourished, malnutrition risk, and malnutrition, respectively. Eating Assessment Tool score of ≥3 was accepted as dysphagia. Serum vitamin B, vitamin D, and folate deficiencies were also evaluated. The Epworth Sleepiness Scale score of ≥11 points indicated EDS.

Results: The mean age was 79.1±7.5 years. The prevalence of EDS was 22.75%. In patients with dementia, those with EDS had significantly lower MNA scores and more frequent dysphagia (P < .05). In patients without dementia, those with EDS have lower MNA scores than those without EDS; malnutrition, dysphagia, and vitamin D deficiency were higher (P < .05). In multivariable analysis adjusted for age, gender, living status, ischemic heart disease, cerebrovascular events, polypharmacy, dementia, and insomnia, the association between EDS and malnutrition [odds ratio (OR) 1.73, 95% confidence interval (CI) 1.37-2.20], dysphagia (OR 2.01, 95% CI 1.33-2.88), and vitamin D deficiency (OR 2.0, 95% CI 1.12-3.55) persisted.

Conclusions And Implications: There is a significant relationship between EDS and malnutrition risk, dysphagia, and vitamin D deficiency in older adults. Therefore, when examining an older patient with EDS, dysphagia, malnutrition, and vitamin D levels should be evaluated, or EDS should be investigated in an older patient with malnutrition, dysphagia, and vitamin D deficiency. Thus, it will be possible to manage all these conditions more effectively.
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http://dx.doi.org/10.1016/j.jamda.2021.05.035DOI Listing
October 2021

Association between Food Insecurity and Sarcopenia among Adults Aged ≥65 Years in Low- and Middle-Income Countries.

Nutrients 2021 May 31;13(6). Epub 2021 May 31.

Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, 08830 Barcelona, Spain.

Limited literature has investigated the association between food insecurity and sarcopenia in low- and middle-income countries (LMICs). Therefore, the aim of the present study was to investigate the association between food insecurity and sarcopenia among adults aged ≥65 years in six LMICs. Community-based cross-sectional data of the Study on Global Ageing and Adult Health were analyzed. Sarcopenia was defined as the presence of low skeletal muscle mass based on indirect population formula, and either slow gait or low handgrip strength. In the past, 12-month food insecurity was assessed with two questions on frequency of eating less and hunger due to lack of food. Multivariable logistic regression analysis was conducted. The final sample consisted of 14,585 individuals aged ≥65 years (mean (SD) age 72.6 (11.5) years; 55.0% females). The prevalence of sarcopenia among those with no food insecurity was 13.0% but this increased to 24.4% among those with severe food insecurity. After adjustment for potential confounders, compared to no food insecurity, severe food insecurity was associated with 2.05 (95%CI = 1.12-3.73) times higher odds for sarcopenia. In this large representative sample of older adults from multiple LMICs, it was found that severe food insecurity is associated with higher odds for sarcopenia. Addressing food insecurity in such settings may be an effective strategy to curb the high prevalence of sarcopenia in LMICs.
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http://dx.doi.org/10.3390/nu13061879DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8227512PMC
May 2021

Association between food insecurity and fall-related injury among adults aged ≥65 years in low- and middle-income countries: The role of mental health conditions.

Arch Gerontol Geriatr 2021 Sep-Oct;96:104438. Epub 2021 May 24.

Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, Spain; Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France; ICREA, Pg. Lluis Companys 23, 08010, Barcelona, Spain.

Purpose: We investigated the association between food insecurity and fall-related injury among older adults from six low- and middle-income countries (LMICs), and the extent to which this association is mediated by mental health.

Methods: Cross-sectional, community-based, nationally representative data from the WHO Study on global AGEing and adult health (SAGE) were analyzed. Past 12-month food insecurity was assessed with two questions on frequency of eating less and hunger due to lack of food. Fall-related injury referred to those that occurred in the past 12 months. Multivariable logistic regression analysis and mediation analysis were conducted to assess associations.

Results: Data on 14,585 adults aged ≥65 years [mean (SD) age 72.5 (11.5) years; 54.9% females] were analyzed. After adjustment for potential confounders, severe food insecurity (versus no food insecurity) was associated with 1.95 (95%CI = 1.11-3.41) times higher odds for fall-related injury. Moderate food insecurity was not significantly associated with fall-related injury (OR = 1.34; 95%CI = 0.81-2.25). The mediation analysis showed that 37.3%, 21.8%, 17.7%, and 14.0% of the association between severe food insecurity and fall-related injury was explained by anxiety, sleep problems, depression, and cognition, respectively.

Conclusion: Severe food insecurity was associated with higher odds for injurious falls among older adults in LMICs, and a large proportion of this association may be explained by mental health complications. Interventions to improve mental health among those who are food insecure and a strong focus on societal and government efforts to reduce food insecurity may contribute to a decrease in injurious falls.
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http://dx.doi.org/10.1016/j.archger.2021.104438DOI Listing
September 2021

Anxiety symptoms and mild cognitive impairment among community-dwelling older adults from low- and middle-income countries.

J Affect Disord 2021 08 2;291:57-64. Epub 2021 May 2.

Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona 08830, Spain; ICREA, Pg. Lluis Companys 23, 08010, Barcelona, Spain.

Aim: Anxiety may be a risk factor for mild cognitive impairment (MCI) but there is a scarcity of data on this association especially from low- and middle-income countries (LMICs). Thus, we investigated the association between anxiety and MCI among older adults residing in six LMICs (China, Ghana, India, Mexico, Russia, South Africa), and the mediational effect of sleep problems in this association.

Methods: Cross-sectional, community-based, nationally representative data from the WHO Study on global AGEing and adult health (SAGE) were analyzed. The definition of MCI was based on the National Institute on Ageing-Alzheimer's Association criteria. Multivariable logistic regression analysis, meta-analysis, and mediation analysis were conducted to assess associations.

Results: The final sample included 32,715 individuals aged ≥50 years with preservation in functional abilities [mean (standard deviation) age 62.1 (15.6) years; 48.3% males]. Country-wise analysis showed a positive association between anxiety and MCI in all countries (OR 1.35-14.33). The pooled estimate based on meta-analysis with random effects was OR=2.27 (95%CI=1.35-3.83). Sleep problems explained 41.1% of this association.

Conclusions: Older adults with anxiety had higher odds for MCI in LMICs. Future studies should examine whether preventing anxiety or addressing anxiety among individuals with MCI can lead to lower risk for dementia onset in LMICs, while the role of sleep problems in this association should be investigated in detail.
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http://dx.doi.org/10.1016/j.jad.2021.04.076DOI Listing
August 2021

Comment on "Comparison of the Accuracy of Short Cognitive Screens Among Adults With Cognitive Complaints in Turkey".

Alzheimer Dis Assoc Disord 2021 Apr-Jun 01;35(2):188

Department of Geriatric Medicine Bezmialem Vakif University, Faculty of Medicine, Istanbul, Turkey.

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http://dx.doi.org/10.1097/WAD.0000000000000448DOI Listing
June 2021

Risk factors for high fall risk in elderly patients with chronic kidney disease.

Int Urol Nephrol 2021 May 8. Epub 2021 May 8.

Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Adnan Menderes Bulvarı (Vatan Street), 34093, Fatih, İstanbul, Turkey.

Purpose: Patients with chronic kidney disease (CKD) usually represent an aging population, and both older age and CKD are associated with a higher risk of falling. Studies on risk factors among subjects with CKD are lacking.

Methods: Records of outpatients from one geriatric clinic in Turkey were retrospectively reviewed. A result of ≥ 13.5 s on the timed up and go (TUG) test was accepted as a high risk of falls. Independent predictors of an increased risk of falls among subjects with CKD (estimated glomerular filtration rate of < 60 mL/min/1.73 m) were identified using logistic regression models.

Results: Patients with CKD (n = 205), represented the 20.2% of the entire cohort and was identified as an independent predictor of increased fall risk (OR 2.59). Within the CKD cohort, serum folic acid levels and frailty were independent predictors of an increased risk of falls. The CKD/fall risk group was older, had a lower median years of education, lower vitamin D levels, and lower serum folic acid levels than the CKD/non-fall risk group. In addition to higher serum creatinine and potassium levels, the only significant difference between patients with CKD/fall risk and a matched non-CKD/fall risk was a lower median folic acid level in the former group.

Conclusions: Frailty and low folic acid levels are independently associated with an increased risk of falls among elderly outpatients with CKD. Prevention of frailty may reduce the risk of falls in these subjects. Possible benefit of folic acid supplementation requires further studies.
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http://dx.doi.org/10.1007/s11255-021-02884-wDOI Listing
May 2021

Prevalence of erectile dysfunction in male survivors of cancer: a systematic review and meta-analysis of cross-sectional studies.

Br J Gen Pract 2021 05 29;71(706):e372-e380. Epub 2021 Apr 29.

Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Vienna, Austria.

Background: Prevalence of erectile dysfunction (ED) in male survivors of cancer across cancer types has not been systematically analysed.

Aim: To estimate the prevalence of ED in all types of cancer and identify characteristics associated with ED in survivors of cancer.

Design And Setting: Systematic review and meta-analysis (MA) of cross-sectional studies.

Method: MEDLINE, CINAHL, PsycINFO, and EMBASE were searched, targeting reports published from inception to 1 February 2020. All retrospective or prospective studies reporting prevalence of ED in male patients with cancer and using a validated tool for detection of ED were included. A random-effects MA model was used to pool prevalence of ED as absolute estimates at three different stages, that is, 'healthy', 'at diagnosis', and 'after treatment'. A univariate MA regression including the three-level group variable as the only independent variable was used to assess the difference in ED prevalence across the three groups. Further MAs were conducted for studies involving patients at diagnosis and after treatment, and statistical inferences were made with setting for multiple testing controlling for a false discovery rate (FDR) <0.05.

Results: In total, 1301 studies were assessed for inclusion. Of these, 141 were potentially eligible and subsequently scrutinised in full text. Finally, 43 studies were included with a total of 13 148 participants. Overall, pooled data of the included studies showed an ED prevalence of 40.72% (95% confidence interval [CI] = 31.80 to 50.29) in patients with cancer, with prevalences of 28.60% (95% CI = 12.10 to 53.83) at time of diagnosis and 42.70% (95% CI = 32.97 to 53.03) after treatment, with significant difference between these two stages and across cancer locations, controlling for an FDR <0.05.

Conclusion: Erectile dysfunction was particularly high in male survivors of cancer and was associated with cancer treatment, cancer site, and age.
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http://dx.doi.org/10.3399/bjgp20X714197DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8087306PMC
May 2021

What are optimum target levels of hemoglobin in older adults?

Aging Clin Exp Res 2021 Apr 28. Epub 2021 Apr 28.

Department of Internal Medicine, Faculty of Medicine, Bezmialem Vakif University, İstanbul, Turkey.

Aim: The aim of this study is to identify optimum target levels of hemoglobin (Hgb) in older males and females according to cognitive performance, mood state, nutrition intake, balance-walking functions, muscle strength and performance in daily life activities.

Method: A total of 1942 geriatric patients who had undergone comprehensive geriatric assessment were evaluated. The patient's demographic characteristics, comorbid diseases, number of drugs, cognitive performance, mood and nutritional states, basic and instrumental daily living activity indexes were obtained from hospital files. Hgb levels were analyzed on the same day. Receiver Operating Characteristic analysis was used to detect the optimum level of Hgb according to the best performance of geriatric assessment parameters.

Results: 1095 participants took part of who 71.9% were female and the mean age was 76.92 ± 7.38 years (65-103 years). There was a significant negative correlation between age, number of drugs used, Geriatric Depression Scale-15, Timed Up and Go test and Hgb in both sexes while a significant positive correlation was found between Barthel and Lawton activities of daily living, Tinetti test, Mini Nutritional Assessment, Mini-Mental State Examination and Hgb (p < 0.05). The optimum Hgb levels were ≥ 13.0 for females and ≥ 13.9 in males.

Conclusion: Findings from the present study in relation to Hgb and key geriatric evaluation parameters suggests that the optimum level of Hgb for older females and males is higher than the level of Hgb in current definitions. Data from this study suggest that the optimum value of the Hgb level is 13.0 for females and 13.9 for males.
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http://dx.doi.org/10.1007/s40520-021-01854-7DOI Listing
April 2021

Excessive daytime sleepiness is associated with an increased frequency of falls and sarcopenia.

Exp Gerontol 2021 07 20;150:111364. Epub 2021 Apr 20.

Department of Cancer Epidemiology and Prevention Research, Alberta, Health Services, Holy Cross Centre, AlbertaT5J 3E4, Canada.

Background: This cross-sectional study aimed to examine associations between excessive daytime sleepiness (EDS) with falls and falls related conditions in older adults.

Methods: To assess EDS, the Epworth Sleepiness Scale was used, with a score of ≥11/24 points indicating EDS. Number of falls and fall history (at least one) in the last year were recorded. Timed Up and Go test (TUG) was used to assess fall risk. Sarcopenia was defined by SARC-F tool. A grip strength score of the dominant hand, measured with a hand-grip dynamometer, less than 16 kg in females and 27 kg in males was accepted as dynapenia. Frailty status was defined by five dimensions including shrinking, exhaustion, low levels of activity, weakness, and slowness with those scoring positive on ≥3 dimensions being categorized as frail. The relationship between EDS with outcomes including fall, number of falls, falls risk, dynapenia, sarcopenia and frailty was investigated.

Results: Of the 575 outpatients (mean age 78.7 ± 7.5 years, female:70.4%), the prevalence of EDS was 19.8%. In the multivariable model adjusted for age, sex, living status, marital status, polypharmacy, osteoarthritis, Parkinson disease, depression and dementia; EDS was significantly associated with the number of falls last year (IRR = 1.94, 95% CI: 1.42-2.65) and sarcopenia (OR = 2.41, 95% CI: 1.41-4.12). EDS was not significantly associated with TUG based fall risk, frailty and dynapenia.

Conclusions: EDS was observed in approximately one in every five older adults. EDS should be evaluated as part of geriatric assessment. Moreover, older patients with EDS should be further assessed for falls and sarcopenia.
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http://dx.doi.org/10.1016/j.exger.2021.111364DOI Listing
July 2021

The evaluation of relationship between polypharmacy and anticholinergic burden scales.

North Clin Istanb 2021 11;8(2):139-144. Epub 2021 Mar 11.

Department of Geriatric Medicine, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey.

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.
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http://dx.doi.org/10.14744/nci.2020.17136DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8039107PMC
March 2021

The clinical implications and importance of anemia in older women.

Acta Clin Belg 2021 Apr 7:1-7. Epub 2021 Apr 7.

Department of Geriatric Medicine, Bezmialem Vakif University, Faculty of Medicine, Istanbul, Turkey.

: The objective of this study was to investigate associations between anemia with geriatric syndromes and comprehensive geriatric assessment (CGA) parameters in older women.: 886 older outpatient women were included . Anemia was defined as a hemoglobin concentration below 12 g/dL. patients were divided into two groups as anemic and non-anemic. The relationships between anemia and CGA parameters/geriatric syndromes were determined.: The mean age of the participants was 76.00 ± 8.91. The prevalence of patients with anemia was 15.35%. There was a significant difference between anemic and non-anemic groups in terms of age, Charlson Comorbidity Index, body mass index, the number of drugs used, and the presence of chronic renal failure (p < 0.05). After adjustment for these covariates, anemia was associated with Timed Up and Go test (OR: 1.10, 95% CI: 1.02-1.18), muscle strength (OR: 0.99, 95% CI: 0.83-0.99), dynapenia (OR: 1.92, 95% CI: 1.06-3.47), Mini Nutritional Assessment scores (OR: 0.88, 95% CI: 0.83-0.94), poor nutritional status (OR: 1.97, 95% CI: 1.10-3.48), Fried scores (OR: 1.42, 95% CI: 1.24-1.68), frailty (OR: 2.58, 95% CI: 1.42-4.69), falls (OR: 1.78, 95% CI: 1.10-2.92) and polypharmacy (OR: 2.31, 95% CI: 1.38-3.86).: In the present study anemia was associated with frailty, polypharmacy, poor nutritional status, falls, and decreased muscle strength. Therefore, anemia may be a sign of poor health status in older women. When anemia is detected in an older woman, CGA should be strongly considered if not routinely performed.
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http://dx.doi.org/10.1080/17843286.2021.1913388DOI Listing
April 2021

The relationship between osteoporosis and sarcopenia, according to EWGSOP-2 criteria, in outpatient elderly.

J Bone Miner Metab 2021 Jul 5;39(4):684-692. Epub 2021 Apr 5.

Unit for Aging Brain and Dementia, Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Balcova, Izmir, 35340, Turkey.

Introduction: Osteoporosis and sarcopenia are significant health problems that mainly affect older adults. This study aimed to investigate the relationship between sarcopenia and osteoporosis.

Materials And Methods: The study included 444 participants who had undergone a dual-energy X-ray absorptiometry scan, handgrip test, 4-m walking speed test, and bioimpedance analysis within the past year. Participants were classified into control, osteopenia, or osteoporosis groups according to the World Health Organization classification. Sarcopenia was diagnosed according to the European Working Group on Sarcopenia in Older People-2 criteria.

Results: The mean age of the participants was 75.88 ± 7.20 years, and 80.9% were females. There were 144, 230, and 70 participants in the osteoporosis, osteopenia, and control groups, respectively. Probable sarcopenia was identified in 94 subjects, sarcopenia in 61, and severe sarcopenia in 72 participants. After adjusting for age, gender, and body mass index, probable sarcopenia and severe sarcopenia were associated with osteoporosis (p < 0.05). Low muscle strength, and low physical performance were associated with osteoporosis (p < 0.02). When osteoporosis was evaluated only according to the femoral neck T score, low muscle strength and low physical performance were found to be related not only to osteoporosis (p < 0.001), but also to osteopenia (p < 0.05). Additionally, probable sarcopenia was associated with femoral neck osteopenia (p < 0.01).

Conclusions: In this study, probable sarcopenia and severe sarcopenia were associated with osteoporosis in older adults. Furthermore, we found that low muscle strength, or dynapenia, which is the determining criterion of sarcopenia, was related to femoral neck osteopenia and osteoporosis.
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http://dx.doi.org/10.1007/s00774-021-01213-6DOI Listing
July 2021

Objectively measured far vision impairment and sarcopenia among adults aged ≥ 65 years from six low- and middle-income countries.

Aging Clin Exp Res 2021 Nov 28;33(11):2995-3003. Epub 2021 Mar 28.

Parc Sanitari Sant Joan de Déu, CIBERSAM, Dr Antoni Pujadas, 42, 08830, Sant Boi de Llobregat, Barcelona, Spain.

Background: There are currently no studies on visual impairment and sarcopenia. We investigated the cross-sectional association between objectively measured far vision impairment and sarcopenia in a nationally representative sample of older adults aged 65 years and over from six low- and middle-income countries (LMICs).

Methods: Cross-sectional, community-based data from the study on global ageing and adult health (SAGE) were analyzed. Far vision acuity was measured using the tumbling E LogMAR chart and classified as: no vision impairment (6/12 or better); mild vision impairment (6/18 or better but worse than 6/12); moderate vision impairment (6/60 or better but worse than 6/18); severe vision impairment (worse than 6/60). Sarcopenia was defined as having low skeletal muscle mass and either a slow gait speed or a weak handgrip strength. Associations were assessed with multivariable logistic regression.

Results: Fourteen thousand five hundred and eighty five individuals aged ≥ 65 years were included in the analysis [mean (SD) age 72.6 (11.5) years; 54.1% females]. After adjustment for multiple potential confounders, compared to those with no vision impairment, the OR (95% CI) for sarcopenia in those with mild, moderate, and severe vision impairment were 1.10 (0.87-1.40), 1.69 (1.25-2.27), and 3.38 (1.69-6.77), respectively. The estimates for females and males were similar.

Conclusions: The odds for sarcopenia increased with increasing severity of far vision impairment among older people in LMICs. The mere co-occurrence of these conditions is concerning, and it may be prudent to implement interventions to address/prevent sarcopenia in those with far vision impairment through the promotion of physical activity and appropriate nutrition.
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http://dx.doi.org/10.1007/s40520-021-01841-yDOI Listing
November 2021

Association between food insecurity and depression among older adults from low- and middle-income countries.

Depress Anxiety 2021 04 9;38(4):439-446. Epub 2021 Mar 9.

Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Barcelona, Spain.

Background: To examine the association between self-reported food insecurity and depression in 34,129 individuals aged ≥50 years from six low- and middle-income countries (LMICs) (China, Ghana, India, Mexico, Russia, and South Africa).

Methods: Cross-sectional, community-based, nationally representative data from the WHO Study on global AGEing and adult health (SAGE) were analyzed. Self-reported past 12-month food insecurity was assessed with two questions on frequency of eating less and hunger due to lack of food. Questions based on the World Mental Health Survey version of the Composite International Diagnostic Interview were used for the endorsement of past 12-month DSM-IV depression. Multivariable logistic regression analysis and meta-analysis were conducted to assess associations.

Results: In total, 34,129 individuals aged ≥50 years [mean (SD) age, 62.4 (16.0) years; 52.1% females] were included in the analysis. Overall, the prevalence of moderate and severe food insecurity was 6.7% and 5.1%, respectively, while the prevalence of depression was 6.0%. Meta-analyses based on countrywise estimates showed that overall, moderate food insecurity (vs. no food insecurity) is associated with a nonsignificant 1.69 (95% confidence interval [CI] = 0.82-3.48) times higher odds for depression, while severe food insecurity is significantly associated with 2.43 (95% CI = 1.65-3.57) times higher odds for depression.

Conclusions: In this large representative sample of older adults from six LMICs, those with severe food insecurity were over two times more likely to suffer from depression (compared with no food insecurity). Utilizing lay health counselors and psychological interventions may be effective mechanisms to reduce depression among food-insecure populations. Interventions to address food insecurity (e.g., supplemental nutrition programs) may reduce depression at the population level but future longitudinal studies are warranted.
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http://dx.doi.org/10.1002/da.23147DOI Listing
April 2021

The association between objective vision impairment and mild cognitive impairment among older adults in low- and middle-income countries.

Aging Clin Exp Res 2021 Oct 4;33(10):2695-2702. Epub 2021 Mar 4.

Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, 08830, Barcelona, Spain.

Aim: The association between visual impairment and mild cognitive impairment (MCI) has not been investigated to date. Thus, we assessed this association among older adults from six low- and middle-income countries (LMICs) (China, India, Ghana, Mexico, Russia, and South Africa) using nationally representative datasets.

Methods: Cross-sectional, community-based data from the WHO Study on global AGEing and adult health (SAGE) were analyzed. Visual acuity was measured using the tumbling ElogMAR chart, and vision impairment (at distance and near) was defined as visual acuity worse than 6/18 (0.48 logMAR) in the better-seeing eye. The definition of MCI was based on the National Institute on Aging-Alzheimer's Association criteria. Multivariable logistic regression was conducted.

Results: Data on 32,715 individuals aged ≥ 50 years [mean (SD) age 62.1 (15.6) years; 51.2% females] were analyzed. Compared to those without far or near vision impairment, those with near vision impairment but not far vision impairment (OR = 1.33; 95% CI = 1.16-1.52), and those with both far and near vision impairment (OR = 1.70; 95% CI = 1.27-2.29) had significantly higher odds for MCI. Only having far vision impairment was not significantly associated with MCI.

Conclusions: Visual impairment is associated with increased odds for MCI among older adults in LMICs with the exception of far vision impairment only. Future longitudinal and intervention studies should examine causality and whether improvements in visual acuity, or early intervention, can reduce risk for MCI and ultimately, dementia.
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http://dx.doi.org/10.1007/s40520-021-01814-1DOI Listing
October 2021

Assocıatıons between mıld hyponatremıa and gerıatrıc syndromes ın outpatıent settıngs.

Int Urol Nephrol 2021 Oct 18;53(10):2089-2098. Epub 2021 Feb 18.

Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakıf University, Adnan Menderes Bulvarı (Vatan Street), Fatih, 34093, Istanbul, Turkey.

Purpose: The impact of mild hyponatremia on geriatric syndromes is not clear. Our aim was to determine associations between mild hyponatremia and results of comprehensive geriatric assessment tools in outpatient settings.

Methods: We reviewed medical records of 1255 consecutive outpatient elderly subjects and compared results of comprehensive geriatric assessment measures among patients with mild hyponatremia (serum Na 130-135 mEq/L) versus normonatremia (serum Na 136-145 mEq/L). The comprehensive geriatric assessment measures included the Basic and Instrumental Activities of Daily Living, Mini Mental State Examination, Geriatric Depression Score, Tinetti Mobility Test, the Timed Up&Go Test, the Mini Nutritional Assessment, the handgrip test, the Insomnia Severity Index, polypharmacy, recurrent falls, urinary incontinence, orthostatic hypotension, and nocturia.

Results: Of the 1255 patients, 855 were female (68.1%), and the mean age was 73.7 ± 8.3 years. Mild hyponatremia was detected in 108 patients (8.6%). The median serum sodium was 140.5 [interquartile range (IQR) 138.4-141.8] versus 133.8 [IQR, 132.3-134.2] in normonatremia and mild hyponatremia groups, respectively (p < 0.001). The only significant difference for comorbidities between normonatremia and mild hyponatremia groups was the frequency of hypertension (66.9% versus 76.7%, respectively (p = 0.041). None of the comprehensive geriatric assessment tools conferred a significant association with mild hyponatremia. Of the 1061 subjects with available survival data, 96 (9.0%) deceased within 3-4 years of follow-up (p = 0.742). Hyponatremia as an independent variable did not have a significant effect on mortality in univariate logistic regression analysis (OR 1.13, 95% CI 0.55-2.33, p = 0.742).

Conclusion: Mild hyponatremia does not apparently affect results of geriatric assessments significantly. Whether particular causes of hyponatremia may have different impacts should be tested in further studies.
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http://dx.doi.org/10.1007/s11255-021-02789-8DOI Listing
October 2021
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