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Background An increase in the use of health-related mobile applications is expected in the future. It is believed that mobile applications are valuable tools for patients, caregivers, and healthcare professionals. The use of mobile applications to improve medication adherence in older adults is effective, but it must be developed based on the special needs of older adults for high quality and long-term use. The aim of this Delphi survey study is to develop the content of a mobile application aimed to improve medication adherence among older adults by obtaining views from a panel including healthcare professionals, patients and patient care givers. Methods An online Delphi method was implemented by using a questionnaire platform to obtain consensus on key content for a mobile application. Pharmacists, physicians, nurses, patients and patient caregivers were invited to participate in the consensus. Results A total of 107 health care professionals, patients and care givers were invited to the study to develop consensus for the content of the mobile application. The response rates to three surveys were 56%, 90%, and 96%, respectively. Content including reminders for the patient on when to take the medicine, instructions for medications such as taking medication on an empty or full stomach or every morning or evening, feedback for getting new prescriptions when the medications are about to run out, information on what to do if the patient forgets to take the medication, and confirmation after the patient takes the medication, visual and written instructions for specific medications, information about medication doses specific to the patient’s prescription, reminders to take medication one hour before or after based on the requirement of empty or full stomach administration and reminder when is the appropriate time for physician appointment were selected as critical. Conclusions The content was created for the potential development of a mobile application to improve medication adherence. These findings could serve as a foundation for designing a mobile application tailored specifically for older adults in the future. Clinical trial number Not applicable.

Background Anticholinergic and/or sedative mediations are one of the most commonly prescribed medication groups in older adults. This study aimed to assess the prevalence of anticholinergic and/or sedative mediations use in community dwelling older adults as well as potentially associated factors with their use. Methods A cross sectional study was conducted among community dwelling older adults who accepted invitation for geriatric screening in the Public Education Centres (PEC) in Türkiye. The subgroup study population was selected among those who used at least one medication. The prevalence of anticholinergic and/or sedative mediations use, comprehensive geriatric tests, drug–drug interactions and polypharmacy were assessed. Statistical analysis was performed to identify associated factors with anticholinergic and/or sedative mediations use. Results A total of 608 older adults voluntarily participated in the study from the 16 PEC. Among these 372 were eligible (61%). The prevalence of anticholinergic and/or sedative medications use was 36% among the community dwelling older adults. Polypharmacy was present in 32% of the them. Drug–drug interactions involved anticholinergic and/or sedative medications was common (42%). Polypharmacy ( p  < 0.001) and poor physical function (frailty, p  = 0.026; sarcopenia, p  = 0.003; instrumental activities of daily living, p  = 0.001; and activities of daily living, p  = 0.045) were found to be associated with the use of anticholinergic and/or sedative medications in this study. Conclusions With common anticholinergic and/or sedative mediations use and its associated risk for polypharmacy, poor physical function and drug-drug interactions, their use must be balanced with their potential risks and benefits.

Background and aim Sarcopenia and sarcopenic obesity (SO) are associated with adverse health outcomes in older people. Data on sarcopenia- and SO-related mortality are insufficient for hospitalized older people. The aim of this study was to evaluate the relationship between sarcopenia, SO and mortality among hospitalized older people. Methods Two-centered prospective observational study was conducted among 350 hospitalized older people in geriatric units of two university hospitals. Sarcopenia was defined according to the European Working Group on Sarcopenia in Older People. Obesity was defined according to fat mass percentage. Medical history, cognitive status, nutritional status and functionality and laboratory tests were assessed. All-cause mortality rate was recorded at 2 years. Results The prevalence of SO was 21.1%. The prevalence of sarcopenia was 11.4%. Both sarcopenia (log rank p  < 0.001) and SO (log rank p  < 0.001) were associated with all-cause mortality at 2 years. There was no difference between sarcopenia and SO for mortality. SO (HR 5.23, p  < 0.001), sarcopenia (HR 9.26, p  < 0.001), male gender (HR 2.25, p  = 0.035), Lawton IADL (HR 0.77, p  = 0.02), heart failure (HR 3.25, p  = 0.02) and chronic obstructive lung disease (HR 5.16, p  = 0.01) were independently related to all-cause mortality. Discussion and conclusions Both sarcopenia and SO showed an independent relationship for 2-year all-cause mortality after hospital discharge. These results suggest that preventive and treatment options should be taken to decrease mortality associated with these conditions among hospitalized older people.

Background Vitamin D deficiency is known to cause increased predisposition to various infectious diseases and the addition of vitamin D to antimicrobial treatment may improve treatment responses. However, the relationship between vitamin D and Helicobacter pylori ( H. pylori ) remains to be determined. Aims To assess the association between vitamin D deficiency and H. pylori infection. Methods This cross-sectional study included patients aged 65 and over, who underwent gastroscopy and had gastric biopsy performed between 2010 and 2017. Of the 441 patients, 254 had available 25-hydroxyvitamin D level results and were included in the analyses. Patients were categorized into H. pylori (+) and H. pylori (−) groups, according to histopathological examination results of gastric biopsies. Serum 25(OH) vitamin D levels less than 20 ng/mL were defined as vitamin D deficiency. Results Of all patients, 43 were H. pylori (+) and 211 were H. pylori (−). More patients had vitamin D deficiency (< 20 ng/mL) in the H. pylori (+) group than the H. pylori (−) group (86% vs 67.3%, p  = 0.014). The proportion of H. pylori (+) patients decreased across increasing quartiles of 25(OH) vitamin D levels ( p for trend = 0.010). In multivariable logistic regression analysis, vitamin D deficiency was associated with increased odds of H. pylori infection after adjustment for age, gender, and Charlson Comorbidity Index (OR = 3.02, 95% CI 1.19–7.69, p  = 0.020). Conclusion Vitamin D deficiency can be associated with increased risk of H. pylori infection. The potential protective effect of vitamin D against H. pylori infection and its possible role in the treatment of H. pylori should be evaluated in prospective trials.

Background and aims : Obesity is one of the most common diseases in the world. Particularly in elderly subjects, the effects of weight loss on cardiac functions have not been previously investigated by means of pulsed wave tissue doppler imaging (PWTDI). Using PWTDI, we examined the effects of weight loss on cardiac functions and left ventricular (LV) mass in obese geriatric women. Methods : Thirteen obese women aged 66–83 years (mean age 71.2±4.9 yrs) with a body mass index 35.&49 kg/m 2 (mean body mass index 39.9±4.3 kg/m 2 ) were evaluated by echocardiography and PWTDI. Only subjects with uncomplicated obesity were included. All measurements, including anthropometric variables, systolic and diastolic indices, and LV mass, were made before and after a 6-month Orlistat plus hypocaloric diet. Myocardial systolic wave (Sm) velocity, isovolumic acceleration (IVA), myocardial precontraction time (PCTm) and the PCTm to contraction time (CTm) ratio were calculated as systolic indices. Early diastolic wave (Em), late diastolic wave (Am), Em to Am ratio, myocardial relaxation time (RTm), deceleration time (DT) and isovolumic relaxation time (IVRT) were determined as diastolic measurements. Results : Subjects lost an average of 8.4±1.2 kg. LV mass decreased significantly after weight loss (p<0.001). In addition, IVRT decreased significantly (p=0.038). Only RTm decreased significantly (p=0.016), whereas other PWTDI parameters of LV remained the same. In the right ventricle, Sm velocity, IVA, Em, and Am velocities were similar. However, the PCTm to Am ratio decreased significantly (p=0.006), and the Em to Am ratio increased (p=0.04) and RTm decreased significantly (p=0.016) after weight loss. Conclusions : In obese geriatric women, weight loss improves ventricular diastolic functions and decreases LV mass. It also contributes to partial improvement in right ventricular systolic function.

Purpose Parkinson’s Disease (PD), a neurodegenerative disorder, is associated with substantial morbidity. α-Klotho, an anti-aging protein known for its neuroprotective properties, has gained attention. This study aims to assess serum levels of α-Klotho in PD patients. Methods This study is a cross-sectional case-control study. PD was diagnosed according to UK Parkinson Disease Society Brain Bank criteria. Serum α-Klotho level was measured using a commercially available enzyme-linked immunosorbent assay. Results Of the 314 participants in the study, 157 were patients with PD and 157 were controls. Lower levels of α-Klotho were observed in PD (0.85 nmol/L) in comparison to the controls (1.47 nmol/L, p  < 0.001). α-Klotho levels were also significantly lower among PD patients with dementia compared to PD patients without dementia. In logistic regression analysis, α-Klotho (OR: 0.04, p  < 0.001) demonstrated a significant relationship between PD. A significant correlation was identified between α-Klotho levels and Mini-Mental State Examination scores in PD patients. The sensitivity and the specifity of α-Klotho were 90% and 65% for predicting PD. Conclusions Our findings suggest that α-klotho could potentially serve as a biomarker. However additional studies are needed to confirm our findings. Key points Aim This study aimed to investigate the potential association between α-Klotho, a protein implicated in longevity, and Parkinson’s Disease, the most prevalent motor system disorder. Findings Our findings revealed both an association between serum α-Klotho protein and Parkinson’s Disease and its potential value for diagnostic applications. Message This study demonstrates an association between α-Klotho protein levels and Parkinson’s Disease, suggesting its potential as a biomarker for Parkinson’s Disease diagnosis.

The most affected area and characteristic fluid dynamics of peritoneal fluid circulation form the substance of this presentation. Currently, it is well known that diaphragmatic procedures in advanced ovarian cancer are safe and feasible and do not increase long-term morbidity.1 2 On that basis surgeons performing advanced operations for ovarian cancer may contribute to better surgical and oncological outcomes if they have solid anatomic knowledge and competency in the diaphragmatic surgical procedures applied in ovarian cancer surgery. Subperitoneal carbon dioxide insufflation and towel-aided dissection may facilitate and accelerate the procedure.4 For a case of glissonectomy, we present some tips and anatomical landmarks for extraperitoneal diaphragmatic stripping and partial resection (Video 1).

Objectives: To assess the impact of sarcopenia and vitamin D levels on the severity of lower urinary tract symptoms (LUTS). Methods: A total of 193 male patients, aged 60 years and above, who visited the geriatric outpatient clinic at Ibn-i Sina Hospital in Ankara, Turkey, between December 2019 and March 2021, were enrolled. Sarcopenia was diagnosed according to the criteria set by the European Working Group on Sarcopenia in Older People. The presence and severity of lower urinary tract symptoms were assessed using the International Prostate Symptom Score questionnaire, categorizing symptom severity as mild or moderate-to-severe. Results: The median patient age was 71 years (range: 66-77). Sarcopenia affected 24.9% of the population studied. Mild LUTS was observed in 43.5% and moderate-to-severe LUTS was observed in 56.5% of patients. Sarcopenia prevalence was significantly higher in the individuals with moderate-to-severe LUTS compared to those with mild-LUTS (p=0.021). After adjusting for Charlson comorbidity index and age, only vitamin D levels were significantly associated with increased odds of moderate-to-severe LUTS (odds ratio [OR]=0.95, 95% confidence interval [CI]: [0.92-0.98], p=0.002). Sarcopenia was not significantly associated with the severity of LUTS (OR=2.04, 95% CI: [0.94-4.45], p=0.070). An inverse linear trend was observed between quartiles of 25 (OH) vitamin D and LUTS severity. As 25 (OH) vitamin D levels increased, the proportion of patients with moderate-to-severe LUTS decreased (p=0.023). Conclusion: Sarcopenia did not significantly impact LUTS severity, but low vitamin D levels were associated with moderate-to-severe LUTS. Keywords: aged, prostatic hyperplasia, lower urinary tract symptoms, sarcopenia, vitamin D

Background Frailty indicates older people who are vulnerable to stressors. The relation between ultrasonographic parameters of muscle and frailty among older people has yet to be investigated. Aims The aim of the study is to investigate the relationship between frailty and the ultrasonographic measurements of the rectus femoris muscle (RFM). Methods This cross-sectional study included 301 participants who were ≥65 years. The FRAIL questionnaire assessed frailty. The thickness, cross-sectional area (CSA), fascicle length, pennation angle (PA), stiffness, and echogenicity of RFM were assessed by ultrasound. The accuracy of parameters in predicting the frailty was evaluated by ROC analysis. Results Of all 301 participants, 24.6% were frail. Pre-frail and frail participants had significantly lower thickness ( p  = 0.002), CSA ( p  = 0.009), and fascicle length ( p  = 0.043) of RFM compared to robust. PA was significantly lowest in frails ( p  < 0.001). The multivariate logistic regression analysis showed that PA values lower than 10.65 degrees were an independent predictor of frailty (OR = 0.83, 95% Cl: 0.70–0.97, p  = 0.019). Results of ROC analysis demonstrated a satisfactory result between the PA and frailty (AUC = 0.692, p  < 0.001). Discussion Thickness, CSA, and PA of RFM were found to be lower in frail subjects, which may indicate the changes in muscle structure in frailty. Among all parameters, lower PA values were independent predictors of frailty. These findings may indicate a novel ultrasound-based method in frailty, that is more objective and unrelated to the cross-sectional evaluation. Conclusions Ultrasonographic measurements of RFM, especially the lower PA may predict frailty in older people. As an objective and quantitative method, PA may be used to define frailty with acceptable sensitivity.

Objective: Nocturnal hypertension (HT) predicts HT-related end-organ damage and cardiovascular mortality, with a complex pathophysiology involving multiple factors. Vitamin D is considered an emerging contributor. This study examined the relationship between vitamin D level and nocturnal HT in older adults with HT. Materials and Methods: This cross-sectional study examined 219 patients aged [greater than or equal to] 60 years, who underwent ambulatory blood pressure (BP) monitoring. An average nighttime systolic BP [greater than or equal to] 120 mm Hg and/or diastolic BP [greater than or equal to] 70 mm Hg was diagnosed as nocturnal HT. Vitamin D insufficiency was defined as serum 25 (OH) vitamin D levels 30 ng/mL. Results: The prevalence of nocturnal HT was 69.9% among older hypertensive adults. In the group with nocturnal HT, there was a significantly higher percentage of patients with vitamin D insufficiency than those without (89.5% vs. 72.7%; p=0.002). A reverse linear relationship was noted between the quartiles of 25 (OH) vitamin D and the occurrence of nocturnal HT. The percentage of individuals with nocturnal HT declined as the quartiles of 25 (OH) vitamin D increased (p-value for trend = 0.015). In the multivariate logistic regression analysis, after accounting for age, Charlson's comorbidity index, and average daytime systolic BP values, vitamin D insufficiency was linked to a significantly higher likelihood of nocturnal HT (OR=4.92, 95% CI=1.66-14.61, p=0.004). Conclusion: Vitamin D insufficiency may contribute to the development of nocturnal hypertension in older hypertensive adults. Keywords: 25-Hydroxyvitamin D 2, aged, ambulatory blood pressure monitoring, hypertension, blood pressure