Syndromes In Older Adults Research Articles

Prevalence of geriatric syndromes and associated factors in Iranian older adults with type 2 diabetes: A population-based correlational study

Background & Aim: Geriatric syndromes are known as a major obstacle in the treatment and care of older adults with diabetes. This study aimed to determine the prevalence of geriatric syndromes and associated factors in community-dwelling older adults with diabetes in the south of Tehran, Iran, in 2022.
 Methods & Materials: A population-based correlational study was conducted among 392 older adults with diabetes, covered by selected health centers in the south of Tehran, Iran, using the multistage sampling method. Persian forms of geriatric assessment tools were used, including Mini-Mental State Examination, Activities of Daily Living, Instrumental Activities of Daily Living, Mini Nutritional Assessment, and Geriatric Depression Scale. The obtained data were analyzed by descriptive and chi-square test in SPSS-26.
 Results: The mean age of the participants was 69.5±6 years (63% female, 37% male). About 54.6% of the older adults with diabetes studied had three or more Geriatric syndromes. Polypharmacy was the most prevalent geriatric syndrome (76.5%). The number of geriatric syndromes had a significant association with female gender (p<0.001), lower education (p<0.001), loss of the spouse (p= 0.004), and lower-income (p=0.019). Also, with the increase in the number of diabetes comorbidities, the occurrence of all geriatric syndromes increased significantly (p<0.001).
 Conclusion: The prevalence of geriatric syndromes in older adults with diabetes in the south of Tehran is very high and warning. Due to the increasing population of older adults in Iran, policymakers and healthcare providers should take appropriate actions to confront the issue with a comprehensive understanding of the present condition.

Association between Telomere Length and Geriatric Status in Centenarians

Aim. To evaluate the association between telomere length and frailty and individual geriatric syndromes in older adults. Materials and methods. The database of a hundred-year-old citizen of the city of Moscow was analyzed. The analysis was carried out using the data driven from the Comprehensive Geriatric Assessment (CGA), in particular, Age is not a Hindrance Scale, the Barthel index, Instrumental Activities of Daily Living (IADL), Mini Nutritional Assessment (MNA), Mini-Mental State Examination (MMSE), and Geriatric Depression Scale (GDS-15). DNA was isolated from frozen blood and a study of telomere length was performed. The comparison of telomere length in groups of patients with frailty and individual geriatric syndromes was carried out. Results. The study involved 60 people (98±1.8 years, 86.7% women). The analysis found no differences in telomere length in study participants with and without frailty, as well as in the analysis of individual geriatric syndromes. No correlation was found between telomere length and the results of comprehensive geriatric assessment scales. There was no difference in telomere length in patients who died within 3 years of follow-up and no. Conclusion. No relationship was found between telomere length and frailty. Thus, telomere length cannot be considered as a reliable biomarker of functional aging.

Is laryngopharyngeal reflux symptom index correlated with geriatric syndromes in older adults?

Is laryngopharyngeal reflux symptom index correlated with geriatric syndromes in older adults?

Recurrent lower urinary tract infections: more than an infection for older women.

Older adults tend to have more urinary tract infections (UTIs). The frequency of recurrent lower urinary tract infections (rLUTIs) increases with age. rLUTIs are associated with long-term chronic effects on geriatric syndromes in older adults. We aimed to investigate possible risk factors that influence rLUTIs in older adults based on comprehensive geriatric assessment (CGA). This cross-sectional study included 235 older adults admitted to Gaziantep University's Geriatric Outpatient Clinic between June 1 and November 30, 2022. All patients underwent CGA. The Geriatric Depression Scale (GDS), the European Quality of Life-Five Dimension (EQ-5D) questionnaire, the Pittsburgh Sleep Quality Index (PSQI), the Katz Index of Activities of Daily Living (ADL), the Lawton and Brody Index of Instrumental Activities of Daily Living (IADL), and the Mini Nutritional Assessment (MNA) tool were,administered. Handgrip strength (HGS) and gait speed were also measured, and the number of falls in the last year was recorded. The mean age of the participants was 72.8 ± 6.8 years and 61.3% were female. Sixty-four patients had rLUTIs. The rLUTI group had higher frequencies of sarcopenia, hypertension, and diabetes; higher numbers of comorbidities and medications; higher GDS and PSQI scores; and more reported falls. They had lower ADL, MNA, EQ-5D, and gait speed scores. HGS was found to be lower in women with rLUTIs. Higher numbers of comorbidities and GDS scores and lower HGS were independent predictors of rLUTIs in women (p = 0.011, OR: 1.75; p = 0.018, OR: 1.14; and p = 0.042, OR: 0.91, respectively). We revealed that decreased HGS, higher GDS, and the number of comorbidities in older women were independent risk factors for rLUTIs. Our findings offer a new perspective on the importance of CGA in diagnosing and preventing rLUTIs.

The relationship between urinary incontinence and abdominal muscle thickness in community-dwelling older women undergoing comprehensive geriatric assessment.

Urinary incontinence (UI) is one of the most common geriatric syndromes in older adults, especially in women. The aim of this study is to show the relationship between urinary incontinence and abdominal muscle thickness measured by muscle ultrasonography (US) in community-dwelling older women adults. Eighty-seven community-dwelling older women participated in our study. The presence and the type of UI were recorded. Clinical and demographic characteristics were collected, and a comprehensive geriatric assessment was performed on all participants. Abdominal muscle layer thicknesses were evaluated with muscle US. The prevalence of UI was 55.2% (n = 48) of the study population. The median [IQR] age of the patients in the UI group was 73.0 [69.0-77.5] years and it was 69.0 [67.0-73.0] years in patients without UI (p = 0.007). Abdominal muscle thicknesses were measured smaller in patients with UI than those without UI except for internal oblique muscle thickness. The median [IQR] rectus abdominis muscle thickness was lower in patients with UI than in patients without UI, and the difference was statistically significant (p < 0.003). RA muscle was associated with UI regardless of age, polypharmacy, malnutrition, and frailty (OR: 0.58; 95% CI 0.38-0.89; p = 0.01). We have shown that UI was independently related to the rectus abdominis muscle thickness, which may reflect the function and mass of the pelvic floor muscles.

Poor sleep quality is an overlooked risk for geriatric syndromes in older adults with type 2 diabetes mellitus

ABSTRACT Background Aging and type 2 diabetes mellitus (DM) are two different conditions that impair sleep quality. The primary objective of this study was to investigate the impact of sleep quality on geriatric syndromes in older diabetic adults. Methods Comprehensive geriatric assessment was performed on 236 patients. The assessment included the Geriatric Depression Scale (GDS), Beck Anxiety Inventory (BAI), European Quality of Life Questionnaire (EQ-5D), Mini Mental Statement Examination (MMSE), Pittsburgh Sleep Quality Index (PSQI), Mini Nutritional Assessment, and measurement of handgrip strength (HGS). Results Of the participants, 55% had DM, and 61.4% had poor sleep quality. Poor sleep prevalence was higher in diabetic patients (68.5%) than in non-diabetics (52.8%). Diabetic patients with poor sleep quality had higher frequencies of chronic pain, recurrent urinary tract infections, confirmed sarcopenia, and frailty (p = 0.015, p < 0.001, p = 0.027, and p < 0.001, respectively), a higher number of comorbidities and higher GDS and BAI scores (p = 0.046, p < 0.001 and p < 0.001, respectively), and lower scores of activities of daily living, HGS, and EQ-5D index (p = 0.023, p = 0.004, and p < 0.001, respectively) compared to diabetic patients with good sleep quality. According to the correlation analysis results, PSQI score had a positive correlation with GDS score (r = 0.461, p < 0.001) and a negative correlation with Mini Nutritional Assessment score (r = –0.317, p < 0.001), skeletal muscle mass index (r = –0.283, p = 0.002) and HGS (r = –0.307, p < 0.001) scores in diabetic older adults. Conclusion Poor sleep quality in older diabetic patients has a negative impact on several geriatric syndromes. Our findings suggest that poor sleep quality is an independent risk factor for depression, malnutrition, and lower muscle mass in older diabetic adults. Improving sleep quality may play a crucial role in preventing and managing geriatric syndromes in this population.

Relationship between food insecurity and geriatric syndromes in older adults: A multicenter study in Turkey

AimsIn this study, the aim was to determine the prevalence of geriatric syndromes such as frailty, sarcopenia risk and malnutrition in older adults and to investigate the relationship between food insecurity, and frailty, risk of sarcopenia and malnutrition. MethodsThe study was cross-sectional. It was conducted between February 2022 and June 2022 with 707 older adults. The data were collected through the face-to-face interview method with a questionnaire including the Descriptive Information Form, Household Food Insecurity Access Scale (HFIAS), Frail Scale, Sarcopenia Risk Screening Scale (SARC-F) and Mini Nutritional Assessment-Short Form (MNA-SF). Numbers, percentages, mean, standard deviation, Pearson chi-square test and binary logistic regression analysis were used in data analysis. ResultsIn the present sample, 30% of the participants experienced some degree of food insecurity. The prevalence of frailty, sarcopenia risk, and malnutrition in the participants was 15.3%, 19.5%, and 1.3%, respectively. We determined that food insecurity was not associated with pre-frailty/frailty and sarcopenia risk. After adjusment for potential counfounders moderate and severe food insecurity was associated with higher odds of malnutrition risk and malnutrition (AOR: 2.06, 95% CI: 1.21–3.51, p:0.007). ConclusionWhile food insecurity is not associated with pre-frailty/frailty and sarcopenia risk, moderate and severe food insecurity is a modifiable risk factor for malnutrition risk and malnutrition. Thus, economic and social policies to eliminate food insecurity should be implemented, and efforts to prevent food insecurity should be planned through inter-sectoral cooperation.

Geriatric Syndromes in Older Adults Hospitalized with COVID-19 in Montreal, Canada

BackgroundOlder adults are more vulnerable to severe infection and mortality due to COVID-19. They have atypical presentations of the disease without respiratory symptoms, making early diagnosis clinically challenging. We aimed to compare the baseline characteristics, presentation, and disease course of older (≥70 yrs & ≥90 yrs) and younger (<70 yrs) patients hospitalized with COVID-19.MethodsRetrospective review of 429 consecutive patients hospitalized at two tertiary care hospitals in Montreal, Canada, with PCR-confirmed COVID-19. Baseline characteristics, presentation, in-hospital complications, and outcomes were recorded. Desegregation by age was performed to compare older versus younger individuals. Additional subgroup analyses were performed amongst patients ≥70 stratifying by sex, living situation, and those presenting with geriatric syndromes compared to those without.ResultsPatients ≥70 (n=260) presented less frequently with respiratory symptoms compared to patients <70 (n=169) (52% vs. 32%). 11% of patients ≥70 and 24% of patients ≥90 presented with a geriatric syndrome as their sole symptom compared to 3% of those <70. Older adults were more likely to develop disease complications (including delirium, acute kidney injury, and hypernatremia) and had higher in-hospital mortality (32% vs. 13%). Subgroup analyses revealed heightened vulnerability to complications in older men, those from long-term care, and those with at least one geriatric syndrome upon presentation.ConclusionsOlder adults presenting to hospital with COVID-19 often have no respiratory symptoms and can present with only a geriatric syndrome. New geriatric syndromes in older individuals should trigger evaluation for COVID-19 and consideration for early initiation of multidisciplinary care to prevent complications.

Plasma Cell-Free Mitochondrial DNA as a Marker of Geriatric Syndromes in Older Adults With HIV.

Older people with HIV experience more comorbidities and geriatric syndromes than their HIV-negative peers, perhaps due to residual inflammation despite suppressive antiretroviral therapy. Cell-free mitochondrial DNA (cfmtDNA) released during necrosis-mediated cell death potentially acts as both mediator and marker of inflammatory dysregulation. Thus, we evaluated plasma cfmtDNA as a potential biomarker of geriatric syndromes. Participants underwent the Montreal Cognitive Assessment (MoCA), frailty testing, and measurement of plasma cfmtDNA by qPCR and inflammatory markers including C-reactive protein, interleukin-6 (IL-6), interferon gamma, and tumor necrosis factor alpha in this cross-sectional study. Across 155 participants, the median age was 60 years (Q1, Q3: 56, 64), one-third were female, and 92% had HIV-1 viral load <200 copies/mL. The median MoCA score was 24 (21, 27). The plasma cfmtDNA level was higher in those with cognitive impairment (MoCA <23) ( P = 0.02 by the t test) and remained significantly associated with cognitive impairment in a multivariable logistic regression model controlling for age, sex, race, CD4 T-cell nadir, HIV-1 viremia, and depression. Two-thirds of participants met the criteria for a prefrail or frail state; higher plasma cfmtDNA was associated with slow walk and exhaustion but not overall frailty state. Cognitive dysfunction was not associated with C-reactive protein, IL-6, interferon gamma, or tumor necrosis factor alpha, and frailty state was only associated with IL-6. Plasma cfmtDNA may have a role as a novel biomarker of cognitive dysfunction and key components of frailty. Longitudinal investigation of cfmtDNA is warranted to assess its utility as a biomarker of geriatric syndromes in older people with HIV.

Association of geriatric syndromes in older adults with chronic obstructive pulmonary disease.

BackgroundGeriatric syndromes (GS) are multi‐factorial conditions that make older adults vulnerable to morbidities and poor outcomes. The main objective was to observe the frequency of GS in older patients with COPD.MethodsA case‐control study was conducted in the Geriatric department of a tertiary care hospital in India to evaluate geriatric syndromes including falls, cognitive impairment, frailty, functional impairment, urinary incontinence, malnutrition, and depression in patients with COPD and controls without COPD. The factors having a significant association with the occurrence of these GS in COPD patients were observed.ResultsIn this study, 150 cases and 150 controls were included. The mean age of the participant was 65.85±5.54, with 76% males. Functional impairment, cognitive impairment, frailty, urinary incontinence, and malnutrition were significantly higher in COPD patients. The independent variables which increased the odds of geriatric syndromes were dyspnoea (≥2 mMRC grade) (AOR:3.54,95% CI:1.06‐11.8) and low socioeconomic status (AOR: 4.14, 95% CI: 1.03‐16.54), while male gender showed inverse association (AOR: 0.08,95% CI: 0.01‐0.99).ConclusionGeriatric syndromes are common in older COPD patients, and assessment for them should be done routinely in these patients.

Low muscle mass and Charlson comorbidity index are risk factors for short-term postoperative prognosis of elderly patients with gastrointestinal tumor: a cross-sectional study

BackgroundSarcopenia is one of the most frequent syndromes in older adults and one of its main characteristics is low muscle mass. Gastrointestinal tumor is a malignant disease with high incidence. This study aimed to investigate the risk factors of low muscle mass in older adults with gastrointestinal tumor, the prognostic indicators of and short-term outcomes after resection for gastrointestinal tumor, and to explore the relationship between low muscle mass and short-term postoperative prognosis.MethodA total of 247 older patients with gastrointestinal tumors who underwent radical resection in 2019 were included in this study. Relevant indexes were calculated using L3 slice image of computed tomography (CT) to evaluate low muscle mass. Short-term postoperative complications and length of stay were considered as short-term outcomes of this study.ResultsAdvanced age, lower higher body mass index (BMI), lower hemoglobin, having history of abdominal surgery and higher visceral fat index (VFI) were risk factors of low muscle mass, while higher BMI and lower subcutaneous fat index (SFI) were protective factors of low muscle mass. Further multivariate logistic regression analysis showed that having history of abdominal surgery, advanced age and lower BMI were independent risk factors. Low muscle mass and higher Charlson comorbidity index were independent risk factors of short-term postoperative complications in older adults with gastrointestinal tumor. Higher Charlson comorbidity index gave rise to longer length of stay.ConclusionsLow muscle mass and higher Charlson comorbidity index predict poor short-term prognosis of older patients undergoing gastrointestinal tumor resection.

Do Long-Term Complications of Type 2 Diabetes Increase Susceptibility to Geriatric Syndromes in Older Adults?

Background and Objectives: Type 2 diabetes is one of the common chronic diseases in the elderly. It is thought that long-term complications of type 2 diabetes will negatively affect the quality of life in elderly individuals. It is possible that geriatric syndromes, especially frailty syndrome, are associated with diabetic complications, too. In this study, we aimed to evaluate the effect of macrovascular and microvascular complications of type 2 diabetes on frailty and other geriatric syndromes. In addition, the effect of these complications on quality of life was also reviewed. Materials and Methods: We conducted a cross-sectional study for four months. Comprehensive geriatric assessment tests were done on all patients. The Fried frailty index (FFI) was used for the evaluation of frailty syndrome. We assessed malnutrition by mini nutritional assessment short-form (MNA-SF), and Global Leadership Initiative on Malnutrition criteria (GLIM). The EWGSOP 2 criteria were used for the diagnosis of sarcopenia. Quality of life (QoL) was evaluated using the short form-36 (SF-36) questionnaire. Data analysis was done by SPSS version 22. Results: 237 females and 142 males with a mean age of 71.7 ± 6.1 years were included in the study. The frequency of macrovascular and microvascular complications was 41.4% and 68.1%, respectively. Frailty was found to be associated with macrovascular complications (p = 0.003). Handgrip strength, skeletal muscle mass index, and gait speed were decreased in the presence of macrovascular complications (p = 0.043, p < 0.001, p < 0.001). QoL was also decreased in patients with macrovascular complications (p = 0.003). Nutritional status and handgrip strength were negatively affected in patients with diabetic neuropathy (p = 0.019, p = 0.014). Polypharmacy was also found to be associated with macrovascular complications (p < 0.001, p < 0.001). Macrovascular complications were 2.5 times more common in malnourished patients according to GLIM and 3.2 times more common in patients with decreased gait speed. Conclusion: In this study, we observed that both macrovascular and microvascular complications of diabetes increase susceptibility to geriatric syndromes in elderly individuals. It could be useful to conduct prospective studies in which we can compare the effectiveness of treatment methods on this subject.

Malnutrition in Older Adults-Recent Advances and Remaining Challenges.

Malnutrition in older adults has been recognised as a challenging health concern associated with not only increased mortality and morbidity, but also with physical decline, which has wide ranging acute implications for activities of daily living and quality of life in general. Malnutrition is common and may also contribute to the development of the geriatric syndromes in older adults. Malnutrition in the old is reflected by either involuntary weight loss or low body mass index, but hidden deficiencies such as micronutrient deficiencies are more difficult to assess and therefore frequently overlooked in the community-dwelling old. In developed countries, the most cited cause of malnutrition is disease, as both acute and chronic disorders have the potential to result in or aggravate malnutrition. Therefore, as higher age is one risk factor for developing disease, older adults have the highest risk of being at nutritional risk or becoming malnourished. However, the aetiology of malnutrition is complex and multifactorial, and the development of malnutrition in the old is most likely also facilitated by ageing processes. This comprehensive narrative review summarizes current evidence on the prevalence and determinants of malnutrition in old adults spanning from age-related changes to disease-associated risk factors, and outlines remaining challenges in the understanding, identification as well as treatment of malnutrition, which in some cases may include targeted supplementation of macro- and/or micronutrients, when diet alone is not sufficient to meet age-specific requirements.

Management of acute coronary syndromes in older adults.

Older patients are underrepresented in prospective studies and randomized clinical trials of acute coronary syndromes (ACS). Over the last decade, a few specific trials have been conducted in this population, allowing more evidence-based management. Older adults are a heterogeneous, complex, and high-risk group whose management requires a multidimensional clinical approach beyond coronary anatomic variables. This review focuses on available data informing evidence-based interventional and pharmacological approaches for older adults with ACS, including guideline-directed management. Overall, an invasive approach appears to demonstrate a better benefit-risk ratio compared to a conservative one across the ACS spectrum, even considering patients' clinical complexity and multiple comorbidities. Conversely, more powerful strategies of antithrombotic therapy for secondary prevention have been associated with increased bleeding events and no benefit in terms of mortality reduction. An interdisciplinary evaluation with geriatric assessment should always be considered to achieve a holistic approach and optimize any treatment on the basis of the underlying biological vulnerability.

Oral health and geriatric syndromes in older adults in a highly specialized geriatric unit

Aim: To determine the frequency of alterations in oral health conditions (hygiene, prosthesis, and xerostomia) and its association with geriatric syndromes (depression, malnutrition, and frailty) in elderly people attending the highly specialized geriatric care unit. Material and methods: A cross-sectional study was carried out that recruiZted 124 participants (March 2018 to September 2018). A comprehensive geriatric assessment and standardized dental checkups were performed to obtain diagnoses in oral health and geriatric syndromes. To establish the association between oral health conditions and geriatric syndromes a logistical regression analysis was conducted. Results: The mean age was of 78.76 ± 7.08 years, with females being 74.2%. The total amount of edentulous patients was 25.8% and up to 60.5% required some type of prosthesis. 59.4% of the edentulous participants met the diagnosis of frailty. 53.5% of participants with xerostomia were classified as frail. The logistical regression analysis did not show statistical significance. Conclusion: The presence of frailty, malnutrition, and depression was greater in patients with prostheses, xerostomia, and poor oral hygiene. The statistical analysis showed a non-significant risk association between oral health conditions and depression, malnutrition, or frailty. These results highlight the importance of the intentional search for oral pathology during the comprehensive geriatric assessment.

Enhanced Recovery After Surgery in Older Adults Undergoing Colorectal Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Enhanced recovery after surgery is increasingly applied in older adults undergoing colorectal surgery. This systematic review and meta-analysis evaluated the impact of enhanced recovery protocols on clinical outcomes including hospital-acquired geriatric syndromes in older adults undergoing colorectal surgery. This review was conducted according to PRISMA guidelines. Ovid MEDLINE, Embase, PsycINFO, Scopus, Cochrane Central Register of Controlled Trials, CINAHL, and trial registry databases were searched (January 1980 to April 2020). Two researchers independently screened all articles for eligibility. Randomized controlled trials evaluating enhanced recovery protocols in older adults undergoing colorectal surgery were included. The enhanced recovery protocol was utilized. Primary outcomes of interest were functional decline and delirium. Other outcomes studied were length of stay, complications, readmission, mortality, gut function, mobilization, pain, reoperation, quality of life, and psychological status. Seven randomized trials (n = 1277 participants) were included. In terms of hospital-acquired geriatric syndromes, functional decline was reported in 1 study with benefits reported in enhanced recovery after surgery participants, and meta-analyses showed reduced incidence of delirium (risk ratio, 0.45; 95% CI, 0.21-0.98). Meta-analyses also showed reduction in urinary tract infections (risk ratio, 0.53; 95% CI, 0.31-0.90), time to first flatus (standardized mean differences, -1.00; 95% CI, -1.98 to -0.02), time to first stool (standardized mean differences, -0.59; 95% CI, -0.76 to -0.42), time to mobilize postoperatively (standardized mean differences, -0.92; 95% CI, -1.27 to -0.58), time to achieve pain control (standardized mean differences, -0.59; 95% CI, -0.90 to -0.28), and hospital stay (mean differences, -2.20; 95% CI, -3.46 to -0.94). The small number of randomized trials in older adults is a limitation of this study. Enhanced recovery protocols in older adults undergoing colorectal surgery appear to reduce the incidence of delirium and functional decline, 2 important hospital-acquired geriatric syndromes, as well as to improve other clinical outcomes. Future research should measure these geriatric syndromes and focus on high-risk older adults including those with frailty.

The Withdrawal After the Withdrawal: Managing Benzodiazepine Reduction and Post-Acute Withdrawal in Older Adults

<h3>Introduction</h3> Post-acute withdrawal, also described as protracted, extended or persistent withdrawal, refers to a syndrome that includes anxiety, irritability, hostility, mood instability, fatigue, insomnia and increased physical complaints often related to gastrointestinal symptoms, pain and weakness. Unlike acute withdrawal, where treatment guidelines and practices are highly predictable and protocol driven; post-acute interventions are highly symptom driven and individualized. Attention to co-occurring medical and psychiatric disorders is vital as well. It is well-known that benzodiazepines pose greater risks to older adults including confusion, ataxia, syncope, risk of falls, fractures, delirium and excess hospitalizations. Even with these known risks about 20-25% of all inappropriate prescriptions for benzodiazepines are given to older adults. There is limited literature on managing post-acute withdrawal syndromes in older adults, with few available guidelines for medication management of emerging symptoms. The additional challenges of the COVID-19 pandemic have increased both the stress on older adults in need of care and of providers seeking to engage patients in therapeutic relationships. We focus on representative cases of older adults seeking treatment related to benzodiazepines withdrawal and describe flexible treatment approaches for their evolving and complex needs. <h3>Methods</h3> Cases studies were identified from the patient population at Mount Sinai Beth Israel, an urban medical center serving a multicultural and socioeconomically diverse population that includes several NORC sites. Mount Sinai Beth Israel has been serving the population of lower Manhattan since 1889 and provides full service behavioral health care including opioid treatment programs. Patients were identified from those who presented to the ambulatory care center that offers adult, geriatric and dual-diagnosis services. A personalized treatment planning approach was developed in each case and included the time period of the COVID-19 quarantine. <h3>Results</h3> Mr A: 64 year old man with Generalized Anxiety Disorder, Panic Disorder, Opioid Use Disorder in sustained remission on Methadone 270mg daily and Sedative Hypnotic Use Disorder. The patient entered treatment for impending Benzodiazepine withdrawal after losing his provider. He was taking alprazolam 2mg, clonazepam 6m and zolpidem 10mg daily over the past 30 years. Following treatment for acute withdrawal and treatment with a slow taper of clonazepam the patient has been struggling with episodic anxiety and feelings of loss. Isolation and boredom related to COVID-19 quarantine conditions have contributed to this making the issue of worsening anxiety with protracted withdrawal symptoms difficult to delineate. Ms B:74 year old woman with Generalized Anxiety Disorder entered treatment after her provider closed his practice. The patient was prescribed diazepam 40mg, lorazepam 2mg and zolpidem 10mg daily for the past 5 years. In addition she was prescribed dextroamphetamine 20 mg daily for 3 years for fatigue. Over a 2 year period the medications were tapered using clonazepam; the dextroamphetamine was discontinued. While being maintained on clonazepam 0.5mg daily she started to complain of fearfulness, loneliness, insonia and chronic pain which increased with the onset of the COVID-19 quarantine. Mirtazpine 7.5mg was started at bedtime with improvement. Ms D: 59 year old woman with PTSD, Major Depressive Disorder, Alcohol Use Disorder, Cannabis Use Disorder and Cocaine Use Disorder treated with lorazepam 2 mg daily entered treatment after a previous provider was unable to administer Naltrexone LAI. The dose was reduces by 25% every 3 to 4 weeks while mirtazapine was utilized to manage emerging symptoms of depression and insomnia. <h3>Conclusions</h3> We found that patients often entered treatment as a result of prior providers either refusing to continue prescribing benzodiazepines or limiting their practice. Patients responded well to engagement but under the increased stress of COVID-19 quarantine conditions symptoms increasingly emerged. Our population included patients who were also receiving MAT for sustained remission of Opioid Use Disorder and faced greater risks related to benzodiazepine use. Patients were receptive to educational interventions regarding the risks of continuing use and were able to engage in treatment. Despite the proven negative outcomes of chronic use providers continue to prescribe benzodiazepines inappropriately to older adults. The need to care for patients treated with these agents is high. Post-acute withdrawal syndrome is poorly understood and under recognized in older adults. Efforts such as de-prescribing, patient centered approaches to rational prescribing and use remote education programs should be increased. COVID-19 pandemic conditions lead to an increase in overall symptoms reported but did not prevent patients from engaging in successful treatment.

Frailty Syndrome in Older Adults and Related Sociodemographic Factors in the North of Iran: A Population-Based Study

Background: The global incidence rate of frailty syndrome among older adults aged 60 and over has been estimated to be 43.4 cases per 1000 persons/years. Objectives: This study aimed to determine the prevalence of pre-frailty and frailty syndromes in community-dwelling older adults and assess the correlated sociodemographic factors. Methods: All elderly people recruited in the second phase of the Amirkola Health and Ageing Cohort Project, including 2135 older adults aged ≥60 years living in Amirkola, North of Iran, were invited to participate in this study using the census method. The standard "FRAIL" scale was used to assess the frailty syndrome. The individuals who obtained a score of three or more and one or two were classified as frail and pre-frail cases, respectively. Results: Totally, 2010 older adults with a mean age of 70.41±7.65 years were included in this study. Out of them, 672 (33.4%; 95% CI: 31.37-35.50%) cases met the criteria for frailty syndrome, and 874 (43.5%) individuals were regarded as pre-frail. The prevalence of frailty was significantly higher in females (50.8%; 95% CI: 47.58-54.05%), compared to males (18.7%; 95% CI: 16.41-21.05%). Multivariate logistic regression analysis revealed that age ≥85 (OR=7.27; 95% CI: 4.12-24.46) and female gender (OR=2.67; 95% CI: 2.30-9.95) had the highest effect on frailty in older adults. Conclusion: One out of every three elderly people (aged ≥60) in Amirkola, North of Iran, had frailty syndrome. Older age, female gender, lower education level, low level of satisfaction with income, marital status (single), living alone, and unemployment increased the risk of frailty in older adults.

Physical Frailty Phenotype and the Development of Geriatric Syndromes in Older Adults with Coronary Heart Disease

BackgroundFrailty, a clinical state of vulnerability, is associated with subsequent adverse geriatric syndromes in the general population. We examined the long-term impact of frailty on geriatric outcomes among older patients with coronary heart disease. MethodsWe used the National Health and Aging Trends Study, a prospective cohort study linked to a Medicare sample. Coronary heart disease was identified by self-report or International Classification of Diseases (ICD) codes 1-year prior to the baseline visit. Frailty was measured using the Fried physical frailty phenotype. Geriatric outcomes were assessed annually during a 6-year follow-up. ResultsOf the 4656 participants, 1213 (26%) had a history of coronary heart disease 1-year prior to their baseline visit. Compared to those without frailty, subjects with frailty were older (ages ≥75: 80.9% vs 68.9%, P < 0.001), more likely to be female, and belong to an ethnic minority. The prevalence of hypertension, stroke, falls, disability, anxiety/depression, and multimorbidity were much higher in the frail, than nonfrail, participants. In a discrete time survival model, the incidence of geriatric syndromes during 6-year follow-up including 1) dementia, 2) loss of independence, 3) activities of daily living disability, 4) instrumental activities of daily living disability, and 5) mobility disability were significantly higher in the frail than in the nonfrail older patients with coronary heart disease. ConclusionIn patients with coronary heart disease, frailty is a risk factor for the accelerated development of geriatric outcomes. Efforts to identify frailty in the context of coronary heart disease are needed, as well as interventions to limit or reverse frailty status for older patients with coronary heart disease.

White Matter Microstructure Underlies the Effects of Sleep Quality and Life Stress on Depression Symptomatology in Older Adults

Sleep complaints are the most prevalent syndromes in older adults, particularly in women. Moreover, they are frequently accompanied with a high level of depression and stress. Although several diffusion tensor imaging (DTI) studies reported associations between sleep quality and brain white matter (WM) microstructure, it is still unclear whether gender impacts the effect of sleep quality on structural alterations, and whether these alterations mediate the effects of sleep quality on emotional regulation. We included 389 older participants (176 females, age = 65.5 ± 5.5 years) from the 1000BRAINS project. Neuropsychological examinations covered the assessments of sleep quality, depressive symptomatology, current stress level, visual working memory, and selective attention ability. Based on the DTI dataset, the diffusion parameter maps, including fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD), were calculated and normalized to a population-specific FA template. According to the global Pittsburgh Sleep Quality Index (PSQI), 119 poor sleepers (PSQI: 10∼17) and 120 good sleepers (PSQI: 3∼6) were identified. We conducted a two by two (good sleepers/poor sleepers) × (males/females) analysis of variance by using tract-based spatial statistics (TBSS) and JHU-ICBM WM atlas-based comparisons. Moreover, we performed a voxel-wise correlation analysis of brain WM microstructure with the neuropsychological tests. Finally, we applied a mediation analysis to explore if the brain WM microstructure mediates the relationship between sleep quality and emotional regulation. No significant differences in brain WM microstructure were detected on the main effect of sleep quality. However, the MD, AD, and RD of pontine crossing tract and bilateral inferior cerebellar peduncle were significant lower in the males than females. Voxel-wise correlation analysis revealed that FA and RD values in the corpus callosum were positively related with depressive symptomatology and negatively related with current stress levels. Additionally, we found a significantly positive association between higher FA values in visual-related WM tracts and better outcomes in a visual pattern recognition test. Furthermore, a mediation analysis suggested that diffusion metrics within the corpus callosum partially mediated the associations between poor sleep quality/high stress and depressive symptomatology.