2019-11-07, Veronese, Nicola, Smith, Lee, Torbahn, Gabriel, Jackson, Sarah E., Yang, Lin, SOYSAL, PINAR, Rivasi, Giulia, Rafanelli, Martina, Petrovic, Mirko, Maggi, Stefania, Isik, Ahmet Turan, Demurtas, Jacopo, SOYSAL, PINAR

Purpose Orthostatic hypotension (OH) is associated with older age and many negative clinical outcomes in geriatric practice. We aimed to capture the breadth of outcomes that have been associated with the presence of OH and systematically assess the quality, strength and credibility of these associations using an umbrella review with integrated meta-analyses. Methods We systematically searched several major databases from their commencements through to 16th May 2019 for meta-analyses of observational studies of OH and any health-related outcome. We used these metrics to categorize the strength of evidence of significant outcomes (p < 0.05) from class I (convincing) to class IV (weak), according to the pre-established criteria. Results From 975 abstracts, seven meta-analyses of 12 outcomes were included. For each outcome, the median number of studies was four, and the median number of participants was 46,493, with a median of 3630 incident cases. There was suggestive (class III) evidence that OH was associated with significantly higher risk of coronary heart disease (HR = 1.32, 95% CI 1.12-1.56), stroke (HR = 1.22, 95% CI 1.08-1.38), congestive heart failure (HR = 1.30, 95% CI 1.09-1.55), all-cause mortality (RR = 1.50, 95% CI 1.24-1.81), falls (OR = 1.84, 95% CI 1.39-2.44), and dementia (HR = 1.22, 95% CI 1.11-1.35). Conclusion The current evidence base indicates that OH is significantly associated with a range of adverse cardiovascular, cognitive, and mortality outcomes in older people, although the strength of this evidence remains only suggestive. Further research in larger samples and with lower risk of bias is required to build a fuller picture of the impact of OH on health.

2019-05-21, Dokuzlar, O, Koc, Okudur, Smith, L, Isik, AT, Aydin, AE, SOYSAL, PINAR

Background Women aged 65 years and over are at increased risk of falling. Falls in this age group increase the risk of morbidity and mortality. Aims The aim of the present study was to find the most common factors that increase the risk of falling in older women, by using four different assessment methods. Methods 682 women, who attended a geriatric outpatient clinic and underwent comprehensive geriatric assessment, were included in the study. History of falling last year, the Timed Up and Go (TUG) test, Performance-Oriented Mobility Assessment (POMA), and 4-m walking speed test were carried out on all patients. Results The mean age (SD) of patients were 74.4 (8.5) years. 31.5% of women had a history of falling in the last year. 11%, 36.5%, and 33.3% of patients had a falling risk according to POMA, TUG and 4-m walking speed test, respectively. We identified the following risk factors that increase the risk of falling, according to these four methods: urinary incontinence, dizziness and imbalance, using a walking stick, frailty, dynapenia, higher Charlson Comorbidity Index and Geriatric Depression Scale score, and lower basic and instrumental activities of daily living scores (p < 0.05). We found a significant correlation between all the assessment methods (p < 0.001). Conclusion There is a strong relationship between fall risk and dizziness, using a walking stick, dynapenia, high number of comorbidities, low functionality, and some geriatric syndromes such as depression, frailty, and urinary incontinence in older women. Therefore, older women should routinely be screened for these risk factors.

2019-07-25, Dutoglu, E, Soysal, P, Smith, L, Isik, AT, Arik, F, Kalan, U, Kazancioglu, RÜMEYZA, SOYSAL, PINAR, KAZANCIOĞLU, RÜMEYZA

2019-05-01, SOYSAL, PINAR, Veronese, Nicola, STUBBS, Brendon, Maggi, Stefania, Jackson, Sarah E, DEMURTAS, Jacopo, Celotto, S., KOYANAGI, AI, Bolzetta, F., Smith, Lee, SOYSAL, PINAR

2019-12-01, Veronese, Nicola, Demurtas, Jacopo, SOYSAL, PINAR, Smith, Lee, Torbahn, Gabriel, Schoene, Daniel, Schwingshackl, Lukas, Sieber, Cornel, Bauer, Jurgen, Cesari, Matteo, Bruyere, Oliviere, Reginster, Jean-Yves, Beaudart, Charlotte, Cruz-Jentoft, Alfonso J., Cooper, Cyrus, Petrovic, Mirko, Maggi, Stefania, SOYSAL, PINAR

Key summary pointsAimTo investigate associations of sarcopenia with adverse health-related outcomes, through an umbrella review method.FindingsSarcopenia appears to be significantly associated with several adverse outcomes in older people, with a strong evidence for increased risk of mortality, disability, and falls.MessageSarcopenia is associated with several adverse health-related outcomes in older people, indicating the need of assessing this condition in daily practice. AbstractBackgroundThe clinical relevance of sarcopenia has increasingly been recognized. However, whether it is associated with the development of other medical conditions is still unclear. Therefore, we aimed to capture the scale of outcomes that have been associated with the presence of sarcopenia and systematically assess the quality, strength, and credibility of these associations using an umbrella review methodology.MethodsA systematic review in several databases was carried out, until 20th February 2019. For each association, random-effects summary effect size, 95% confidence intervals (CIs), heterogeneity (I-2), evidence for small-study effect, evidence for excess significance bias, and 95%-prediction intervals were estimated. We used these metrics to categorize the evidence of significant outcomes (p<0.05) from class I (convincing) to class IV (weak), according to pre-established criteria.ResultsFrom 358 abstracts, 6 meta-analyses with 14 associations were included. Sarcopenia was associated with higher risk of other comorbidities and mortality in 11 of 14 outcomes explored. However, only 3 outcomes (i.e., association between sarcopenia and increased risk of death in community-dwelling older people [odds ratio, OR=3.60; 95% CI 2.96-4.37; n=14,305], disability [OR=3.04; 95% CI 1.80-5.12; n=8569], and falls [OR=1.60; 95% CI 1.31-1.97; n=12,261]) presented a highly suggestive evidence (class II). Other association was classified as having only a weak evidence.ConclusionSarcopenia is associated with several adverse health-related outcomes in older people, and its associations with mortality, disability, and falls are supported by a highly suggestive evidence. The effect of interventions on sarcopenia to improve these outcomes needs to be investigated.

2019-11-08, Grabovac, Igor, Koyanagi, Ai, Yang, Lin, SOYSAL, PINAR, McDermott, Daragh, Isik, Ahmet Turan, Veronese, Nicola, Smith, Lee, SOYSAL, PINAR

The present study aimed to investigate associations between alcohol consumption and sexual activity. Data were from 1,622 men and 2,195 women aged >= 50 years participating in the English Longitudinal Study of Ageing. Adjusted multivariable logistic regression was used to assess associations between baseline frequency of alcohol use in the last year or binge drinking in the last week and sexual activity at 8-year follow-up. Regular alcohol consumption in the last year at baseline was associated with 111% higher odds (95% CI 1.36-3.27) of any past-year sexual activity at follow-up in men and 76% higher odds (95% CI 1.26-2.46) in women. Frequent alcohol consumption was associated with 175% higher odds (95% CI 1.75-4.32) of sexual activity in men and 100% higher odds (95% CI 1.38-2.89) in women, relative to drinking alcohol never or rarely. Binge drinking was positively associated with sexual activity at follow-up, with odds of being sexually active at follow-up 52% higher (95% CI 1.07-2.15) among men who reported binge drinking at baseline and 57% higher (95% CI 1.11-2.23) among females. These findings do not outweigh the health risks associated with excessive alcohol consumption. Health practitioners should consider these findings when encouraging older adults to reduce their alcohol consumption.

2019-01-01, Gursu, MELTEM, ARICI, MUSTAFA, Ates, Kenan, Kazancioglu, RÜMEYZA, Yavas, Pinar Guneser, Öztürk, Murat, ALTUN, BÜLENT, Arinsoy, Turgay, GÜRSU, MELTEM, KAZANCIOĞLU, RÜMEYZA

Background/Aims: Refugee dialysis is a worldwide growing dilemma with limited experience. This report presents the largest hemodialysis (HD) patient registry data of Syrian refugees in Turkey. Methods: Demographic, clinical, laboratory, and dialysis practice data of 345 Syrian HD patients during one year were collected and analyzed. Results: There were 345 prevalent Syrian HD patients at the end of 2016. Majority of the patients were placed in the Southeast Anatolian Region. The majority of the patients (74.8%) are in the age range of 20-64 years. Dialysis vintage in Turkey is less than 12 months in 20.8% and less than one month in 29.3% of patients. The vascular access was arteriovenous fistula in the majority of patients (72.5%). Kt/V is over 1.7 in 57%, serum albumin is above 35 g/L in 65.8% and hemoglobin level is more than 100 g/L in %65.2 of the patients. The ratio of patients with serum phosphorus level of 1.13-1.77 mmol/L was 56.2%. Twenty Syrian HD patients (14 male, 6 female) died within the year 2016 and annual mortality rate was 5.7%. Conclusion: This study with the largest number of Syrian refugees undergoing maintenance hemodialysis showed good dialysis practices, acceptable values for dialysis adequacy and biochemical parameters along with lower mortality compared to native HD population of Turkey. Longer follow up will enrich the knowledge related to care of refugee population in all over the world.

2019-12-01, Smith, Lee, Koyanagi, Ai, Pardhan, Shahina, Grabovac, Igor, Swami, Viren, SOYSAL, PINAR, Isik, Ahmet, Lopez-Sanchez, Guillermo F., McDermott, Daragh, Yang, Lin, Jackson, Sarah E., SOYSAL, PINAR

Sexual activity is a central component of intimate relationships and has been shown to have numerous benefits for health and wellbeing. Studies have shown that people with disabilities often report less satisfaction with their sex lives, but none have examined the levels of sexual activity in older adults with visual problems. We investigated associations between self-rated eyesight and sexual activity in a population-based sample of older adults. Analyses were conducted using data from 2587 men and 3238 women participating in the English Longitudinal Study of Ageing. Participants provided information on self-rated eyesight in three domains: overall, at distance, and up close (categorised as: excellent/very good/good/fair-poor), sexual activity (any vs. none in the last year), and frequency of sexual intercourse in the last month (not at all, once, 2-3 times, once a week or more) among those who were sexually active. Associations between self-rated eyesight and sexual activity were examined using adjusted logistic regression. Relative to excellent self-rated eyesight, fair-poor eyesight was consistently associated with significantly lower odds of being sexually active in men (overall eyesight OR 0.41, 95% CI 0.26-0.64, p < 0.001) but not in women (overall eyesight OR = 0.99, 95% CI 0.70-1.41, p = 0.959). However, among women who were sexually active, there was some evidence that fair-poor eyesight was associated with lower frequency of sexual intercourse in the last month (e.g. fair-poor eyesight at distance OR = 0.45, 95% CI 0.31-0.66, p < 0.001). No association between self-rated eyesight and frequency of sexual intercourse was observed for men. Identifying ways to help older patients with impaired vision achieve a more active sex life could help to improve the health and wellbeing of this population group. Visual impairment is associated with lower prevalence of any sexual activity in older men, and lower frequency of sexual intercourse in older women.

2019-04-01T00:00:00Z, GÖKÇAL, ELİF, KOLUKISA, MEHMET, Mustafayev, Nihat, ASİL, Talip, GÖKÇAL, ELİF, KOLUKISA, MEHMET, ASİL, TALIP

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an adult-onset inherited small vessel disease of the brain caused by NOTCH3 mutations. Clinical characteristics of CADASIL include recurrent infarctions, migraine with aura, mood disturbances and cognitive impairment. We report a 35 year-old migraine-free patient with unusual presentation with acute simultaneous multiple subcortical infarctions causing progressive bulbar palsy as the initial manifestation. Hepresented with slurred speech progressing to anarthria and bilateral palsy of lower motor cranial nerves within 24 hour. Initial acute subcortical infarcts enlarged and new infarcts developed in bilateral hemispheres. There was diffuse leukoencephalopathy involving temporal horns and the patient had positive familiy history of migraine and young stroke. CADASIL was diagnosed genetically when NOTCH3 mutationwas shown. The patient improved after treatment with liquid hydration and antiplatelet agent. We experienced with the patient that CADASIL may present with unusual progressive manifestations and bilateral simultaneous infarctions. Irrespective of clinical presentation, patients with leukoencephalopathy and positive familiy history should be tested for NOTCH3 mutation.