1
|
Abstract
Vitamin-D receptors are found in a variety of cells with the potential to regulate many cellular functions. Higher COVID-19 severity has been reported in individuals, which are known to have lower vitamin-D levels. The relation between vitamin-D and COVID-19 has been analysed with a number of studies but only few met high standards. Studies revealed discordant findings. There is no data from interventional trials clearly indicating that vitamin-D supplementation may prevent against COVID-19. An increasing number of observational studies put forward the preventive feature of adequate vitamin-D status for COVID-19 mortality. Yet, there are again conflicting findings. This narrative review summarizes the current evidence and provides a practical advice to lessen the impact of COVID-19 by ensuring recommended vitamin-D intakes. This approach would not be harmful, but potentially useful. Vitamin-D is safe especially if it does not exceed the upper-tolerable-limit. Daily doses are recommended over the weekly or monthly higher doses. Mega-doses are not recommended because of its potential to lead adverse events. The target level of vitamin-D is proposed above 30 ng/mL in majority of the studies. Nonetheless, one should consider that the benefit is foreseen to be small, and some time (months) may be needed for such effect.
Collapse
Affiliation(s)
- Gülistan Bahat
- Division of Geriatrics, Department of Internal Medicine, Istanbul Medical School, Istanbul University, Capa, Istanbul, Turkey,CONTACT Gülistan Bahat Istanbul University, Istanbul Medical School, Turgut Ozal Mıllet Street, Capa, Istanbul34390, Turkey
| | - Duygu Erbas Sacar
- Division of Geriatrics, Department of Internal Medicine, Istanbul Medical School, Istanbul University, Capa, Istanbul, Turkey
| | - Mirko Petrovic
- Section of Geriatrics, Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
| |
Collapse
|
2
|
Catikkas NM, Erdogan TO, Reginster JY, Oren MM, Aydin CO, Sacar DE, Ozkok S, Kilic C, Karan MA, Bahat G. Prevalence and determinants of falls in community-dwelling older adults in Türkiye: A population-based cross-sectional study conducted between 2014-2015. Curr Aging Sci 2023; 16:133-142. [PMID: 36624652 DOI: 10.2174/1874609816666230109153424] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/30/2022] [Accepted: 11/12/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE Falls are a common public health problem in older adults regarding increased morbidity, mortality, and healthcare costs. Determining the factors associated with falls is of utmost importance for detecting at-risk people. We present a field study conducted to examine the prevalence of falls and the associated factors among community-dwelling older adults. METHODS In this population-based cross-sectional study, we included adults aged >60 years living in the Fatih District of the Istanbul Province between November 2014-May 2015, through a simple random sampling method. We noted age, sex, falls, fear of falling, number of diseases and medications, the presence of diabetes, hypertension, dyslipidemia, urinary and fecal incontinence, and chronic pain. Frailty was assessed with the FRAIL questionnaire. Functional capacity was evaluated by Katz's 6-item ADL and Lawton Brody's 8-item IADL scales. The European quality-5 dimension (EQ-5D) questionnaire was used for the quality of life assessment. The cognitive status screening was conducted with a Mini-cog test. Depressive mood was evaluated with the Geriatric Depression scale short form (GDS-SF). Malnutrition screening was conducted by the mini-nutritional assessment short form. Handgrip strength (HGS) was measured with a hand dynamometer. Body composition was assessed through a bioimpedance analysis. The 4-meter usual gait speed was recorded. The European Working Group on Sarcopenia in Older People2 (EWSGOP2) criteria was used for the sarcopenia definition. The Romberg and the postural instability tests were evaluated for balance and gait. Continuous variables were expressed as mean±standard deviation or median and interquartile range for descriptive statistics, while categorical variables were expressed as the number and percentages. The differences between groups were determined through an independent sample t-test or Mann-Whitney U test when required. Chi-square and Fisher's exact tests were applied for categorical variables. A multivariate logistic regression analysis was used to determine the independent factors associated with falls among the factors identified as significant in univariate analyses. RESULTS The prevalence of falls was 28.5% [mean age: 75.4±7.3 (range: 61-101 years), 53.6% female], and a significant association was identified between falls and the number of diseases and medications, diabetes, chronic pain, frailty, ADL, IADL, and EQ-5D scores, dementia, GDS-SF score and level of ambulation in univariate analyses (p=0.001, 0.030, 0.030, 0.010, 0.004, 0.040, 0.007, 0.003, 0.030 and 0.007, respectively). In the multivariate analysis, positive dementia (OR=3.66, 95% CI=1.40-9.53; p=0.010) and frailty screenings (OR =1.47, 95% CI=1.05-2.06; p=0.020) were identified as associates of falls. CONCLUSION Falls were independently associated with positive dementia and frailty screening. These results will help develop specific and tailored precautions for at-risk groups to prevent the negative outcomes of falls.
Collapse
Affiliation(s)
- Nezahat Muge Catikkas
- Istanbul University Istanbul Medical School Department of Internal Medicine Division of Geriatrics Capa, 34093 Istanbul, Türkiye
| | - Tugba Obekli Erdogan
- Istanbul University Istanbul Medical School Department of Internal Medicine Division of Geriatrics Capa, 34093 Istanbul, Türkiye
| | - Jean Yves Reginster
- University of Liège Liège Medical School Department of Public Health, Epidemiology and Health Economics Liège, Belgium
| | - Meryem Merve Oren
- Istanbul University Istanbul Medical School Department of Public Health Capa, 34093 Istanbul, Türkiye
| | - Caglar Ozer Aydin
- Istanbul University Istanbul Medical School Department of Internal Medicine Division of Geriatrics Capa, 34093 Istanbul, Türkiye
| | - Duygu Erbas Sacar
- Istanbul University Istanbul Medical School Department of Internal Medicine Division of Geriatrics Capa, 34093 Istanbul, Türkiye
| | - Serdar Ozkok
- Istanbul University Istanbul Medical School Department of Internal Medicine Division of Geriatrics Capa, 34093 Istanbul, Türkiye
| | - Cihan Kilic
- Istanbul University Istanbul Medical School Department of Internal Medicine Division of Geriatrics Capa, 34093 Istanbul, Türkiye
| | - Mehmet Akif Karan
- Istanbul University Istanbul Medical School Department of Internal Medicine Division of Geriatrics Capa, 34093 Istanbul, Türkiye
| | - Gulistan Bahat
- Istanbul University Istanbul Medical School Department of Internal Medicine Division of Geriatrics Capa, 34093 Istanbul, Türkiye
| |
Collapse
|
3
|
Erbas Sacar D, Kılıc C, Oren MM, Erdogan T, Ozkok S, Ozer Aydın C, Catikkas NM, Karan MA, Bahat G. Probable sarcopenia: associations with common geriatric syndromes and comorbidities in Turkish geriatric patients from a university hospital. Eur Geriatr Med 2022; 13:1299-1308. [PMID: 36029439 DOI: 10.1007/s41999-022-00691-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 08/12/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE EWGSOP2 defines "probable sarcopenia" as the presence of low muscle strength without non-muscle causes. The associations of probable sarcopenia have been studied in few reports to date, and our intention in this study is to identify associations of probable sarcopenia with common geriatric syndromes in a sample of older adults who attended the geriatric outpatient clinic of Istanbul University Hospital. METHODS The present study was designed as a retrospective cross-sectional study. We performed a comprehensive geriatric assessment to the participants. Univariate analyses were performed to determine relationship of probable sarcopenia with age, sex, common geriatric syndromes, i.e., frailty, falls, polypharmacy, malnutrition, and comorbidities, i.e., diabetes mellitus, hypertension, chronic kidney disease, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), depression, osteoporosis, and the variables found to be significant were included in logistic regression analyses. The results are presented as an odds ratio (OR), with a 95% confidence interval (CI). RESULTS Included in the study were 456 participants with a mean age of 74.6 ± 6.6 years, of which 71.1% were female. Probable sarcopenia was identified in 12.7% (n = 58) of the sample. A multivariate analysis was carried out, the factors associated with probable sarcopenia were identified as male sex (OR 0.269, 95% CI 0.142-0.510), frailty (OR 4.265, 95% CI 2.200-8.267) and chronic kidney disease (OR 3.084, 95% CI 1.105-8.608). CONCLUSION Probable sarcopenia was more significantly associated with frailty than with other geriatric syndromes, signifying its importance as a marker for frailty. The study further identified chronic renal failure as a factor significantly associated with probable sarcopenia among the variety of studied diseases that frequently accompany aging.
Collapse
Affiliation(s)
- Duygu Erbas Sacar
- Department of Internal Medicine, Division of Geriatrics, Istanbul Medical School, Istanbul University, Topkapı Mahallesi, Turgut Özal Street No: 118, 34093 Fatih/İstanbul Capa, 34390, Istanbul, Turkey.
| | - Cihan Kılıc
- Department of Internal Medicine, Division of Geriatrics, Istanbul Medical School, Istanbul University, Topkapı Mahallesi, Turgut Özal Street No: 118, 34093 Fatih/İstanbul Capa, 34390, Istanbul, Turkey
| | - Meryem Merve Oren
- Department of Public Health, Istanbul Medical School, Istanbul University, Topkapı Mahallesi, Turgut Özal Street No: 118, 34093 Fatih/İstanbul, Istanbul, Turkey
| | - Tugba Erdogan
- Department of Internal Medicine, Division of Geriatrics, Istanbul Medical School, Istanbul University, Topkapı Mahallesi, Turgut Özal Street No: 118, 34093 Fatih/İstanbul Capa, 34390, Istanbul, Turkey
| | - Serdar Ozkok
- Department of Internal Medicine, Division of Geriatrics, Istanbul Medical School, Istanbul University, Topkapı Mahallesi, Turgut Özal Street No: 118, 34093 Fatih/İstanbul Capa, 34390, Istanbul, Turkey
| | - Caglar Ozer Aydın
- Department of Internal Medicine, Division of Geriatrics, Istanbul Medical School, Istanbul University, Topkapı Mahallesi, Turgut Özal Street No: 118, 34093 Fatih/İstanbul Capa, 34390, Istanbul, Turkey
| | - Nezahat Muge Catikkas
- Department of Internal Medicine, Division of Geriatrics, Istanbul Medical School, Istanbul University, Topkapı Mahallesi, Turgut Özal Street No: 118, 34093 Fatih/İstanbul Capa, 34390, Istanbul, Turkey
| | - Mehmet Akif Karan
- Department of Internal Medicine, Division of Geriatrics, Istanbul Medical School, Istanbul University, Topkapı Mahallesi, Turgut Özal Street No: 118, 34093 Fatih/İstanbul Capa, 34390, Istanbul, Turkey
| | - Gulistan Bahat
- Department of Internal Medicine, Division of Geriatrics, Istanbul Medical School, Istanbul University, Topkapı Mahallesi, Turgut Özal Street No: 118, 34093 Fatih/İstanbul Capa, 34390, Istanbul, Turkey
| |
Collapse
|
4
|
Ozkok S, Aydin CO, Sacar DE, Catikkas NM, Erdogan T, Bozkurt ME, Kilic C, Karan MA, Bahat G. Sarcopenic obesity versus sarcopenia alone with the use of probable sarcopenia definition for sarcopenia: Associations with frailty and physical performance. Clin Nutr 2022; 41:2509-2516. [PMID: 36219979 DOI: 10.1016/j.clnu.2022.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/04/2022] [Accepted: 09/09/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND & AIMS Ageing brings alterations in body composition, as skeletal muscle gradually declines and accumulation of adipose tissue accompanies it. Although sarcopenia (S) and obesity (O) were separately reported to be associated with frailty and poor physical performance, whether they bring more detrimental or favorable effect when they coexist (i.e. sarcopenic obesity; SO) is an issue needs clarification. We aimed to study the associations of SO and S alone with frailty and poor physical performance, by using probable S definition. METHODS This was a retrospective, cross-sectional study including community dwelling older adults who were ≥60 years old and admitted to the outpatient clinic of a tertiary hospital between 2012 and 2020. We measured handgrip strength via hand dynamometer and defined decreased muscle strength as probable S. We performed bioimpedance analysis to evaluate body composition and used fat percentile method to define obesity. We assessed nutritional status via Mini-Nutritional Assessment-Short Form, frailty via FRAIL scale, and physical performance via Timed Up and Go (TUG) test. We examined the associations of four body phenotypes, i.e. non-S non-O, SO, S alone and O alone with frailty and impaired TUG in univariate and multivariate analyses (Model 1). We further performed a head to head analysis of SO vs S to see if one of them was associated more with frailty and impaired TUG (Model 2). RESULTS There were 1366 older adults included in the study (mean age: 74.6 ± 6.9; 68.3% female). The prevalences of non-S non-O, S alone, SO and O alone were 53.5, 7.5, 2.8 and 36.2%, respectively. Multivariate analysis adjusted for age, gender and nutritional status revealed that both SO and S alone were independently associated with frailty and impaired TUG, with SO demonstrating lower odds than S alone (OR = 5.9 and 6.05 for frailty, and 3.9 and 4.4 for TUG, respectively). Head-to-head comparison between SO and S alone in Model 2 showed that two groups did not demonstrate significant difference in terms of the frailty and impaired TUG risk. CONCLUSION Although SO and S groups demonstrated similar risks, obesity accompanying sarcopenia might show a favorable trend in terms of frailty and poor physical performance, compared to sarcopenia alone. Longitudinal studies are needed to reveal whether an obesity paradox exists for frailty and physical performance in older adults.
Collapse
Affiliation(s)
- Serdar Ozkok
- Division of Geriatrics, Department of Internal Medicine, Istanbul University, Istanbul Medical School, 34093, Istanbul, Turkey
| | - Caglar Ozer Aydin
- Division of Geriatrics, Department of Internal Medicine, Istanbul University, Istanbul Medical School, 34093, Istanbul, Turkey
| | - Duygu Erbas Sacar
- Division of Geriatrics, Department of Internal Medicine, Istanbul University, Istanbul Medical School, 34093, Istanbul, Turkey
| | - Nezahat Muge Catikkas
- Division of Geriatrics, Department of Internal Medicine, Istanbul University, Istanbul Medical School, 34093, Istanbul, Turkey
| | - Tugba Erdogan
- Division of Geriatrics, Department of Internal Medicine, Istanbul University, Istanbul Medical School, 34093, Istanbul, Turkey
| | - Meris Esra Bozkurt
- Division of Geriatrics, Department of Internal Medicine, Istanbul University, Istanbul Medical School, 34093, Istanbul, Turkey
| | - Cihan Kilic
- Division of Geriatrics, Department of Internal Medicine, Istanbul University, Istanbul Medical School, 34093, Istanbul, Turkey
| | - Mehmet Akif Karan
- Division of Geriatrics, Department of Internal Medicine, Istanbul University, Istanbul Medical School, 34093, Istanbul, Turkey
| | - Gulistan Bahat
- Division of Geriatrics, Department of Internal Medicine, Istanbul University, Istanbul Medical School, 34093, Istanbul, Turkey.
| |
Collapse
|
5
|
Ozkok S, Aydin CO, Sacar DE, Catikkas NM, Erdogan T, Kilic C, Karan MA, Bahat G. Associations between polypharmacy and physical performance measures in older adults. Arch Gerontol Geriatr 2021; 98:104553. [PMID: 34653922 DOI: 10.1016/j.archger.2021.104553] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 10/06/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES A preserved ambulation is one of the keypoints for functionality and polypharmacy, a common problem in older adults, is associated with worse functional status. Our aim was to examine the associations of polypharmacy with certain physical performance measures used to evaluate ambulation. METHODS This retrospective, cross-sectional study was conducted in a geriatric outpatient clinic. Using ≥5 medications was accepted as polypharmacy. Usual gait speed (UGS), chair sit-to-stand test (CSST), timed up and go test (TUG) and short physical performance battery (SPPB) were performed to assess physical performance status. We created two models for logistic regression analyses: Model 1 was adjusted for age, sex and body mass index (BMI). We added comorbidities to Model 1 and further created Model 2. RESULTS There were 392 participants (69.1% were female, mean age: 73.9±6.2 years). Polypharmacy was seen in 62.5%. Participants with polypharmacy presented with a poor physical performance compared to the no-polypharmacy group (p<0.001, for each). In multivariate analyses, polypharmacy was independently associated with poor SPPB (Odds Ratio (OR)=2.5; 95% Confidence Interval (CI)=1.3-4.7 and OR=2.4; 95% CI=1.2-4.8 for Model 1 and 2, respectively) and long CSST (OR= 2.6; 95% CI=1.3-5.2 and OR=3.7; 95% CI=1.7-8.2 for Model 1 and 2, respectively). There was a significant association between polypharmacy and slow UGS in Model 1 (OR=1.9; 95% CI=1.0-3.5); but relationship did not persist after adding comorbidities into the first model (OR=1.6; 95% CI= 0.8-3.1). There was no significant association between long TUG and polypharmacy in any of the models. CONCLUSION Polypharmacy is well-known with its association with falls and fractures in older adults and this might be explained by its association with poor physical performance. Whether polypharmacy causes a deterioration in physical performance is an issue needs to be enlightened by further longitudinal studies.
Collapse
Affiliation(s)
- Serdar Ozkok
- Department of Internal Medicine, Division of Geriatrics, Istanbul Medical School, Istanbul University, Capa, 34390, Istanbul, Turkey.
| | - Caglar Ozer Aydin
- Department of Internal Medicine, Division of Geriatrics, Istanbul Medical School, Istanbul University, Capa, 34390, Istanbul, Turkey
| | - Duygu Erbas Sacar
- Department of Internal Medicine, Division of Geriatrics, Istanbul Medical School, Istanbul University, Capa, 34390, Istanbul, Turkey
| | - Nezahat Muge Catikkas
- Department of Internal Medicine, Division of Geriatrics, Istanbul Medical School, Istanbul University, Capa, 34390, Istanbul, Turkey
| | - Tugba Erdogan
- Department of Internal Medicine, Division of Geriatrics, Istanbul Medical School, Istanbul University, Capa, 34390, Istanbul, Turkey
| | - Cihan Kilic
- Department of Internal Medicine, Division of Geriatrics, Istanbul Medical School, Istanbul University, Capa, 34390, Istanbul, Turkey
| | - Mehmet Akif Karan
- Department of Internal Medicine, Division of Geriatrics, Istanbul Medical School, Istanbul University, Capa, 34390, Istanbul, Turkey
| | - Gulistan Bahat
- Department of Internal Medicine, Division of Geriatrics, Istanbul Medical School, Istanbul University, Capa, 34390, Istanbul, Turkey
| |
Collapse
|
6
|
Affiliation(s)
- Gulistan Bahat
- Division of Geriatrics, Department of Internal Medicine, Istanbul Medical School, Istanbul University, Capa, 34390, Istanbul, Turkey.
| | - Duygu Erbas Sacar
- Division of Geriatrics, Department of Internal Medicine, Istanbul Medical School, Istanbul University, Capa, 34390, Istanbul, Turkey
| |
Collapse
|