Common Geriatric Syndromes Research Articles

THE FALL IN THE GERIATRIC POPULATION: EPIDEMIOLOGY AND PREVENTION

The article discusses the fall as a significant public health problem. According to the World Health Organization, approximately 37.3 million cases of medically related falls occur each year. Human age is one of the major risk factors. Along with the "aging" trend of the society, the number of elderly people is increasing. Consequently, the number of falls and traumatic injuries caused by it increases for this quota.In developed countries, special attention is paid to studying the epidemiological characteristics of the fall in the population aged 65 and older. Such attention is that it is possible to plan and implement various preventive measures specifically for the target group and develop relevant recommendations to improve quality of life.The fall is one of the most common geriatric syndromes that threatens the independent lifestyle of older people and is related not only to medical but also social and economic aspects. However, epidemiological data of the fall are not properly studied in developing countries, including Georgia.Therefore, to reduce the traumatic injuries caused by falls in Georgia, it is essential to conduct appropriate epidemiological studies, identify the most critical risk factors, raise public awareness, and develop and implement appropriate preventive measures.

Loneliness and physical function impairment: Perceived health status as an effect modifier in community-dwelling older adults in Ghana

BackgroundAlthough loneliness and physical function impairment (PFI) are common geriatric syndromes and public health issues, little is known about how their associations vary via self-perception of health. We examine how loneliness is associated with PFI, and whether the association is modified by perceived health status. MethodsWe conducted a cross-sectional analysis of 1201 adults aged ≥ 50 years from the Aging, Health, Psychological Well-being and Health Seeking Behavior Study (AgeHeaPsyWel–HeaSeeB) in Ghana. We assessed loneliness using the three-item short-form of the UCLA Loneliness Scale, and PFI was measured with a seven-item scale on mobility-related deficiencies. Adjusted logistic regressions and moderation analysis evaluated the hypothesized associations. ResultsThe prevalence of moderate, severe loneliness, and PFI were 37.5%, 17.7%, and 36.1%, respectively. Regressions showed that loneliness was associated with a 23% increased risk of PFI after adjusting for several potential confounders (OR = 1.23; 95%CI = 1.03–2.81). PFI sub-types revealed similar risks. The loneliness-PFI association was significantly moderated by perceived health status such that a positive health perception attenuated the effect of loneliness on PFI (OR = 0.46, 95%CI = 0.23–0.90). ConclusionsIndividuals who were lonely had significantly higher odds for PFI but the effect was tempered by perceived health status. Social policy and public health practices for healthy aging should address loneliness and negative health perception among older people.

Optimizing voice-controlled intelligent personal assistants for use by home-bound older adults.

Social isolation is a major public health concern, as isolated individuals are at increased risk of poor overall health, as well as at increased risk of unhealthy behaviors. During the COVID-19 pandemic, social distancing strategies have led to increased rates of loneliness and social isolation. There is a clear need for strategies to mitigate the effects of social isolation and loneliness on the mental and physical health of older adults. In this study, we sought to better understand how voice-controlled intelligent personal assistants (VIPAs) could be leveraged to reduce loneliness and social isolation among home-bound older adults. Patients and geriatric experts were recruited to use VIPA devices (Google Home) in their homes for 4 weeks and then provide feedback. No prior training was provided. Geriatric experts were recruited via email solicitation from the Northwestern Medicine Geriatrics Clinic, and patients were solicited directly from geriatric primary care physicians. The investigators used qualitative analysis to identify codes and overarching themes. A total of 288 comments were received from 16 participants. Eight major themes were identified: Administrative, Companionship, Home Control, Education, Emergencies, Entertainment, Health and Well-Being, and Reminders. Results demonstrate that VIPAs can be useful across multiple domains and potentially play a role in providing physical, social, and cognitive stimulation to home-bound older adults. VIPAs have a wide range of functionality, many of which could be implemented to focus on common geriatric syndromes and may ultimately be a tool to help mitigate social isolation and the consequential loneliness.

P.0671 The role of intranasal ketamine in treatment-resistant depression

To compare the prevalence of cognitive dysfunction, depression, lower mobility performance, disability and falls in older community-dwelling individuals with type 2 diabetes mellitus (T2DM) and in controls of similar age.We conducted a cross-sectional study in primary health care settings in 3 semi-urban regions in Greece. Were assessed 403 community-dwelling older persons (age ≥65 years, median: 73), 198 with and 205 without diabetes. Common geriatric syndromes were studied using structured individual interviews and widely-used screening scales. An ensuing secondary analysis per age group was performed.After adjusting for several confounding factors, the diabetes group presented a 2-fold greater odds of having abnormal scores in Mini Mental State Examination (95%CI: 1.2–3.4, p = 0.006), a 1.5-fold greater odds of abnormal performance in the Clock Drawing Test (95%CI: 1.0–2.4, p = 0.05) and a 2-fold greater odds of slower performance in Timed-Up-And-Go test (95%CI: 1.1–3.4, p = 0.022). In the analysis per age group, impaired cognitive and mobility performances were observed in individuals with diabetes of the younger subgroup (65–74 years), while in the older subgroup (≥75 years), those differences disappeared.In a community-dwelling population aged ≥65 years, cognitive and physical fragilisation is more frequent and is observed at an earlier age in individuals with T2DM than in those without.

Selección de lo mejor del año 2021 en cardiología geriátrica

In this text we review some of the main studies related to the diagnosis and treatment of the most prevalent cardiovascular diseases in older patients published during the last year, also highlighting the importance of adequate prevention, both primary and secondary. Similarly, prevalent entities such as ischemic heart disease, atrial fibrillation or heart failure, among others, deserve special attention, as well as the role of cardiac rehabilitation in older patients, given its benefits and prognostic impact regarding it addresses to a large extent some of the common geriatric syndromes in this population. Finally, we review some important aspects in the current COVID-19 pandemic and some of the works led by the Geriatric Cardiology Section of the Spanish Society of Cardiology.

Effect of Poor Nutritional Status and Comorbidities on the Occurrence and Outcome of Pneumonia in Elderly Adults.

Background: Malnutrition and comorbidity are two common geriatric syndromes. The pathology of pneumonia is multifactorial, making its diagnosis and management a great challenge. Hospital-acquired pneumonia (HAP) and community-acquired pneumonia (CAP) are two main types of pneumonia. However, the effect of geriatric syndromes on pneumonia and its prognosis have not been clearly explored.Methods: We collected the relevant electronic data of inpatients aged over 65 years and diagnosed with pneumonia in the Geriatrics Department Building of the First Affiliated Hospital with Nanjing Medical University between December 2018 and December 2019, and further divided them into HAP group and CAP group. The correlations of age, age-adjusted Charlson Comorbidity Index (aCCI), basic diseases and nutritional indexes (i.e., albumin, electrolyte, hemoglobin) with pneumonia and prognosis were analyzed. We analyzed the associations between infection prognosis/infection level and age, nutritional status, aCCI and underlying diseases, using linear regression model. The box plot was applied to present infection outcome, and the nomogram was built for predicting infection outcomes. We utilized the heat map to show the associations between nutritional status and infection level/outcome in all infected patients, HAP, and CAP.Results: The final study comprised samples of 669 pneumonia patients divided into HAP group (n = 517) and CAP group (n = 152). In all patients, the infection outcome was negatively correlated with age (P = 0.013). The level of albumin was negatively correlated with infection prognosis in all patients (P = 0.03), and negatively correlated with neutrophil count and CRP (P = 0.008, P < 0.001). ACCI was positively correlated with CRP (P = 0.003). The prognosis was negatively associated with age and albumin level. In the patients with basic dementia/Alzheimer's disease and chronic obstructive pulmonary disease/asthma, the prognosis was worse.Conclusion: There was a correlation between poor nutritional status-related indexes and inflammatory indexes. A poor nutritional status might predict a high risk of pneumonia in elderly adults. Advanced age and comorbidities were risk factors for the occurrence and poor prognosis of pneumonia. Therefore, comorbidities should be well-treated in the elderly with pneumonia.

Особливості лікування цукрового діабету 2-го типу у людей похилого віку

Цукровий діабет (ЦД) стає однією з найпоширеніших проблем людей похилого віку. Поширеність ЦД у всьому світі серед людей старше 65 років у 2017 році становила 123 мільйони осіб. Очікується, що в 2045 році чисельність таких хворих подвоїться. У літніх пацієнтів із ЦД виявляється підвищений ризик розвит­ку загальних геріатричних синдромів, зокрема слабко­сті, когнітивних порушень і деменції, нетримання сечі, травматичних захворювань, падінь і переломів, інвалідності, побічних ефектів поліпрагмазії, що мають неабиякий вплив на якість життя і можуть знизити ефективність лікування цукрового діабету. У цьому аналітичному огляді літератури розглянуто глікемічні мішені, а також кращі варіанти лікування людей похилого віку з ЦД 2-го типу на підставі сучасних міжнародних рекомендацій.

Elderly patients with cognitive impairments on an ambulance care

BACKGROUND: Cognitive impairment is one of the most common geriatric syndromes that occur in the elderly. Dementia is a severe cognitive disorder that results in the professional, social, and functional impairment and gradual loss of independence. However, in most cases, the stage of dementia is preceded by a long period of non-dementia cognitive impairment. In this regard, one of the priorities of public health is to identify potentially reversible forms of dementia and cognitive impairment in the early stages.&#x0D; AIM: To assess demographic characteristics, co-morbidities and factors that are associated with cognitive impairment in adults aged 65 years and over and to determine the prevalence of cognitive disorders in aging population.&#x0D; MATERIALS AND METHODS: cross-sectional study included all patients aged 65 years and older who attended the ambulance care from 24.10.2019 to 15.12.2019 in Saint Petersburg. Measurements: the Montreal cognitive assessment test, the 15-item Geriatric Depression Scale. Data collection included a full medical history, blood pressure measurement, a medication review and blood tests (complete blood count, lipids, hormones, glucose, ALT, AST and creatinine).&#x0D; RESULTS: The prevalence of mild cognitive impairment was 62.9 % (95 % CI 56-70), severe cognitive impairment 8.2 %. We detected that hypertension, stroke, sleep disorders, subjective memory complaints and symptoms of depression were identified as factors associated with CI after adjustment for covariates. Hypertension and depression were related with cognitive impairment (p 0.05). Also patients with depression scored worse in global cognition and attention function (p 0.05). Patients with diabetes had association with a decrease in abstraction function (p = 0.02). Low hemoglobin levels were related with poor global cognition and memory impairment (p 0.01). Beta-blocker use was significantly associated with poor global cognition and memory impairment (p 0.01).&#x0D; CONCLUSIONS: We found that elders have a high prevalence of cognitive disorders. We also demonstrated association between co-morbidities and factors as hypertension, anemia, diabetes, depression and administration of beta-blockers with poor cognitive performance in the elderly.

The Effect of Different Exercise Training Types on Functionality in Older Fallers

Background: Fall is one of the most common geriatric syndromes in the elderly population. It is important to determine the most effective exercise training in elderly individuals who are at risk of falling. Aim: To investigate the effects of different exercise trainings on functionality in older fallers. Method: A total of 30 older adults, 16 females and 14 males, were enrolled in this randomized controlled trial. The older adults were divided into 3 groups: vestibular exercise (VE), posturography balance exercise (PBE), and square step exercise (SSE) groups. All groups received VE training. Sensory Organization Test (SOT), Adaptation Test (ADT), Fall Efficacy Scale (FES), Montreal Cognitive Assessment (MoCA), Vestibular Disorders Activities of Daily Life Scale (VADL), and the World Health Organization Quality of Life Scale–Older Adults Module (WHOQOL-Old) were administered before and at the end of the 24 training sessions. Results: The MoCA and the composite balance score of the SOT were improved in the PBE and SSE groups and the FES in all groups. According to multiple comparison analyses, toes up in the VE and PBE groups, toes down of the ADT in the PBE group, VADL in the PBE and SSE groups, the WHOQOL-Old in all groups significantly improved (P &lt; .010). Conclusion: VE training alone is not sufficient for older fallers. A combination of PBE and SSE training, which was applied 3 times a week for 8 weeks, was more effective in improving functionality in older fallers.

The frequency and influencing factors of common geriatric syndromes in hospitalized patients

Background: Geriatric syndromes affect the quality of life of older adults and pose a heavy burden on society and families. Comprehensive geriatric assessment (CGA) is a multi-dimensional diagnotic process including medical assessment, physical function assessment, cognitive and psychological function assessment, social/environmental factors assessment. Objective: This study investigated ten common geriatric syndromes by CGA in hospitalized patients and aimed to provide guidance for the comprehensive management of senile patients. Methods: A cross-sectional study was conducted with 376 older inpatients from two tertiary hospitals in Chengdu, China. The survey contained ten geriatric syndromes, including daily living capacity, swallowing disorders, polypharmacy, comorbidities, chronic pain, malnutrition, falls, urinary incontinence, chronic constipation, and pressure sore. Frequency and influencing factors of these geriatric syndromes were assessed by CGA. Results: The highest prevalence of CGA in this study was functional independence which accounted for 89.10% of the 376 patients, followed by malnutrition risk (69.68%), chronic pain (68.09%), polypharmacy(65.16%), chronic constipation(51.60%),urinary incontinence (40.96%). Risk of falls accounted for 35.11% of the total, which was similar to the pressure ulcers risk (33.51%). 13.83% had dysphagia. Only 3.72% of all the patients had comorbidities. There were significant differences in the prevalence of chronic pain and high risk of falls between men and women (P <0.05). There were statistic differences in the prevalence of polypharmacy, chronic pain, high risk of falls, urinary incontinence, and constipation among elderly patients of different ages (P <0.05). Multiple regression analysis showed that the age was the most important factor for geriatric syndromes. Besides, gender, exercise, diet, smoking, economy, culture, marriage, living condition and medical payment were also the influencing factors of geriatric syndromes. Conclusions: Geriatric syndromes were common in China elderly inpatients and age is the most important influencing factor.

Navigating the Treacherous Waters of Geriatric Complexity and Heterogeneity With the Help of Team Science

Multifactorial complexity and heterogeneity challenge the care of older adults and research into the pathophysiology of common geriatric syndromes. Multicomponent interventions matching intervention components with individual risk factors are grounded in precision medicine by ensuring that interventions may be offered to those who will more likely benefit, sparing expense and side effects for those who will not. Nonetheless, the development of mechanism-guided interventions has been hampered by failure to identify single mechanisms for effective targeting within this multifactorial complexity, a problem worsened by historical barriers between research disciplines and silos. Geroscience-guided interventions target biological hallmarks of aging representing mechanisms that geriatric syndromes share with aging. We will present examples of multidisciplinary bench-to-bedside translational science seeking to transform the care of common geriatric conditions as diverse as frailty, voiding disorders and immunization against influenza and pneumococcal infections via geroscience-guided therapies applied with a greater emphasis on heterogeneity of aging and targeting.

Lower-caloric intake but different nutrient profiles in cognition impaired and in frail elderlies

Abstract Background Frailty and dementia are two common geriatric syndromes associated with poor nutritional status. The nutritional role in the pathogenesis of frailty and dementia remains unclear. We examined the associations between energy intake and frailty/cognition impairment and also compared the nutrient intake between frail and cognition impaired elderlies by sex. Methods Data of 1,920 elderly adults (≧65y) from the 2014-2017 Nutrition and Health Survey in Taiwan was used. Frailty was defined using modified L. Fried criteria. The Chinese Mini-Mental State Examination score was grouped into tertiles: cognitive impairment (score ≦ 23), mild cognitive impairment (score = 24-27), and the normal (score ≧28). Total energy intake was grouped into tertiles. Logistic regression adjusted for age, sex, and sampling strata was used for association test. The trend test was performed using generalized linear model with age adjustment to examine whether various nutrient intake indicators had an ordered relationship with the severity of frailty and cognitive impairment. Results Lower energy intake (men &amp;lt;1540 Kcal or women&amp;lt;1182 Kcal) was significantly associated with frailty (odds ratio [OR]: 1.97; 95% confidence interval [CI]: 1.45-2.66) and cognition impairment (OR: 1.88; 95%CI: 1.43-2.47), respectively. Larger number of micronutrients and food substances per Kg body weight exhibited decreasing trends with MCI (protein, fat, carbohydrate, vitamins B1, B2, B3, B6, B12, C, E, Ca, P, Fe, Mg, K, Zn, dietary fiber, and cholesterol) than with frailty (protein, vitamin B1, B3, B6, C, P, Mg, K, Zn, polyunsaturated fatty acids, and dietary fiber). Conclusions The lower the energy intake, the higher the odds ratio for frailty and for dementia. Dietary quality expressed by nutrient intake per Kg body weight was poorer in elderlies with cognition impairment than those with frailty. Key messages Lower energy intake is associated with MCI and with frailty, respectively. The MCI elderlies involve more micronutrient deficiencies than the frail counterpart.

Elderly Patients in the Intensive Care Unit.

Very old intensive care unit (ICU) patients, aged ≥ 80 years, are by no mean newcomers, but during the last decades their impact on ICU admissions has grown in parallel with the increase in the number of elderly persons in the community. Hence, from being a "rarity," they have now become common and constitute one of the largest subgroups within intensive care, and may easily be the largest group in 20 years and make up 30 to 40% of all ICU admissions. Obviously, they are not admitted because they are old but because they are with various diseases and problems like any other ICU patient. However, their age and the presence of common geriatric syndromes such as frailty, cognitive decline, reduced activity of daily life, and several comorbid conditions makes this group particularly challenging, with a high mortality rate. In this review, we will highlight aspects of current and future epidemiology and current knowledge on outcomes, and describe the effects of the aforementioned geriatric syndromes. The major challenge for the coming decades will be the question of whom to treat and the quest for better triage criteria not based on age alone. Challenges with the level of care during the ICU stay will also be discussed. A stronger relationship with geriatricians should be promoted to create a better and more holistic care and aftercare for survivors.

Diabetes Mellitus in the Elderly

Prevalence of type 2 diabetes is expected to increase gradually with prolongation life expectancy. In a study conducted in the United States, it is found that the prevalence of type 2 diabetes increased from 16% to 23% between 1995 and 2004 [1]. According to current data, in the United States, among adults over 65 years of age 22% to 33% are diagnosed with diabetes. Older individuals with diabetes have higher rates of premature death, functional disability, accelerated muscle loss and coexisting illness, such as HTN, CAD, and stroke, compared to non-diabetic individuals. Elderly with diabetes also are at greater risk for several common geriatric syndromes, such as polypharmacy, cognitive impairment, urinary incontinence, falls, persistent pain, depression, and sarcopenia. These conditions may adversely affect older adult’s diabetes self-management [2].

Factors associated with health-related quality of life in community-dwelling elderly people in China.

Few studies have comprehensively evaluated the factors associated with health-related quality of life (HRQOL) in the elderly. The purpose of the study is to identify the factors associated with HRQOL using a comprehensive geriatric assessment of community-dwelling elderly people in Beijing, China. A cross-sectional survey of 896 community-dwelling elderly people in Beijing was conducted through face-to-face interviews. Data regarding sociodemographic factors, chronic disease (assessed by the Cumulative Illness Rating Scale for Geriatrics, CIRS-G), common geriatric syndromes and HRQOL (assessed by the EuroQol 5-Dimension questionnaire, EQ-5D) were collected using a structured questionnaire. Binary logistic regression analysis was used to identify the factors related to HRQOL. The CIRS-G comorbidity index was negatively related to the EQ-5D index and EQ-Visual Analog Scale (VAS) (P < 0.05). Geriatric syndromes such as chronic pain and non-optimal nutrition were negatively related to HRQOL (P < 0.05), and the negative influence of geriatric syndromes on the EQ-5D index was stronger than that of the cumulative comorbidities. Functional status in daily living activities was positively related to HRQOL (P < 0.05). Receiving care from children was positively related to EQ-VAS (P < 0.05). Besides cumulative comorbidities and geriatric syndromes, in particular nutritional problems and chronic pain exert a substantial negative impact on the HRQOL of elderly people in China, whereas family support is an important protective factor. Geriatr Gerontol Int 2020; 20: 422-429.

Adherence to recommended practices for perioperative anesthesia care for older adults among US anesthesiologists: results from the ASA Committee on Geriatric Anesthesia-Perioperative Brain Health Initiative ASA member survey

BackgroundWhile specific practices for perioperative care of older adults have been recommended, little is known regarding adherence by US physician anesthesiologists to such practices. To address this gap in knowledge, the ASA Committee on Geriatric Anesthesia and the ASA Perioperative Brain Health Initiative undertook a survey of ASA members to characterize current practices related to perioperative care of older adults.MethodsWe administered a web-based questionnaire with items assessing the proportion of practice focused on delivery of care to older adults, adherence to recommended practices for older surgical patients, resource needs to improve care, and practice characteristics.ResultsResponses were collected between May 24, 2018, and June 29, 2018. A total of 25,587 ASA members were invited to participate, and 1737 answered at least one item (6.8%). 96.4% of respondents reported that they had cared for a patient aged 65 or older within the last year. 47.1% of respondents (95% confidence interval, 44.6%, 49.7%) reported using multimodal analgesia among patients aged 65 and older at least 90% of the time, and 25.5% (95% CI, 23.3%, 27.7%) provided preoperative information regarding postoperative cognitive changes at least 90% of the time. Over 80% of respondents reported that preoperative screening for frailty or dementia, postoperative screening for delirium, and preoperative geriatric consultation occurred in fewer than 10% of cases. Development of practice guidelines for geriatric anesthesia care and expansion of web-based resources were most frequently prioritized by respondents as initiatives to improve care in this domain.DiscussionMost survey respondents reported providing anesthesia care to older adults, but adherence to recommended practices varied across the six items assessed. Reported rates of screening for common geriatric syndromes, such as frailty, delirium, and dementia, were low among survey respondents. Respondents identified multiple opportunities for ASA initiatives to support efforts to improve care for older surgical patients.

Geriatric syndromes in an urban elderly population in Cameroon: a focus on disability, sarcopenia and cognitive impairment.

Introductiongeriatric syndromes are multifactorial conditions that are associated with substantial disability, poor quality of life and mortality in the elderly. The patterns of these conditions are poorly described in sub-Saharan Africa. This study aimed to determine the prevalence and correlates of common geriatric syndromes in Cameroon.Methodswe conducted a cross-sectional study in the geriatrics unit of a university hospital in Cameroon. All people aged ≥55 who attended a health promotion and screening campaign in September 2019 were included. Geriatric syndromes including functional decline, cognitive impairment and sarcopenia were assessed. We also examined sociodemographic characteristics and comorbidities.Resultsoverall, 104 participants were enrolled with median age of 65 (IQR: 62.2 - 70.8). About 67% of participants presented at least one geriatric syndrome. Disability in activities of daily living and instrumental activities of daily living were present in 10% and 38% of participants respectively and associated factors were male gender (OR 4.7, p=0.005), age 75 and above (OR 5.7, p=0.027), osteoarthritis (OR 3.3, p=0.055) and polypharmacy (OR 7.7, p=0.012). Sarcopenia occurs in 26% with female gender (OR 3.1, p=0.029) and SARC-F ≥4 (OR 4.9, p=0.002) as associated factors. Cognitive impairment was present in 20% of participants and associated with illiteracy (p=0.008).Conclusionour study shows a high prevalence of geriatric syndromes in older adults in an urban area. Geriatric principles and frailty awareness should be considered in clinical care of older adults in our setting.

P2542Adherence to the 2016–2018 ESC guidelines for stroke prevention in atrial fibrillation: an Italian field practice in a cohort of geriatric patients

Abstract Background The 2016 and 2018 ESC guidelines for stroke prevention in atrial fibrillation (AF) recommend the use of non-vitamin K antagonist oral anticoagulants (NOACs) in all AF patients except for the EHRA type 1, for which remains the indication to vitamin K antagonist oral anticoagulants (VKAs). Purpose To evaluate the adherence to the ESC guidelines in the management of anticoagulant therapy (OAC) in the prevention of cardioembolism in geriatric (age ≥65) AF patients at 3 medical-geriatric inpatient wards of the Sant'Orsola Hospital in Bologna (Emilia Romagna region, Italy). Methods Between April 1st and October 1st 2018, 138 consecutive AF inpatients were prospectively enrolled at the start or at the change or at the interruption of the OAC. Results The main characteristics of the cohort were: mean age 84,6 years (range 65–102), M/F = 64/74, mean Charlson score 4,4, mean ADL/IADL 3,45/2,01 and mean CHA2DS2VASc/ HAS-BLED scores 5/3. Thirty-eight percent (N=52) of patients needed walking aids. Polypharmacy (intake of ≥5 drugs) was present in 31,9% (N=44) of patients and anemia in 50% (N=69: acute 6,5%, chronic 34,8%, mixed 8,7%). Half of the patients (N=69) presented new onset AF. Only 68% of patients (N=47) with known AF (N=69) were in OAC (37,6% in VKAs and 30,4% in NOACs). At the admission, the mean INR of AF in VKAs was 3,53 (range 1,54–10). The hospital decision on the anticoagulation in 91 patients (22 with known AF not in OAC at home, and 69 with new-onset AF), defined as “naïve” to OAC, was evaluated: 26,3% (N=24) started NOACs, 45% (N=41)VKAs, 8,7% (N=8) anticoagulant low molecular weight heparin (EBPM), and 20% (N=18) didn't start OAC. The decision was supported by consultant cardiologists and/or angiologists in 72,5% of cases (N=66). The choice of the VKAs was mainly due to chronic kidney disease (CKD) and acute kidney failure. Patients who started NOACs were significantly younger than those who started VKAs (age: 78,2 vs 86,5; p&lt;0.001) and had a better preserved renal function (Cockroft-Gault GFR: 69,6 vs 48,1 ml/min; p&lt;0.001). However, the mean GFR of VKAs patients was clearly above the lower limit set by the guidelines. The main causes of the switching between NOACs and VKAs (N=14, 10,1%) were stroke-TIA occurrence (N=7, 57,1%) and CKD (N=4, 28,5%). OAC was definitively interrupted (N=31, 22,4%) mostly for severe clinical conditions (N=16, 51,6%) and anemia (N=7, 22,5%). Conclusions In this “real life” cohort the deviation from the ESC guidelines was 52%. According to the guidelines only 11 (26,8%) of the patients who started VKAs would have been excluded from treatment with NOACs. Our experience underlines the presence of “fear” in the use of NOACs in geriatric patients, in particular with CKD. Probably it's worth to question if the current guidelines provide reliable indications regarding the safety and manageability of the NOACs in the presence of the most common geriatric syndromes.

Screening Value of Social Frailty and Its Association with Physical Frailty and Disability in Community-Dwelling Older Koreans: Aging Study of PyeongChang Rural Area.

Population aging is a challenge, therefore efficient frailty screening has been increasingly emphasized for mass older populations. This study aimed to evaluate the prevalence of social frailty and its association with physical frailty, geriatric syndromes and activity of daily living (ADL) disability in community-dwelling older adults. A cross-sectional study was conducted with 408 older adults (mean age, 75 years; 58% female) in the Aging Study of PyeongChang Rural Area. A five-item social frailty index was administered (range: 0–5); (1) going out less frequently; (2) rarely visiting the homes of friends; (3) feeling unhelpful to friends and family; (4) being alone; and (5) not talking with someone every day. Social frailty was defined as ≥2 positive responses. Physical frailty was assessed according to the Cardiovascular Health Study frailty phenotype criteria. We used logistic regression to examine whether social frailty can identify older adults with common geriatric syndromes including ADL disability, independently of age, gender, and physical frailty. Social frailty was present in 20.5% (14.5% in male and 25.0% in female) and 11.5% was not overlapped with physical frailty. Social frailty increased risk of ADL disability (odds ratio, 2.53; 95% confidence interval, 1.26–5.09) and depressed mood (odds ratio, 4.01; 95% confidence interval, 1.30–12.39) independently of age, gender, and physical frailty. The predictive power for disability was maximized by using both frailty indices (C statistic 0.73) compared with either frailty index alone (C statistic: 0.71 for social frailty and 0.68 for physical frailty). Social frailty screening is important as it can identify frail older adults who are not captured by demographic characteristics and physical frailty. Moreover, assessment of both social frailty and physical frailty can better detect disability and geriatric syndromes.

Nocturia and its clinical implications in older women

The aim of this study is to demonstrate the relationship between nocturia and geriatric syndromes, and comprehensive geriatric assessment parameters (CGA) in older women. 858 older outpatient women were included in this cross-sectional study. For the nocturia variable, the question, “Generally, during the past 30 days, how many times did you usually urinate after you have gone to sleep at night until the time you got up in the morning?’’ was used. The relationships between nocturia status and common geriatric syndromes, and CGA parameters were determined. The mean age of patients was 74.1 ± 8.0 years. The prevalence of patients who reported average of 0, ≥1, ≥2, ≥3, and ≥4 nocturnal episodes was 14.7%, 85.3%, 66.3%, 42.13%, and 24.1%, respectively. When all the covariates including age, education, Charlson Comorbidities Index score, glomerular filtration rate, antimuscarinic drugs and alpha-blockers use, diabetes mellitus, chronic obstructive pulmonary disease, and incontinence were adjusted, there were higher rates of insomnia, recurrent falls and higher scores of Timed Up-Go test in older women with ≥2 nocturia episodes (p < 0.05). There was a significant correlation between ≥3 nocturia episodes and lower Instrumental Activities of Daily Living scores and a significant correlation between ≥4 nocturnal episodes and frailty and polypharmacy (p < 0.05). Nocturia is quite common and associated with insomnia, frailty, polypharmacy, incontinence, falls, lower gait speed, and functionality in older women.Therefore, nocturia is very important for geriatric practice and ≥2 nocturia episodes can be a marker of poor health status in older women.