Geriatric Outpatient Clinic Research Articles

Relationship Between the Amount of Amalgam Filling and Cognition in Older Adults

Introduction: This study aimed to evaluate the relationship between dental amalgam filling and cognition in older adults. Materials and Methods: A total of 169 patients aged 65 years and above were recruited from a geriatric outpatient clinic. Their socio-demographic and chronic disease data were recorded. All patients underwent oral examinations. Amalgam filling index scores were calculated for individuals with amalgam fillings. The participants were divided into a study group [amalgam (+)] and a control group [amalgam (–)] based on their amalgam-filling statuses. For sub-analysis, the amalgam-filled group was categorised according to high (≥4.191) and low (<4.191) mean index scores. Standardised mini-mental test, clock drawing test and Lawton–Brody instrumental activities of daily living scale were conducted for all patients. Results: About 46.2% (n=78) of participants were female, mean age was 69.6 ± 6.3 years and 53.7% (n=89) had amalgam fillings. There was no significant difference in the standardised mini-mental test, clock drawing test and Lawton–Brody instrumental activities of daily living scale scores between the study and control groups (all p>0.05), or in all test scores between participants with high and low amalgam scores in the group with amalgam fillings. Conclusions: This study showed that dental amalgam fillings were not associated with cognitive decline in older adults. Keywords: Aged; Cognitive Dysfunction; Dental Amalgam.

Effects of a shared decision making intervention for older adults with multiple chronic conditions: the DICO study

BackgroundTo evaluate the effects of a shared decision making (SDM) intervention for older adults with multiple chronic conditions (MCCs).MethodsA pragmatic trial evaluated the effects of the SDMMCC intervention, existing of SDM training for nine geriatricians in two hospitals and a preparatory tool for patients. A prospective pre-intervention post-intervention multi-center clinical study was conducted in which an usual care group of older patients with MCC and their informal caregivers was included before the implementation of the intervention and a new cohort of patients and informal caregivers after the implementation of the intervention. SDM was observed using the OPTIONMCC during video-recorded consultations. Patient- and caregivers reported outcomes regarding their role in SDM, involvement, perceived SDM and decisional conflict were measured. The differences between groups regarding the level of observed SDM (OPTIONMCC) were analyzed with a mixed model analysis. Dichotomous patient-reported outcomes were analyzed with a logistic mixed model.ResultsFrom two outpatient geriatric clinics 216 patients with MCCs participated. The mean age was 77.3 years, and 56.3% of patients were female. No significant difference was found in the overall level of SDM as measured with the OPTIONMCC or in patient-reported outcomes. However, at item level the items discussing ‘goals’, ‘options’, and ‘decision making’ significantly improved after the intervention. The items discussing ‘partnership’ and ‘evaluating the decision-making process’ showed a significant decrease. Fifty-two percent of the patients completed the preparatory tool, but the results were only discussed in 12% of the consultations.ConclusionThis study provides scope for improvement of SDM in geriatrics. Engaging older adults with MCCs and informal caregivers in the decision making process should be an essential part of SDM training for geriatricians, beyond the SDM steps of explaining options, benefits and harms. More attention should be paid to the integration of preparatory work in the consultation.

Self-efficacy and Optimism in Frail Older Men Without Functional Disability Attending Geriatric Outpatient Clinic: A Case-control Study

Self-efficacy and Optimism in Frail Older Men Without Functional Disability Attending Geriatric Outpatient Clinic: A Case-control Study

The Impact of Dementia Caregiver Support Programs: Turning High-Risk Older Adult Caregivers into Models of Resilient Aging

Research has shown that spouse caregivers of people living with dementia suffer high rates of emotional and other health issues, and even a higher risk of mortality, all of which can additionally negatively impact the care of the person with dementia. However, dementia care models that incorporate caregiver support, training and resource navigation into the primary care setting improved clinical care outcomes for both individuals living with dementia and their caregivers, while lowering overall health care spending (The UCLA Alzheimer's and Dementia Care Program for Comprehensive, Coordinated, Patient-centered Care: Preliminary Data (nih.gov)).The presentation will highlight research that shows the measurable impact of dementia caregiver support in the context of research about caregiver dementia grief, stress process models of couples, and creative aging. The presentation will then give an overview of how this evidence has been translated into the various models of dementia caregiver support aimed at delivering value-based care in the Mass General Brigham (MGB) hospital system: the Dementia Care Collaborative at Massachusetts General Hospital, dementia case management in the geriatric outpatient clinic at McLean Hospital, and Mind and Memory Care Program at the MGB system level. Presenters will then bring the research to life by applying these concepts to clinical vignettes and to reflections of spouse dementia caregivers enrolled in support programs who have been able to turn the predictable story of an increasingly frail, ill-equipped, and social-isolated vulnerable caregiver into the less common but within-reach narrative of a resilient person who becomes better-connected, makes better decisions to promote their own health, who grows in competence and confidence to care for their spouse with dementia.This presentation will incorporate pragmatic skill-building approaches implemented in these programs which can be utilized by a broad range of clinicians who may encounter caregiver stress as part of the dementia care that they provide. These approaches are derived from a range of modalities – e.g., Cognitive Behavioral Therapy, Motivational Interviewing, Problem Solving Therapy, Solution-Focused Therapy – that help to uncover and highlight the strengths of older adult caregivers. For clinicians who are interested in adding services like this to their practice, the speakers will also discuss the evolving models of funding for their positions and key skills one would look for in hiring for such a position.The session will then open for audience participation.

All Mixed Up!! Challenges Faced and Lessons Learned in the Outpatient Management of Bipolar Disorder in Older Adults

This session will highlight several challenging and complicated cases of bipolar disorder treated in an outpatient geriatric psychiatry clinic. We will share our lessons learned from these clinical encounters with the assistance of Dr. Tawny Smith, a clinical psychiatric pharmacist. Dr. Garcia-Pittman will provide background information regarding bipolar disorder in older adults and lead the group discussion at the conclusion of the session. Dr. Polackal will present a case highlighting how proper recognition of mixed features lead to a new diagnosis of late life bipolar disorder. Dr. Polackal will provide guidance for accurate screening and diagnosis of mixed symptoms, focusing on how these symptoms can present differently in the geriatric patient. She will then discuss treatment, focusing on recent literature updates. Dr. Bovio will discuss a case of a patient with bipolar I disorder treated on dual therapy with valproic acid and quetiapine. Dr. Bovio will discuss management considerations when using valproic acid in older adults and the available evidence for the use of dual agents. Dr. Donley will present a clinical case highlighting the use of cariprazine in a patient with bipolar disorder. He will focus on consequences of rapid dose escalation, and review clinical pearls related to the unique mechanism, pharmacokinetics, and further treatment considerations in older adults. Dr. Good will discuss a case of a patient with newly diagnosed bipolar disorder with mixed features who achieved early remission of symptoms with lithium until experiencing lithium toxicity subsequent to a COVID-19 infection. He will review challenges associated with managing patients on lithium in a virtual outpatient clinic during the COVID-19 pandemic and discuss additional clinical factors to consider for patients on lithium who are diagnosed with COVID-19. Dr. Smith will review clinical pearls related to the cases presented. In addition, we will share knowledge regarding literature updates, as well as guidelines for treatment of the aging patient with bipolar disorder.

The impact of social isolation and loneliness on resilient older adults with remitted depressive disorders during the COVID-19 pandemic: two case studies

AuthorsCatherine Gonzalez M.D. and Nancy Donovan M.D. IntroductionSocial Isolation and loneliness (SI/L) representing objective and subjective deficits in social relationships and interactions, are important factors affecting the mental health of older adults. They are also major risk factors for cognitive decline, cardiovascular disease, and premature mortality. During the COVID-19 pandemic, instituted measures such as social distancing, stay-at-home regulations, public closures, and activity limitations, increased social isolation and loneliness for many. It is important for clinicians to recognize how SI/L contributed to worsening psychiatric symptoms during the acute pandemic, the extent to which they still persist and their potential long lasting sequelae. Method/CaseThese case presentations will highlight the impact of SI/L in two elderly patients receiving psychiatric care in an academic outpatient geriatric psychiatry clinic during the COVID-19 pandemic.The first case is a 75-year-old man with history of depression following the death of his wife who was euthymic and stable on a low dose of an SSRI since 2017. Between 2017-2020, he was active, well-functioning, attended religious services weekly, engaged in group grief counseling at his temple, took university extension classes, and visited regularly with family and friends. Due to the COVID-19 pandemic and social restriction measures, he lost all in person connections (counseling, classes, services), and stopped seeing others out of fear of infection and increasing depression. As restrictions eased, many of his former activities returned, albeit virtually but he has been struggling to reconnect, continuing to experience SI/L and depression. Symptoms have only partially improved with CBT and supportive therapy.The second case is a 77-year-old woman with a history of major depression since adulthood, well controlled on low dose SSRI and as needed sleep medication. In the fall of 2019, she had a brief recurrence of depressive symptoms in context of adult son's alcohol abuse and his need to live with her. Symptoms improved as she was active in her church, had many friends and had future trips plans to complete as part of her ‘bucket list’. In spring/summer 2020, depression relapsed as she felt isolated and unsupported during the pandemic and being a witness to son's ETOH and mental health problems without a clear treatment plan/next step. Throughout the last two years, she has been grieving the loss of her ‘pre-covid life’ and the realization that she might not complete her ‘bucket-list’ items. Furthermore, her physical health has been worsening, which has been difficult for her overall well-being. ResultsThese cases highlight the ongoing challenges of the COVID-19 pandemic, in particular its negative impact on geriatric mental health via worsening of SI/L. Even after multiple pandemic surges, vaccines and new treatments, the effects of isolation and social distancing have long lasting effects. In these two cases, high functioning and resilient older adult patients were negatively impacted by isolating public health measures during the pandemic. Recovery, while slow, has been based on re-establishing the quality and quantity of social relationships, re-engagement in meaningful activities and coming to terms with the unique stresses and losses during the pandemic.

The Association of Vitamin D Status with Mild Cognitive Impairment and Dementia Subtypes: A Cross-Sectional Analysis in Dutch Geriatric Outpatients.

Vitamin D deficiency is associated with all-cause dementia and Alzheimer's disease (AD). At the same time, this knowledge is limited specifically for vascular dementia (VaD), while data regarding other subtypes of dementia are even more limited. To investigate the association of 25-hydroxy vitamin D (25(OH)D) status with dementia subtypes in an outpatient geriatric population. In a cross-sectional design, we analyzed data from 1,758 patients of an outpatient memory clinic in The Netherlands. Cognitive disorders were diagnosed by a multidisciplinary team according to international clinical standards. At each first-visit 25(OH)D levels were measured. Data were analyzed using ANCOVA in four models with age, gender, BMI, education, alcohol, smoking, season, polypharmacy, calcium, eGFR, and glucose as co-variates. 25(OH)D was treated as a continuous square rooted (sqr) variable. In the fully adjusted model, reduced 25(OH)D serum levels (sqr) were found in AD (estimated mean 7.77±0.11 CI95% 7.55-7.99): and in VaD (estimated mean 7.60±0.16 CI95% 7.28-7.92) patients compared to no-dementia (ND) patients (estimated mean 8.27±0.09 CI95% 8.10-8.45) (ND-AD: p = 0.006, CI95% 0.08-0.92.; ND-VaD p = 0.004 CI95% 0.13-1.22). We did not find differences in 25(OH)D levels of mild cognitive impairment (MCI) or other dementia patients compared to ND patients, nor differences in comparing dementia subtypes. We observed significantly lower 25(OH)D serum levels in both AD and VaD patients compared to no-dementia patients, but no significant differences between MCI and Lewy body and mixed dementia subtypes in this cross-sectional study of a geriatric outpatient clinic population.

Evaluation of a multifaceted medication review in older patients in the outpatient setting: a before-and-after study

Background The prevalence of medication-related emergency department visits and acute hospital admissions in older patients is rising due to the ageing of the population and increasing prevalence of multimorbidity and associated polypharmacy.Aim To explore whether a combined medication review performed in the outpatient setting reduces the number of medication-related emergency department visits and hospital (re)admissions.Method All consecutive patients visiting the geriatric outpatient clinic underwent a multifaceted medication review (i.e. evaluation by at least a geriatrician, and/or pharmacist and use of clinical decision support system). Subsequently, we analysed the number of, and reason for, emergency department visits, acute hospital admissions and readmissions in the year prior to and the year following the index-date (date of first presentation and medication review).Results A multifaceted medication review reduced the number of potentially medication-related emergency department visits (38.9% vs. 19.6%, p < 0.01), although the total number of ED visits or acute hospital admissions per patient in the year before and after medication review did not differ.Conclusion A multifaceted medication review performed in the outpatient clinic reduced the number of potentially medication-related emergency department visits and could therefore reduce negative health outcomes and healthcare costs.

Changes in Place of Death of Older Adults during the COVID-19 Pandemic: A Retrospective Study from an Aging Country.

In the COVID-19 pandemic, due to the difficulties in patients' applications to health centres, changes have occurred in the places of death of older adults. It is aimed to investigate the change in the places of death of older adults in Turkey, which is one of the countries most affected by the pandemic. Patients admitted to the geriatric outpatient clinic of a university hospital from 01.01.2013 to 29.02.2020 were included. Place and date of death were recorded as hospital or out-of-hospital death. According to results, while the median age of those who died during the pandemic was higher than before (p < 0.001) and during the pandemic, the hospital mortality ratio was higher than before. During the pandemic period, the hospital mortality ratio of older adults has increased in Turkey. This situation, which has occurred despite the increasing healthcare burden, can show the importance of the measures taken and robust health infrastructure.

Integration of a pharmacist-led pharmacogenomic service in a geriatric clinic: Barriers and outcomes

ObjectivesThe primary objective was to identify the proportion of patients who successfully completed PGx testing. Secondary objectives included determining the proportion of patients with actionable PGx results, determining the proportion of patients with a baseline medication intervention within 6 months of successfully completing PGx testing, and identifying barriers for not completing testing. DesignThis was a single center, non-interventional, retrospective cohort study, approved by the institutional review board. Setting and participantsPatients included were 65 years of age or older and referred for PGx testing from geriatric outpatient clinics between May 1, 2019 and July 31, 2020. Outcome measuresThis study aimed to assess the implementation of pharmacist-led pharmacogenomics (PGx) in the care of community-dwelling older adults in an outpatient clinic. Little is known about the acceptance and impact of this type of service within this population. ResultsOf the 67 patients included, majority were female (78%), white (76%), and an average age of 78 years ± 5.98 SD. Majority were insured by Original Medicare or Medicaid (61%), had a history of cognitive impairment (84%), had a referring diagnosis of anxiety (40%) or depression (67%), and were prescribed a selective serotonin reuptake inhibitor (69%) at baseline. Majority successfully completed PGx testing (72%), with 72% having actionable PGx findings and 83% having a pharmacological intervention made thereafter. Nineteen patients did not complete testing (28%), with the primary barrier being not having an appointment scheduled (63%). ConclusionThis study demonstrated majority of older adults were accepting of PGx testing and majority of findings were relevant to clinical care of anxiety, depression, or cognitive impairment.

Serum testosterone level correlates with left ventricular hypertrophy in older women.

Sex hormones may play an important role in age-related cardiac remodeling. However, their impact on cardiac structure and function in females of advanced age still remains unclear. The aim of this study is to evaluate the relationship between sex hormones level and echocardiographic parameters in older women with concomitant cardiovascular diseases. The study group included 52 community-dwelling women with mean age 79.5 ± 2.8 years, consecutive patients of an outpatient geriatric clinic. In all the subjects, a transthoracic echocardiogram was performed and serum testosterone, estradiol, follicle-stimulating hormone, luteinising hormone, dehydroepiandrosterone sulphate, and cortisol levels were determined. Testosterone level correlated positively with interventricular septum diastolic dimension (IVSd) (rS=0.293, p<0.05), left ventricular mass index (rS=0.285, p<0.05), E/E' ratio (rS=0.301, p<0.05), and negatively with E' (rS=-0.301, p<0.05). Estradiol level showed a positive correlation with the posterior wall dimension (rS=0.28, p<0.05). Besides, no significant correlations between clinical or echocardiographic parameters and other hormones were observed. Female subjects with diagnosed left ventricular hypertrophy (LVH) (n=34) were characterized by a significantly higher rate of hypertension (p=0.011), higher waist-to-height ratio (p=0.009), higher testosterone level (0.82 vs. 0.48 nmol/L, p=0.024), higher testosterone/estradiol ratio (16.4 vs. 9.9, p=0.021), and received more anti-hypertensive drugs (p=0.030). In a multiple stepwise logistic regression, the best determinants of LVH were the presence of hypertension (OR=6.51; 95% CI 1.62-26.1), and testosterone level (OR= 6.6; 95% CI 1.19-36.6). Higher serum testosterone levels may contribute to pathological cardiac remodeling, especially in hypertensive women. Estradiol, gonadotropins, DHEAS, and cortisol were not related to echocardiographic parameters.

Sedative use and incidence of falls and hip fractures among older adults in an outpatient geriatric clinic

Objective: To investigate the use of sedatives by older adults attending a private outpatient geriatric clinic in Belo Horizonte (MG), Brazil, and its association with falls and hip fractures. Methods: Using a longitudinal design, the prevalence of benzodiazepine and nonbenzodiazepine (“z-drugs”) intake by older adults was described and their association with the incidence of falls and fractures (30 days after the initial visit) was evaluated through logistic regression. Results: A total of 7821 older adults were included in the study, most of them women (72.50%), with a mean age of 77.5 years and a mean Clinical-Functional Vulnerability Index (IVCF-20) score of 16.5. The overall prevalence of sedative use (any sedative) was 6.19%, with 4.48% benzodiazepines and 1.98% z-drugs. The most widely used sedatives were clonazepam (29.04%), zolpidem (28.65%), and alprazolam (23.44%). Falls were reported for 182 patients (2.33%), with a higher incidence among users of any sedatives (4.34; p = 0.002; OR = 1.94, adjusted for sex, age, and IVCF-20) and benzodiazepines (5.14%; p &lt; 0.001; OR = 2.28) than among non-users (2.19%). Hip fractures occurred in 33 patients (0.42%), and again were more frequent among users of sedatives (1.03%; p = 0.032; OR = 2.57) and benzodiazepines (1.43%; p = 0.003; OR = 3.45) than among non-users (0.38%). Conclusions: The use of sedatives, especially benzodiazepines, is associated with an increased incidence of falls and hip fractures in older adults.

Telehealth use and COVID-19: Assessing older veterans' perspectives.

Video telehealth (VT) technology has increased mental health treatment access for veterans. Although veterans report high levels of satisfaction with VT, age disparities remain. Older adults in the general population face several barriers to using new technology, reflecting a "digital divide" between age cohorts. This trend continued during the COVID-19 pandemic, as older veterans were less likely to use VT-and more likely to use the telephone-for mental health visits than younger veterans. Although VT use has grown considerably during the pandemic, few studies have investigated older veterans' VT use relative to telephone services. Older veterans (aged 65 +) who completed at least one telephone or VT visit in an outpatient geriatric mental health clinic during the first 6 months of COVID-19 received a telehealth satisfaction questionnaire via U.S. mail. While respondents (N = 66) reported moderate levels of satisfaction with VT and telephone appointments, there was less interest in using telehealth exclusively postpandemic. Fewer telephone users reported having access to email and internet and greater barriers to using VT. Veteran rurality was not associated with access to internet or email and did not affect telehealth ratings. Analyses of treatment engagement showed that the rate of missed appointments did not change during COVID-19. Post hoc qualitative analysis of open-ended comments revealed themes of barriers and needs, as well as positive and negative telehealth experiences that were consistent with quantitative findings. Despite experiencing barriers to using VT, older veterans identified potential benefits and solutions to enhance participation across the older adult population. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

External validation of the first prognostic nomogram for older adults with cancer.

The geriatric oncology population tends to be complex because of multimorbidity, functional and cognitive decline, malnutrition and social frailty. Prognostic indices for predicting survival of elderly cancer patients to guide treatment remain scarce. A nomogram based on all domains of the geriatric assessment was previously developed at the National Cancer Centre Singapore (NCCS) to predict overall survival (OS) in elderly cancer patients. This nomogram comprised of six variables (age, eastern cooperative oncology group performance status, disease stage, geriatric depression scale (GDS), DETERMINE nutritional index and serum albumin). To externally validate the NCCS prognostic nomogram. This is a prospective cohort study. The nomogram was developed based on a training cohort of 249 patients aged ⩾70 years who attended the NCCS outpatient geriatric oncology clinic between May 2007 and November 2010. External validation of the nomogram using the Royston and Altman approach was carried out on an independent testing cohort of 252 patients from the same clinic between July 2015 and June 2017. Model misspecification, discrimination and calibration were assessed. Median OS of the testing cohort was 3.1 years, which was significantly higher than the corresponding 1.0 year for the training cohort (log-rank p < 0.001). The nomogram achieved a high level of discrimination in the testing cohort (0.7112), comparable to the training cohort (0.7108). Predicted death probabilities were generally well calibrated with the observed death probabilities, as the joint test of calibration-in-the-large estimates at year 1, 2 and 3 from zeros and calibration slope from one was insignificant with p = 0.432. There were model misspecifications in GDS and serum albumin. This study externally validated the prognostic nomogram in an independent cohort of geriatric oncology patients. This supports the use of this nomogram in clinical practice.

Uptake of vaccination in older Indian patients with cancer: A cross-sectional observational study

ABSTRACT Export Background: Older patients with cancer are at a higher risk of invasive infections. Vaccination is an effective approach to decrease the mortality and morbidity associated with infections. Objectives: Our primary objective was to evaluate the proportion of older patients with cancer who had received routine vaccinations against pneumococcal, influenza, and coronavirus disease 2019 (COVID-19). Our secondary objective was to identify the factors associated with vaccine uptake such as age, sex, education, marital status, comorbidities, and place of residence. Materials and Methods: This cross-sectional observational study was conducted in the geriatric oncology outpatient clinic of the Department of Medical Oncology at the Tata Memorial Hospital, a tertiary care cancer hospital in Mumbai, India, from February 2020 to January 2023. We included all patients aged ≥60 years who were evaluated in the geriatric oncology clinic during the study period and for whom the immunization details were available. The uptake of COVID-19 vaccine was calculated from March 2021 onwards, which was when the COVID-19 vaccine became available to patients aged ≥60 years in India. Results: We enrolled 1762 patients; 1342 (76.2%) were male. The mean age was 68.4 (SD, 5.8) years; 795 (45%) patients were from the west zone of India. Only 12 (0.68%) patients had received the pneumococcal vaccine, and 13 (0.7%) had received the influenza vaccine. At least one dose of the COVID-19 vaccine had been taken by 1302 of 1562 patients (83.3%). On univariate logistic regression, education, marital status, geographic zone of residence, and primary tumor site were correlated with the uptake of COVID-19 vaccine. Factors associated with a greater COVID-19 vaccine uptake included education (up to Std 10 and higher vs. less than Std 10: Odds Ratio [OR], 1.46; 95% confidence interval [CI], 1.07-1.99; P = 0.018, and illiterate vs. less than Std 10: OR, 0.70; 95% CI, 0.50-0.99; P = 0.041), marital status (unmarried vs. married: OR, 0.27; 95% CI, 0.08-1.08; P = 0.046, and widow/widower vs. married: OR, 0.67; 95% CI, 0.48-0.94; P = 0.017), lung and gastrointestinal vs. head-and-neck primary tumors (lung cancer vs. head-and-neck cancer: OR, 1.60; 95% CI, 1.02–2.47; P = 0.038, and gastrointestinal vs .head-and-neck cancer: OR, 2.18; 95% CI, 1.37-3.42; P < 0.001), and place of residence (west zone vs. central India: OR, 0.34; 95% CI, 0.13-0.75; P = 0.015). Conclusion: Fewer than 1 in 100 older Indian patients with cancer receive routine immunization with influenza and pneumococcal vaccines. Hearteningly, the uptake of COVID-19 vaccination in older Indian patients with cancer is over 80%, possibly due to the global recognition of its importance during the pandemic. Similar measures as those used to increase the uptake of COVID-19 vaccines during the pandemic may be beneficial to increase the uptake of routine vaccinations (Clinical Trials Registry, India: CTRI/2020/04/024675).

Older people's perceptions of teleconsultation via telephone during the COVID-19 pandemic: a qualitative study

Objectives: In March/2020, our geriatric outpatient clinic implemented teleconsultation via telephone due to the COVID-19 pandemic. This study aimed to understand older patients’ perceptions of this experience through their narratives. Methods: A qualitative study with Thematic Oral History and thematic analysis. We conducted open-ended interviews in which older patients narrated their perceptions of this experience. Results: Twelve patients were interviewed from December/2021 to January/2022, and 2 themes emerged: older patients’ experience of teleconsultation and possibilities and challenges of telemedicine. Some patients did not identify the call as a teleconsultation. Regarding possibilities, patients reported satisfaction and convenience in specific circumstances. As for challenges, patients reported concerns about the effectiveness of communication and need for physical examination. Conclusion: Teleconsultation is well accepted, as long as situations that require face-to-face interactions are considered. Considering person-centered medicine, listening to the narratives of older people contributes to a better structuring of telemedicine services in geriatrics.

Predictors of two-year mortality in patients with dementia with Lewy bodies.

Data on adverse prognostic factors for mortality in patients with dementia with Lewy bodies (DLB) are limited. The objective of this study was to evaluate two-year mortality predictors in patients with DLB. : Individuals aged ≥ 60 years with a diagnosis of DLB, followed by a tertiary-referral geriatric outpatient clinic from 2006 to 2021, were assessed retrospectively using medical or patient records. The mortality status of the patients in the second year after diagnosis was determined. Demographic and clinical characteristics were reviewed to determine their impact on mortality prediction. A total of 108 patients with DLB participated in this study. The mean age was 78.9 ± 6.6 years, and 49.1% were females. At the end of the two-year follow-up, 23 patients (21.3%) died and 85 patients (78.7%) were still alive. Malnutrition, and cognitive and functional impairments were significantly more common in the mortality group. Age, female sex, functional impairment, moderateto-severe clinical dementia rating, and malnutrition were associated with an increased mortality risk. On the multivariable analysis, malnutrition (HR = 5.00; 95% CI: 1.64-15.24; p: 0.005) was the only independent predictor of two-year-mortality. Patients with DLB had an unfavorable survival outcomes. Approaches to prevent malnutrition can improve prognosis and reduce early mortality in this vulnerable group. However, further studies are needed to determine mortality risk factors in this population.

Assessment of clinical features and coexisting geriatric syndromes in newly diagnosed dementia with Lewy bodies: a retrospective study in a tertiary geriatrics setting in Turkey.

Identifying the associated clinical conditions in patients with newly diagnosed dementia with Lewy bodies (DLB) may contribute to the disease management. This study aimed to examine the clinical features and coexisting geriatric syndromes of patients with newly diagnosed DLB. This cross-sectional study included newly diagnosed DLB participants who were admitted to a tertiary geriatric outpatient clinic. Of the 857 patients with dementia, 116 DLB diagnoses were eligible for analysis. The core and supportive clinical features of DLB were recorded. Geriatric syndromes including polypharmacy, depression, insomnia, dependency, a history of delirium, falls, malnutrition, urinary incontinence, functional impairment, and living alone, were assessed and recorded at baseline. The mean age was 79.0 ± 6.9years, and 50.9% of the participants were female. The majority (63.8%) had mild dementia, 31.9% had moderate, and 4.3% had severe disease. Cognitive fluctuations (78.4%), visual hallucinations (77.6%), and Parkinsonism (73.3%) were the most common clinical features. Functional impairment (59.5%) and urinary incontinence (59.5%) were the leading geriatric syndromes, followed by polypharmacy (56.9%), depressive symptoms (54.7%), falls (52.6%), insomnia (49.1%), malnutrition (24.3%), and delirium (6.0%). Women had more functional impairment and depressive symptoms than men. Although most patients had mild dementia, three-quarters of the DLB cohort had hallucinations, and nearly two-thirds were functionally impaired. The proportion of other serious health conditions also increased, indicating a high comorbidity and geriatric syndrome burden. Comprehensive geriatric assessment is strongly recommended for DLB patients from the time of diagnosis until death to reduce disability and comorbidities. NCT05052450.

Prefrailty subtypes differentially predict 5-year mortality in the functionally independent geriatric population

IntroductionBoth frailty and prefrailty (PF) are related to mortality. However, there is no consensus about the PF subtypes for prediction of the mortality risk. We aimed to compare the 5-year mortality of functionally independent geriatric outpatients with nonfrailty, different PF subtypes and frailty. MethodsThis was a single-center, retrospective cohort study. Community-dwelling older adults who visited the geriatric outpatient clinic in a healthcare institution in Taiwan were enrolled. PF1 was defined based on exhaustion and/or body weight loss whereas PF2 was defined by one or two of the following criteria: weakness, slowness, and low physical activity. Frailty was defined by three or more above criteria. Demographics and results of comprehensive geriatric assessment were compared and Kaplan–Meier survival analysis was used to determine the 5-year survival among the nonfrail, PF1, PF2 and frail groups. ResultsOf the 982 participants, the proportion of PF and frailty was high (PF 45.7% and frailty 24.5%). The cumulative 5-year survival rate of the nonfrail group, PF1, PF2 subgroups and frail group was 98.6%, 95.8%, 89.1% and 81.3% respectively. Age, male sex, PF2 subtype and frailty were significantly associated with 5-year mortality [hazard ratio (95% confidence interval) 1.05 (1.01–1.08), 1.96 (1.08–3.57), 5.18 (1.57–17.09), and 6.87 (2.05–23.04), respectively]. Discussion and conclusionThe proportion of PF and frailty was high in old outpatient population with functional independence. PF2 subtypes and frailty could influence the 5-year mortality risk in these participants. Identifying PF2 participants earlier and instituting prompt intervention may be beneficial in older patients.

Validating the Centre of Excellence on Longevity Self-AdMinistered (CESAM) Questionnaire: An Online Self-Reported Tool for Frailty Assessment of Older Adults.

Subjective health measures are often used to assess frailty, but the validity of self-reported online tools to identify frailty remains to be established. We aimed to assess concurrent, known-groups, convergent and predictive validity of the Centre of Excellence on Longevity Self-AdMinistered (CESAM) questionnaire for frailty assessment of older adults in an outpatient setting. Cross-sectional analysis of 120 participants. Participants of age ≥65 were recruited from an outpatient geriatric clinic. Individuals who had severe neurological, cognitive, or motor deficits were excluded. We assessed concurrent validity with area under receiver operating characteristic curve (AUC) against the Frailty Index (FI) and Clinical Frailty Scale (CFS). We analyzed known-groups validity between CESAM scores with frailty status (CFS and FI), Modified Barthel Index (MBI), and modified Chinese Mini-Mental State Examination (mCMMSE) using 1-way analysis of variance. We evaluated convergent validity using correlations with MBI, the Lawton index, mCMMSE, and Geriatric Depression Scale (GDS). Associations between CESAM-identified frailty for clinician-diagnosed geriatric syndromes, and health-related quality of life (HRQoL) was analyzed using regression analysis. The CESAM questionnaire demonstrated excellent diagnostic performance for frailty using FI ≥0.25 (AUC= 0.88; 95% CI: 0.82-0.94; P < .001) and CFS ≥4 (AUC= 0.78; 95% CI: 0.68-0.88; P < .001). CESAM scores increased significantly with increasing frailty (both CFS and FI), lower MBI, and lower mCMMSE scores (all P < .001), indicating concurrent validity. The moderate-good correlation of CESAM scores with MBI (r=-0.61; P < 0.001), Lawton Index (r=-0.54; P < .001), mCMMSE (r=-0.53; P < .001) and GDS (r= 0.58; P < .001) supports convergent validity. Using a cutoff of ≥8 for frailty identification, CESAM-identified frailty was associated with cognitive impairment (OR= 3.7; 95% CI: 1.7-8.2; P= .001) depression (OR= 4.0; 95% CI: 1.7-9.6; P= .002), falls (OR= 3.1; 95% CI: 1.2-8.2; P= .021) and poorer HRQoL (β=-0.1; 95% CI:-0.2 to-0.02; P= .017). Our results support the validity of an online self-reported tool to identify frailty and geriatric syndromes in an outpatient setting, an approach that is potentially applicable for remote screening of frailty.