Allogeneic hematopoietic cell transplantation (alloHCT) may be the only curative option for some older adults with hematologic malignancies, and its associated risks of significant morbidity and mortality warrant a clear, informed decision-making process. As older adults have not been transplanted routinely until recent years, younger people have been the prototypical group around whom the current process has developed. Yet, this process is applied to older adults who have different considerations than younger patients when making their transplant decision. Older adults do not have the open-ended lives of younger patients and are entitled to consider how to spend their remaining time. They also possess maturity and experience, and with proper knowledge, they can make informed choices rather than moving forward in the transplant process unaware. Notably, older patients face similar problems with the informed decision-making process in nephrology. Strategies such as providing education about alloHCT gradually and repeatedly during induction, presenting recent knowledge from the literature in plain language, and utilizing a team approach to patient education may help older adults make the best decision about transplant in light of their situation and values. Understanding when and how older adults decide on alloHCT is an important first step to further exploring this problem.

Purpose: Urinary incontinence (UI) is very common problem in older problem. This study evaluates the prevalence of UI, and associated factors with UI in community dwelling older people in Turkey.Materials and methods: This was a cross-sectional study as part of a health survey conducted with community dwelling older people. Demographic, clinical data, UI and its types were obtained by interview. Post-void residual (PVR) volume was measured with ultrasound.Results: The prevalence of UI was 43.9%. The most common type was urge UI (23.7%). Associated factors with UI were gender, low income, low education level, chronic diseases, chronic constipation, chronic cough, number of deliveries, benign prostatic hyperplasia, past genitourinary surgery and lower urinary tract symptoms. PVR volume was not related with UI.Conclusions: UI is very common in older people in Turkey. PVR volume is not related to the presence of UI in our study due to the lower prevalence of significantly high PVR volumes and lack of individuals with overflow UI. (C) 2015 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.

Recent studies have shown that vitamin D, an important factor for bone health, can also play a role in reducing the risk for several other diseases. Its deficiency seems to be associated with cardiovascular disease. Arterial stiffness, a well-known predictor of hypertension, morbidity and mortality, increases with advancing age. We evaluated the relationship between serum 25-hydroxyvitamin D levels and arterial pulse wave velocity (aPWV) in an aging population. In randomly selected 876 subjects we studied the association between the vitamin D level and arterial stiffness. We used a Sphygmocor device to measure the aortic pulse velocity (PWV) to evaluate the arterial stiffness. There was a clearly negative trend in aortic PWV among 25-OH-D tertiles. The association between 25-0H-D and aortic PWV remained significant after adjustment for age, gender and other potential confounders; subjects in the first 25-OH-D tertile had adjusted odds ratio 1.9 (1.2-3.0) for having aortic PWV top tertile in multiple regression. Vitamin D levels are inversely associated with increased arterial stiffness in a normative aging population, irrespective of traditional risk factors burden. Further research is needed to clarify the role of vitamin D on arterial stiffness and whether supplemental vitamin D may play a role in prevention of cardiovascular disease or not. (C) 2014 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.

BACKGROUND/OBJECTIVES:Sarcopenia and sarcopenic obesity (SO) are geriatric syndromes leading to physical disability, poor quality of life and death. The aim of this study was to investigate the prevalence of sarcopenia and SO in nursing homes in Turkey and to define local disparities for diagnosing sarcopenia and SO.SUBJECTS/METHODS:This cross-sectional multicenter study was performed in 711 patients in 14 nursing homes. Comprehensive geriatric assessment tests, handgrip strength and calf circumference (CC) measurements were carried out. Sarcopenia was both defined by handgrip strength and CC criteria.RESULTS:According to handgrip strength measurement, 483 (68%) of patients were sarcopenic (male: 72%, female: 63.8%), 228 were non-sarcopenic. The prevalence of SO was 22% (13.7% in men, 30.2% in women). Patients (82.5%) who were diagnosed as sarcopenic by the handgrip strength test were not sarcopenic according to CC sarcopenia criteria. Therefore, we tried to determine the optimal CC value for diagnosing sarcopenia in our population.CONCLUSIONS:Both sarcopenia and SO were prevalent among Turkish nursing home elderly residents. Most of the patients with sarcopenia were obese or overweight. We showed that diagnosing sarcopenia with CC measurement underestimated the sarcopenia prevalence assessed by handgrip strength. So we concluded that, although different assessment methods are recommended for the diagnosis of sarcopenia local disparities should be considered.

The Middle Eastern population is aging rapidly, and as aging is the main risk factor for cancer, the incidence and prevalence of that disease are increasing among all the populations in the region. These developments represent huge challenges to national and community-based health services. At the current state of affairs, most Middle Eastern countries require the cooperation of international agencies in order to cope with such new challenges to their health systems. The focus and emphasis in facing these changing circumstances lie in the education and training of professionals, mainly physicians and nurses, at the primary, secondary and tertiary levels of health services. It is imperative that these training initiatives include clinical practice, with priority given to the creation of multidisciplinary teams both at the cancer centers and for home-based services.

Background and aim: Malnutrition is related with serious morbidity and mortality in institutionalized older adults. The aim of this study is to determine the frequency of malnutrition in nursing homes and care homes and to identify the factors associated with malnutrition in these settings.Methods: This multicenter study was conducted in 14 centers of nursing homes/care homes in three different cities. Total number of 1797 residents aged >= 65 years was enrolled. Malnutrition screening was made by Mini Nutritional Assessment Short Form (MNA-SF) and full MNA. Statistical analyses were conducted by SPSS 15.0.Results: The median age (min-max) of the study population was 78.0 (65.0-108.0) and 917 (51%) were female. MNA-SF score of the residents was 11(0-14). According to the MNA-SF 850(49.3%) residents had normal nutritional status, 654 (38.3%) residents were at malnutrition risk, and 204 (11.9%) had malnutrition. Number of medications, gender, duration of stay in the institution, frequency of family visits, social security status, type of nursing home (government or not), daily life activities (ADL), Geriatric Depression Scale (GDS) and MMSE scores, get up & go test, hypertension, dementia, depression, and Parkinson disease were associated with malnutrition. Regression analyses revealed that get up&go test, GDS, hypertension, and ADL were independently related to malnutrition diagnosed by MNA-SF.Conclusion: This study provides important information on the prevalence and associated factors of malnutrition in a large multicentered setting of nursing homes and care homes. It will direct the screening plans and interventions taken in order to detect, prevent, and manage malnutrition in these settings. (C) 2013 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.

Background: Asymptomatic bacteriuria (ASB) is common among the older persons. Several factors may precipitate ASB, including age-related changes in genitourinary system and comorbid diseases. Unnecessary antibiotic use for ASB could be associated with increased antibiotics resistance. The aim of this study was to determine the prevalence and related factors of ASB among the elderly living in the community.Methods: In this study, 625 patients admitted to our geriatric outpatient clinic were enrolled. Comprehensive geriatric and physical assessment, a standardized questionnaire, medical history, and urine and blood sampling were performed. ASB was defined as identical microorganisms isolated from two consecutive urine specimens (>= 10(5) colony-forming units/mL).Results: Mean age of patients was 72.4 +/- 5.6 and 394 (63%) were female. The prevalence of ASB was 6.2%. Whereas female gender was associated with ASB, presence of ASB was not associated with age, previous urinary tract infection (UTI), urolithiasis, genitourinary surgery, and/or urinary incontinence. Similarly, diabetes mellitus (DM), obesity, hypertension, and creatinine clearance were not found to be associated with presence of ASB. Laboratory results were similar in the subjects with or without ASB. The most commonly isolated organism was Escherichia coli (66.7%). In addition, while the specificity of leukocyte-esterase and nitrite were high, the sensitivity of both tests was low in the subjects with ASB.Conclusions: These results indicate that ASB is common and the main risk factor for ASB is female gender among non-institutionalized elderly. E. coli were the most commonly isolated bacterium. Urine dipstick tests seem to be useful in older persons to exclude the presence of bacteriuria. (c) 2012 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.

Purpose: The aim of our study is to define the association between microvascular complications and plasma viscosity (PV) in the diabetic elderly and to determine whether PV measurement can be used as a potential marker for microvascular complications of diabetes.Methods: In this cross-sectional study consisted of people aged 65 or over, 226 of them had diabetes and 59 of them did not. Those with inflammatory disease, infection and organ failure were not included in the study as they could affect PV. Diabetic cases are categorized into groups according to their microvascular complications. The PV of all the cases was measured by Brookfield DV-II viscometer.Results: PV is significantly higher in diabetic patients when compared to the non-diabetic control group (1.71 +/- 0.17 mPa s and 1.48 +/- 0.06 mPa s respectively, P < 0.001). PV is higher in DM patients with neuropathy as compared to those without any microvascular complications (1.76 +/- 0.16 mPa s and 1.60 +/- 0.07 mPa s respectively, P < 0.001). In all the dual and triple combinations of microvascular complications, the average PV is found to be significantly higher than those with no complications (for all groups P < 0.001). In addition, there is statistically significant positive association between the severity of diabetic retinopathy and PV (P < 0.001).Conclusion: PV is clearly elevated in the diabetic elderly, particularly in patients with microvascular complications. These elevations are significantly correlated with the duration of diabetes, metabolic control level and the number of microvascular complications. Studies are needed to show the cause and effect relationship between diabetic complications and PV in the elderly. (C) 2012 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.

Objective: Erythrocyte sedimentation rate (ESR) despite being a fast and cheap test to evaluate acute phase response, has low sensitivity and specificity. Atypical courses and lack of specific signs and symptoms of the diseases in elderly restrict the use of ESR for diagnosis. We aimed to determine clinical importance and possible etiologies of markedly elevated ESR in older adults.Patients and methods: One thousand six hundred and eighty-two patients consecutively admitted to Ankara University School of Medicine Geriatric clinics were evaluated. A hundred and ten patients with ESR more than 80 mm/h were included into study and evaluated for the possible causes of ESR elevation.Results: Etiology of elevated ESR was due to infectious diseases in 53 (48.2%), malignancy in 19 (17.3%), and collagen tissue diseases in 17(15.5%) patients. Some of the etiologies coexisted in 10 (9.1%) patients. No specific etiology was detected in 31(28.2%) patients. Among infectious diseases, pneumonia (n = 20/ 53,37.7%) was the leading cause followed by urinary tract infections (UTI) (n = 17/53, 32.1%). Multiple myeloma (n = 7/19,36.8%) was the leading cause among malignancies. Rheumatoid arthritis (n = 10/17, 58.8%) was the leading cause among collagen tissue diseases. Leukocyte count and C-reactive protein levels are useful to determine infectious diseases as a cause of markedly elevated ESR. (c) 2012 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.