Showing papers by "Ilker Tasci published in 2020"
TL;DR: It was showed that the use of any drugs with possible or definite anticholinergic properties was associated with an increased risk of falls in frail older adults, emphasizing the importance of medication management with respect to fall prevention in these patients.
20 citations
TL;DR: The results show that one in ten older adults with T2DM are overtreated while one in four require modification of their current antihyperglycemic and antihypertensive treatments.
Abstract: Targeting better glycated hemoglobin (HbA1c) and blood pressure (BP) goals may endanger older adults with type 2 diabetes mellitus (T2DM). Overtreatment of T2DM and hypertension is a trending issue, although undertreatment is still common. We investigated the rates and predictors of overtreatment and undertreatment of glycemia and BP in older adults with T2DM and physicians’ attitudes to deintensify or intensify treatment. Data from older adults (≥ 65 years) enrolled in a large nationwide T2DM survey in 2017 across Turkey were analyzed. Overtreatment of glycemia was defined as HbA1c 9%, and BP undertreatment was defined as SBP > 150 mmHg or DBP > 90 mmHg. Deintensification or intensification rates were calculated according to treatment modification initiated by the treating physician(s). The rate of overtreatment in the glycemia group (n = 1264) was 9.8% (n = 124) and that in the BP group (n = 1052) was 7.3% (n = 77), whereas the rate of undertreatment was 14.2% (n = 180) and 15.2% (n = 160), respectively. In the adjusted model, use of oral secretagogues (sulfonylureas or glinides) (odds ratio [OR] 1.94, 95% confidence interval [CI] 1.2–3.1) and follow-up at a private clinic (OR 1.81, 95% CI 1.0–3.3) were predictors of glycemia overtreatment. BP overtreatment was independently associated with the use insulin-based diabetes therapies (OR 1.86, 95% CI 1.14–3.04). There was no independent association of BP undertreatment to the study confounders. The deintensification and intensification rates were 25 and 75.6%, respectively, for glycemia and 10.9 and 9.2%, respectively, for BP. The results show that one in ten older adults with T2DM are overtreated while one in four require modification of their current antihyperglycemic and antihypertensive treatments. Physicians are eager to intensify medications while they largely ignore deintensification in diabetes management. These results warrant enforced measures to improve the care of older adults with T2DM. ClinicalTrials.gov identifier, NCT 03455101. Type 2 diabetes mellitus (T2DM) is prevalent in the elderly population. Strict glycemia and blood pressure (BP) targets do not improve outcomes but they may increase the rate of adverse events in these patients. Consequently, overtreatment has been an emerging issue in recent years. The overall magnitude of the problem is largely unknown. Therefore, we assessed the rates and predictors of overtreatment and undertreatment of blood glucose and BP in Turkish older adults with T2DM. We also investigated physicians’ reactions to treatment modulation in the overtreated or undertreated patients. Patients participating in the study were: older adults (n = 1264) with T2DM from a cross-sectional, nationwide, multicenter study who followed-up at the same unit during the past 12 months and who did not have decompensated liver disease, psychiatric disorders interfering with cognition or compliance, bariatric surgery in the past 12 months or renal replacement therapy. We found that: These results suggest that measures should be taken to improve physician awareness of drug modification in older patients with T2DM.
16 citations
18 May 2020
TL;DR: The study results show that demented elders have a lower BMD and higher frequency of osteoporosis at the hip, but not at the lumbar spine, irrespective of sex and type of dementia, and it is speculated that not only AD, but also VaD and AD-VaD may be associated with bone loss at the hips.
Abstract: Objectives This study aims to examine bone mineral density (BMD) and osteoporosis in older adults with dementia compared to those with a normal cognitive status and to evaluate the type, severity, and duration of dementia. Patients and methods Between May 2013 and May 2017, a total of 363 participants aged ≥65 years (136 males, 227 females; mean age 78.4±5.4 years; range 66 to 99 years) with and without Alzheimer's disease (AD), vascular dementia (VaD), or mixed dementia (AD-VaD) were included in this single-center, prospective, cross-sectional study. The dementia group included 93 patients with dementia and the control group included 270 age- and sex-matched healthy individuals. We used dual-energy X-ray absorptiometry (DXA) to measure BMD of the lumbar spine, total hip, and femoral neck. Results Controlled for age and sex, demented and non-demented participants had a similar BMD (g/cm2) at lumbar spine [F (1, 358):0.83, p=363], but lower BMD values of total hip [F (1, 359):10.26, p=0.001] and femoral neck [F (1, 359):15.21, p<0.001] in the patients with dementia. Adjusted percentage of osteoporosis and low bone mass based on total hip and femoral neck T-scores were also significantly higher in the patient group. The mean BMD values, frequency of osteoporosis, and low bone mass did not significantly differ according to the subtype of dementia, sex, and disease duration or severity. Conclusion Our study results show that demented elders have a lower BMD and higher frequency of osteoporosis at the hip, but not at the lumbar spine, irrespective of sex and type of dementia. Based on these results, we can speculate that not only AD, but also VaD and AD-VaD may be associated with bone loss at the hip.
11 citations
TL;DR: Turkey’s fight against the COVID-19 pandemic, the problems in geropsychiatric care, and their solutions encountered during the period of social isolation of older adults are focused on.
Abstract: The coronavirus disease 2019 (COVID-19) outbreak in Turkey, caused by severe acute respiratory syndrome coronavirus-2, is a reflection of the global public health crisis, which was declared by the World Health Organization on March 11, 2020 (World Health Organization, 2020a). As the virus is highly contagious and can quickly spread among people, cases started to appear across the country in a short time. All age groups in the community are at risk of becoming infected with the COVID-19. However, older adults are predisposed to have a more severe disease due to comorbid situations, including hypertension, diabetes, coronary heart disease, chronic obstructive heart disease, and renal failure, which reduce vitality and resilience (Zhou et al., 2020). Age-related decline in physiological reserve and the altered innate immune system, called immunosenescence, increases the risk of severe infections in older adults (Weiskopf et al., 2009). But the knowledge obtained from the previous outbreaks or flu seasons could not explain the unexpectedly higher risk of death with the increasing number of chronic diseases of aged people.While no evidence-based treatment strategy exists presently, social distancing has been the primary measure to prevent the spread of the virus. In this situation, the COVID-19 outbreak may cause some mental health issues in older individuals with no mental illness, as well as recurrence of the disease in people with psychiatric illness and stress in both themselves and relatives. In response to this process, the changes in the delivery of mental health services have to meet the needs of older adults better worldwide. This paper focuses on Turkey’s fight against the COVID-19 pandemic, the problems in geropsychiatric care, and their solutions encountered during the period of social isolation of older adults. The precautions to be taken during the outbreak, which seems to have a dynamic process, may change rapidly. This challenge may continue until we have a coronavirus vaccine. Epidemiology The first confirmed case of COVID-19 infection was reported on March 10, 2020, much later than in many European countries (Turkish Ministry of Health, 2020a; World Health Organization, 2020b). The first report of death from COVID-19 came on March 17, 2020, when the total number of cases had reached 98 (Turkish Ministry of Health, 2020a). As of May 12, 141,475 confirmed cases and 3,894 deaths from COVID-19 reported by the Turkish Ministry of Health. The preliminary estimated mortality rate is 2.75%, which is lower than the estimated global average of 6.2% (Turkish Ministry of Health, 2020b; World Health Organization, 2020c). However, these numbers are calculated among the closed cases and are subject to change dynamically as the number of discharged individuals increase. Although the TurkishHealthMinister’s daily briefings have persistently addressed the disease as disproportionately severe in older people, information on confirmed cases anddeaths in different age groupswas still not available to the public as of May 12, 2020.
10 citations
TL;DR: The factors associated with UI in geriatric and all adult inpatients are CDS, sedative medications, end-of life management, and FI plus older age, female sex, and comorbidities for the latter.
6 citations
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TL;DR: Sandoval-Insausti et al. as discussed by the authors investigated the relationship between Macronutrients, diet quality, and frailty in older men. https://doi.org/10.3945/an.114.006940.
Abstract: Dam TTL, Shannon J, Redden DT; Osteoporotic Fractures in Men (MrOS) Research Group Macronutrients, diet quality, and frailty in older men. J Gerontol A Biol Sci Med Sci. 2014;69(6):695-701. 3. Verspoor E, Voortman T, van Rooij FJA, et al. Macronutrient intake and frailty: the Rotterdam Study. Eur J Nutr. 2019. https://doi.org/10.1007/ s00394-019-02131-0. 4. Sandoval-Insausti H, Pérez-Tasigchana RF, López-García E, GarcíaEsquinas E, Rodríguez-Artalejo F, Guallar-Castillón P. Macronutrients intake and incident frailty in older adults: a prospective cohort study. J Gerontol A Biol Sci Med Sci. 2016;7:1329-1334. https://doi.org/10.1093/ gerona/glw033. 5. Strandberg TE, Salomaa V, Strandberg AY, et al. Cohort profile: the Helsinki businessmen study (HBS). Int J Epidemiol. 2016;45:10741074h. 6. Vellas B, Guigoz Y, Garry PJ, et al. The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition. 1999;15(2):116-122. 7. Fritsche KL. The science of fatty acids and inflammation. Adv Nutr. 2015;6: 293S-301S. https://doi.org/10.3945/an.114.006940. 8. Soysal P, Stubbs B, Lucato P, et al. Inflammation and frailty in the elderly: a systematic review and meta-analysis. Ageing Res Rev. 2016;31:1-8. 9. Das A, Cumming RG, Naganathan V, et al. Prospective associations between dietary antioxidant intake and frailty in older Australian men: the Concord Health and Ageing in Men Project. J Gerontol A Biol Sci Med Sci. 2020;75 (2):348-356. https://doi.org/10.1093/gerona/glz054. 10. Nordic Nutrition Recommendations. Integrating Nutrition and Physical Activity. Copenhagen, Denmark: Nordic Council Ministers; 2014. https:// doi.org/10.6027/Nord2014-002. Accessed December 5, 2019.
TL;DR: The T-CogS-TR can be useful as a valid and reliable tool for detecting AD in Turkish elderly patients and may be considered suitable for patients who need more frequent follow-up and cannot easily return to in-person visits.
Abstract: The ability to screen Turkish-speaking older adults for cognitive impairment by phone is lacking. The aim of this study was to translate the existing version of the telephone cognitive screen (T-CogS) into Turkish version (T-CogS-TR) and evaluate its reliability and validity in community-dwelling older adults. We prospectively recruited 104 community-dwelling participants with mild to moderate Alzheimer's disease (AD) and healthy controls. The T-CogS-TR was administered twice via telephone at home, first within 3 days of an in-person administration and again 4 weeks later. We observed acceptable internal consistency (Cronbach α coefficient = 0.738) and internal reliability. The test-retest reliability was excellent. The T-CogS-TR demonstrated significant correlations with Instrumental Activities of Daily Living, Mini-Mental State Examination, Clock-Drawing Test, and Clinician Dementia Rating (P's < .0001). The cutoff value of ≤22 exhibited sensitivity of 96.8%, specificity of 90.2%, positive predictive value of 93.9%, and negative predictive value of 94.9%. The T-CogS-TR can be useful as a valid and reliable tool for detecting AD in Turkish elderly patients. Also, this tool may be considered suitable for patients who need more frequent follow-up and cannot easily return to in-person visits.
TL;DR: The study suggests a novel, single procedure to diagnose sarcopenic dysphagia using the videofluoroscopic swallowing study to determine decreased swallowing muscle function in sarcopenia.
Abstract: In a recent article in the Journal of Oral Rehabilitation, Miyashita and colleagues suggested the usefulness of measuring the amount of laryngeal upward movement and pharyngeal area by the videofluoroscopic swallowing study to determine decreased swallowing muscle function in sarcopenia (1). Although a small number of patients were included making it hard to perform extensive multivariable analyses and to draw firm conclusions, the study suggests a novel, single procedure to diagnose sarcopenic dysphagia.
TL;DR: A case of an older woman with a history of AD who lost weight unintentionally because of the rivastigmine patch, which seems to help reduce those adverse effects, making it more favorable in the treatment of dementia.
Abstract: To the Editor: R ivastigmine is a centrally acting pseudoirreversible inhibitor of acetylcholinesterase (AChE) and butyrylcholinesterase used widely for symptomatic treatment of mild to moderate Alzheimer disease (AD) and Parkinson disease dementia. Long-term tolerability and safety are essential challenges in treatment with rivastigmine because of gastrointestinal (GI) adverse effects, including nausea, vomiting, anorexia, and abdominal pain. However, the rivastigmine patch form seems to help reduce those adverse effects, making it more favorable in the treatment of dementia. Massive weight loss associated with the rivastigmine patch is an uncommon and life-threatening adverse effect. Here, we report a case of an older woman with a history of AD who lost weight unintentionally because of the rivastigmine patch. “MsG”was a 75-year-old womanwho presented to the outpatient service of geriatrics clinic in September 2018 with a history of loss of appetite, fatigue, a feeling of hopelessness, and loss of interest in daily activities. She experienced feeling sick and discomfort for almost 6 months. In addition to these complaints, abdominal pain occurred for 2 months. She lost 42-lb (19 kg) gradually during this period. She started the rivastigmine patch prescribed by her neurologist for AD sinceNovember2017, and thedosage increased to 13.3mg/d (15 cm) inMarch 2018. In addition, her relatives reported that she was brought to an emergency department for nausea and fatigue a couple of times after the dosage raise of rivastigmine patch to 13.3 mg/d (15 cm). Another present medication was low-dose quetiapine (12.5 mg twice daily) for agitation associated with dementia, which was concomitantly started with rivastigmine patch and continued at the same dose since the beginning of treatment. She was not taking any other medications. Her baseline weight and body mass index obtained from medical records were 137 lb (62 kg) and 27.9 kg/cm. There was no history of smoking, alcohol, any substance abuse. Her relatives shared information on emesis and anorexia occurred at 1 month of donepezil use. The written informed consent was obtained from her primary guardian for publication of this case report.
TL;DR: In this paper, the authors found that although some increases were observed in autumn and summer, the level of physical activity in older adults was low in all seasons, however, daily energy expenditure remained constant.
Abstract: Objective: Regular physical activities contributes to better health outcomes in all stages of life. Older adults may have altered levels of exercise at different times of the year. Methods: Community-dwelling older adults (≥65 years of age) in Ankara, is the capital city of Turkey, were recruited prospectively. Physical activity status and the resting metabolic rate were assessed every three months (May, August, November, and February). Results: Overall, 31 individuals were analyzed (mean age; women: 73.9±7.0 years, men: 75.5±5.7 years; women: 65.0%). The level of physical activity was highest in autumn (44.0±41.0 min) and summer (41.0±48.0 min) but lowest in winter (24.0±19.0 min) (p<0.05). The ratio of performing regular daily exercise was highest in summer (25.8%), which decreased significantly in winter (9.7%). No statistically significant changes were noted in the total daily energy expenditure and resting metabolic energy expenditure across four seasons. Conclusion: Although some increases were observed in autumn and summer, the level of physical activity in older adults was low in all seasons. However, daily energy expenditure remained constant. The study suggests that there is a need for improvement in lifestyle behaviors of Turkish older adults to increase health-related quality of life and also to prevent adverse outcomes.
TL;DR: The authors’ rigorous statistical performance is appreciated, however, the potential of confounding of the results by systemic inflammation could be acknowledged based on the available evidence.
Abstract: Zhang et al. [1] have successfully demonstrated some differences in the metabolic profiles in polycystic ovary syndrome (PCOS) patients based on hyperandrogenism and insulin resistance. That study also offers a panel of metabolic biomarkers to distinguish between hyperandrogenism and insulin resistance in PCOS. Thus, the results contribute to the understanding of underlying mechanisms of PCOS as well as research to improve clinical management of women with PCOS [1]. However, we noticed that the authors did not include any variable of inflammation in their study. Well conducted clinical studies have shown that women with PCOS exhibit an elevation in the level of circulating markers of inflammation that is independent of obesity [2]. A causal role for the chronic inflammation in the pathogenesis of PCOS has also been postulated based on the available data. Therefore, inflammatory variables have been suggested as a necessary part of PCOS research. Several authors have also reached evidences of an association between certain metabolomics and chronic inflammation in PCOS patients, particularly the glycoproteins [3]. Moreover, changes in body composition parameters are more frequent in patients with PCOS and such changes as well as feeding behavior can cause some metabolites to differently modulate and/or participate in processes such as low grade inflammation. In conclusion, we appreciate the authors’ rigorous statistical performance, however, the potential of confounding of the results by systemic inflammation could be acknowledged based on the available evidence.