Background: Nonadherence to dietary and fluid restrictions, hemodialysis (HD), and medication treatment has been shown to increase the risks of hospitalization and mortality significantly. Sociodemographic and biochemical parameters as well as psychosocial conditions such as depression and anxiety are known to affect nonadherence in HD patients. However, evidence related to the relative importance and actual impact of these factors varies among studies. Purpose: The aim of this study was to identify the factors that affect nonadherence to dietary and fluid restrictions, HD, and medication treatment. Methods: This descriptive study was conducted on 274 patients who were being treated at four HD centers in Turkey. The parameters used to determine nonadherence to dialysis treatment were as follows: skipping multiple dialysis sessions during the most recent 1-month period, shortening a dialysis session by more than 10 minutes during the most recent 1-month period, and Kt/V < 1.4. The parameters used to determine nonadherence to dietary and fluid restriction were as follows: serum phosphorus level > 7.5 mg/dl, predialysis serum potassium level > 6.0 mEq/L, and interdialytic weight gain > 5.7% of body weight. The Morisky Green Levine Medication Adherence Scale was performed to determine nonadherence to medication treatment. A patient was classified as nonadherent if he or she did not adhere to one or more of these indices. The Hospital Anxiety and Depression Scale was used to identify patient risk in terms of anxiety and depression. Logistic regression was used to determine the predictors of nonadherence. Results: The nonadherence rate was 39.1% for dietary and fluid restrictions, 33.6% for HD, and 20.1% for medication. The risk of nonadherence to dietary and fluid restriction was found to be 4.337 times higher in high school graduates (95% CI [1.502, 12.754], p = .007). The risk of nonadherence to HD treatment was 2.074 times higher in men (95% CI [1.213, 3.546], p = .008) and 2.591 times higher in patients with a central venous catheter (95% CI [1.171, 5.733], p = .019). Longer duration in HD resulted in 0.992 times decrease in risk of nonadherence to treatment (95% CI [0.986, 0.998], p = .005). Conclusions/Implications for Practice: Educational status, being male, having a central venous catheter, and having a short HD duration were found to be risk factors for nonadherence. Nurses must consider the patient's adherence to the dietary and fluid restrictions, HD, and medication treatment at each visit.

OBJECTIVE: Data on the effect of anticholinergic cognitive burden (ACB) in older adults with subjective cognitive decline (SCD) are limited. We aimed to study whether ACB increases the future risk of dementia in older adults with SCD. METHODS: The retrospective cohort analysis was carried out on 1496 older adults. Out of those, 109 older patients with SCD followed up over 36 months were studied. They were divided into two groups according to cognitive status at last visit: group I included the subjects with SCD who did not progress to dementia and group II included those who progressed to dementia. The drugs with anticholinergic effects that were received by subjects three months or more were identified from records. The drugs were categorized as having absent (ACB = 0), possible (ACB = 1), and definite (ACB = 2) anticholinergic properties based on an ACB scale. ACB was calculated for each subject by adding the score of each drug and classified as no or low ACB (ACB ≤ 2) and high ACB (ACB ≥ 3). RESULTS: The mean age of all subjects was 72.5 ± 6.3 years and 66.1% of the sample was female. The median follow-up time for all subjects was 75 months (range, 36–185). Fifteen (13.8%) of 109 participants with baseline SCD developed dementia. High ACB was present in 12 subjects (12.8%) in group I and 7 subjects (46.7%) in group II (p = .001). The 75–84 and 85+ age groups (hazard ratio (HR) = 3.595; CI: 1.117–11.574; p = .032 and HR = 12.203; CI: 2.889–51.537; p = .001, respectively), hypertension (HR = 7.835; CI: 1.020–60.189; p = .048), and high ACB (HR = 4.312; CI: 1.563–11.899; p = .005) were found to be possible risk factors for dementia among subjects with SCD in the univariate model. In the final multivariate Cox regression model, subjects with high ACB had a 4.2-fold the risk of the development of dementia. Metoprolol (28.6%), trazodone (21.4%), and trospium (12.9%) were leading used drugs with anticholinergic properties. Among subjects with a total ACB score ≥ 3, the majority were on trospium (29.0%), followed by metoprolol (16.2%), paroxetine (16.2%), and trazodone (16.2%). CONCLUSION: We found that high ACB increases 4.2-fold the risk of the development of dementia in older adults with SCD in long-term follow up. The results of our study are promising, however, the effect of ACB on cognitive status among subjects with SCD is still lacking. To clarify the association between ACB and the risk of dementia, large and longer prospective studies are needed in this population.

Vitamin D is thought to have a probable helpful effect on the action of insulin. There is little information regarding this relationship in prediabetic elderly subjects in the literature. The aim of this study was to investigate differences in insulin sensitivity and metabolic parameters according to vitamin D levels in prediabetic elderly subjects. Seventy nine elderly subjects (31 male, 48 female; mean age: 75.8±6.04 years) who admitted to the Department of Geriatry of Gulhane Military Medical Faculty were included in the study. According to plasma concentrations of 25(OH)D, the subjects were categorized in 2 groups: those with a level lower than 20 ng/mL (vitamin D deficiency: Group I) and those with a level higher than 20 ng/mL (vitamin D insufficiency [20-30 ng/mL] or vitamin D normal [>30 ng/mL]; Grup II). Serum insulin and HOMA-IR levels in Group I were significantly higher than those in Group II (p=0.025 and p=0.021, respectively). In all the subjects there was a statistically significant negative correlation between plasma 25(OH)D levels and HOMA-IR and insulin levels (r=-0.287 and r=-0.302, respectively). Our results indicate that insulin sensitivity may decrease in prediabetic elderly subjects with vitamin D deficiency. Further randomized, controlled, and prospective studies are necessary to investigate the relationship between vitamin D and these parameters in prediabetic elderly subjects.