Ayfer Durak

Background: Anemia, multiple chronic conditions, and polypharmacy are common in older adults and are associated with adverse clinical outcomes. This study aimed to examine the relationship between anemia, chronic disease burden, and polypharmacy in individuals aged 80 years and older. Methods: This single-center cross-sectional study included individuals aged ≥80 years who were followed in a Healthy Aging outpatient clinic. Anemia was defined using World Health Organization criteria. Comorbidity burden (≥4 chronic conditions) and polypharmacy (≥6 medications) were recorded. Multivariable logistic regression was used to identify factors independently associated with anemia. Results: The study included 134 individuals. The mean age of the participants was 85.5 ± 3.9 years, and 61.2% were women. The overall prevalence of anemia was 51.5%. Compared to non-anemic individuals, those with anemia were older and had significantly higher comorbidity burden and a greater prevalence of polypharmacy. Hemoglobin levels were negatively correlated with both the number of medications and the number of comorbidities. In multivariable logistic regression analyses, age and polypharmacy were independently associated with anemia in one model. In an alternative model accounting for collinearity, age and comorbidity burden remained independently associated with anemia. Conclusions: Anemia is highly prevalent among individuals aged ≥80 years and is associated with comorbidity burden and polypharmacy. The findings suggest that a more holistic clinical approach that also considers these factors may be useful in the evaluation of anemia in this age group. Prospective studies are needed to clarify the direction of these associations.

Introduction: Geriatric syndromes are important clinical conditions that are common in elderly individuals, usually occur as a result of the interaction of more than one system, and negatively affect elderly health. Early identification of risk factors associated with these syndromes and timely implementation of appropriate interventions may contribute to the prevention of future health problems. Fear of falling is a significant risk factor that affects the quality of life in older adults both directly and indirectly. In this study, we aimed to evaluate the distribution of geriatric syndromes by gender and their association with fear of falling.Methods: This study was conducted by retrospectively analyzing the data of comprehensive geriatric assessment performed by a geriatrician in individuals aged 65 years and older who applied to the geriatric outpatient clinic of a tertiary hospital between June 2023 and August 2024. Demographic characteristics of the participants [age, sex, education level (≤5 years, >5 years), and living alone status], comorbidities, and geriatric syndromes were recorded. Within the scope of geriatric syndromes, the following were assessed: functional status [activities of daily living (ADL) and instrumental activities of daily living (IADL)], frailty, sarcopenia, nutritional status, depressive symptoms, cognitive function, sleep disorders, urinary incontinence, history of falls, fear of falling, and polypharmacy.Participants were divided into two groups based on the presence of fear of falling, and logistic regression analysis was performed to identify factors independently associated with fear of falling.Results: A total of 294 patients were included in the study (68.4% female; mean age 76.14 ± 6.77 years). Among the geriatric syndromes, dependence in instrumental activities of daily living (IADL), frailty, sarcopenia, cognitive impairment, urinary incontinence, and fear of falling were more frequently observed in women (p=0.032, 0.030, 0.014, 0.020, 0.011, and 0.034, respectively), while nutritional problems were more prevalent in men (p=0.031).The prevalence of fear of falling was found to be 46.6%. Fear of falling was significantly associated with dependence on basic and instrumental activities of daily living (ADL/IADL), frailty, sarcopenia, depression, urinary incontinence, and history of falls. Age, frailty, history of falls, and depression were identified as independent predictors of fear of falling (p<0.001, 0.016, <0.001, and 0.001, respectively).Conclusion: The fact that certain geriatric syndromes are more commonly seen in women may suggest that greater attention should be given to the health needs of older women. Early recognition of modifiable risk factors, such as fear of falling, may contribute to the prevention of frailty and depression. Screening and proper management of this risk factor, especially in primary healthcare settings frequently accessed by older adults, can significantly contribute to improving their quality of life. Prospective multicenter studies are needed to establish causality.

Aims: Urinary incontinence is a major public health issue that impairs quality of life and increases morbidity in older adults. This study investigated its relationship with clinical, functional, and laboratory parameters in home care patients aged ≥80.Methods: This single-center, cross-sectional study was conducted between May and November 2025 with individuals receiving home care services. Participants were evaluated during home visits and categorized based on the presence of incontinence. Demographic data, medical history (including current chronic diseases and regular medication use), nutritional status [Mini Nutritional Assessment–Short Form (MNA-SF)], level of depression [Geriatric Depression Scale (GDS)], and functional status [Katz Index of Activities of Daily Living (ADL)] were assessed. Laboratory parameters were also recorded. Logistic regression identified factors independently associated with incontinence.Results: 135 participants were evaluated (mean age: 85.6±3.9 years; 61.5% female). The prevalence of incontinence was 34.8%. Living alone, ADL dependency, malnutrition, dementia, and comorbidity count were significantly higher in those with incontinence (p

Background and Objectives: Rapid physiological decline in terminal cancer is frequently accompanied by accelerated skeletal muscle loss. Although bedside ultrasonography (US) is practical and feasible in palliative care settings, the prognostic relevance of short-term muscle change remains unclear. This study aimed to evaluate whether the rate of muscle loss over a 10-day period, assessed by serial ultrasound, is associated with survival duration in terminally ill cancer patients. Materials and Methods: This single-center retrospective cohort study included 87 inpatients with end-stage cancer who underwent bedside ultrasound measurements of the biceps brachii (BB) and rectus femoris (RF). Baseline US was performed within the first three days of admission, followed by a repeat assessment 10 days after baseline (day-10 follow-up ultrasound). Muscle thickness (MT) measurements were normalized by height squared (m²), and 10-day changes were calculated as delta (Δ) indices, defined as baseline minus day-10 values. Because the exposure of interest (Δ) can only be determined after completion of the day-10 assessment, survival timing analyses were anchored to this prespecified landmark. Survival duration was defined as the number of days from the day-10 follow-up ultrasound to death among patients who died within one year. Associations between muscle changes and survival duration were evaluated using correlation analyses and multivariable linear regression adjusted for age, sex, body mass index, Eastern Cooperative Oncology Group (ECOG) performance status, and nutritional risk. The primary analyses focused on survival timing among decedents. Results: Significant muscle loss was observed over the 10-day interval between baseline and 10 days after baseline. Among the 58 patients who died within one year, greater short-term biceps muscle loss, reflected by higher Δ BB muscle thickness index (Δ BB MT-I), was moderately associated with shorter survival duration (r = −0.437, p = 0.0006). In multivariable linear regression analysis, Δ BB MT-I remained independently associated with survival duration (β = −701.19; 95% CI: −1102 to −301; p = 0.0006), whereas RF muscle changes and baseline clinical variables were not statistically significant. Conclusions: Short-term biceps muscle loss assessed by serial ultrasound, as reflected by Δ BB MT-I, is associated with shorter survival duration in terminally ill cancer patients. These findings suggest that dynamic muscle changes, rather than single-time-point measurements, may provide clinically meaningful insight into short-term survival timing. Serial bedside muscle ultrasound may serve as a low-burden adjunct for prognostic communication in palliative care, although prospective time-to-event studies are required for validation.

Background/Objectives: Early risk assessment of nutritional and muscular status in geriatric palliative care patients may facilitate timely, personalized care. This study aimed to evaluate the association between the CONUT score, ultrasound-assessed muscle mass, and short-term mortality at 30, 45, and 60 days. Methods: This prospective, single-center study was conducted in a tertiary palliative care unit between May and September 2024. Muscle mass was assessed via ultrasound by measuring the thickness and cross-sectional area of the rectus femoris and biceps brachii. Nutritional status was evaluated using the CONUT score (low: ≤4, high: ≥5). Mortality at 30, 45, and 60 days was analyzed using Kaplan–Meier curves, Cox regression, and ROC analysis. Results: In a cohort of 200 geriatric palliative care patients (mean age 78.4 ± 10.2 years; 54.5% female), those with higher CONUT scores (≥5) had significantly lower ultrasound-assessed muscle mass and higher short-term mortality rates (48.6% vs. 11.3%, p < 0.001). A CONUT score ≥ 5 and the presence of malignancy independently predicted mortality, with hazard ratios up to 3.72. The CONUT score demonstrated moderate predictive accuracy for short-term mortality, highest at 60 days (AUC = 0.736). Kaplan–Meier analysis revealed significantly reduced survival among patients with higher CONUT scores. Conclusions: A CONUT score ≥ 5 and malignancy independently predicted short-term mortality, and higher CONUT scores were associated with lower muscle mass. The CONUT score may be a useful tool for early risk assessment in geriatric palliative care, though further research is warranted.

Background/aim: Malnutrition and muscle wasting are common in terminal cancer patients and adversely affect prognosis. Bedside muscle ultrasonography (US) has emerged as a practical tool to assess nutritional status and monitor therapy. This study evaluated the relationship between achieving individualized nutritional targets and changes in muscle indices measured by US in terminal cancer patients receiving palliative care. Materials and methods: Subcutaneous fat tissue thickness (SFTT), muscle thickness (MT), and cross-sectional area (CSA) of the rectus femoris (RF) and biceps brachii (BB) muscles were assessed by US over 10 days and normalized to height squared (m²). A total of 95 patients with complete retrospective data were included; 74.7% achieved their caloric targets, while 25.3% did not. Results: Patients who failed to meet caloric goals exhibited significantly greater reductions across all muscle parameters. Among those who achieved caloric targets, protein intake ≥1.5 g/kg/day was associated with reduced muscle loss compared to lower intake. The RF muscle was particularly sensitive to nutritional status, exhibiting more pronounced changes in response to both caloric and protein adequacy. No significant differences were observed between feeding routes, although patients receiving parenteral nutrition tended to exhibit greater decline. Correlation analyses demonstrated a significant negative association between time to achieve caloric targets and muscle preservation, underscoring the importance of early intervention. Linear regression further identified delayed caloric achievement as an independent predictor of accelerated muscle loss. Conclusion: Achieving caloric and high-protein targets is critical for preserving muscle mass in terminal cancer patients. US, particularly of the RF muscle, provides a reliable, noninvasive, and practical tool for monitoring the effects of nutritional interventions in this vulnerable population.

Dementia, particularly Alzheimer’s disease, is a globally growing health concern characterized by cognitive decline. Due to the progressive nature of the disease, individuals with dementia are at high risk of malnutrition. This chapter discusses the contributing factors to malnutrition, its causes, and nutritional management strategies for individuals with dementia. Malnutrition may result from a combination of appetite loss, dysphagia, medication side effects, behavioral changes, and caregiver limitations. As the disease advances, patients become increasingly dependent on others for their nutritional needs, which negatively impacts the quality of life for both patients and caregivers. Nutritional management should include early screening, individualized interventions, oral nutritional support, and if necessary, enteral or parenteral feeding options. Additionally, caregiver education and support are essential components of effective nutritional care. A multidisciplinary approach is crucial for improving the nutritional status and overall well-being of individuals with dementia.

Background/Objectives: Vitamin D deficiency is linked to muscle loss and fat changes in older adults, but data regarding palliative patients are limited. Ultrasound offers a practical tool to assess these changes. This study explores the relationship between vitamin D levels and ultrasound-measured muscle, fat, and their ratio in older adult palliative patients. Methods: This prospective cross-sectional study was conducted in a tertiary palliative care unit (June–September 2024). A total of 187 patients were grouped by serum vitamin D levels (p = 0.037), ADL dependency (p < 0.001), lower BMI (p = 0.020), and reduced CC (p = 0.006). RF-MT, RF-SFT, RF-CSA, BB-MT, and BB-CSA were lower in the deficient group. RF-MT/SFT ratio was higher (p = 0.049). ADL dependency (p = 0.002) and RF-MT/SFT (p = 0.015) were independent predictors. Conclusions: Vitamin D deficiency was linked to a higher muscle-to-fat ratio, mainly due to fat loss rather than muscle gain. This may misrepresent muscle preservation and should be interpreted cautiously. Although vitamin D levels appear to be associated with physical function, additional prospective cohort and interventional supplementation studies are warranted to determine whether routine screening and targeted vitamin D supplementation can effectively support physical function in this population.