Vaccination Rates in Geriatric Outpatient Clinic in Gaziantep Dr. Ersin Arslan Training and Research Hospital

Aim:Vaccination against influenza, pneumococcal disease, herpes zoster and tetanus-diphtheria-acellular pertussis (Tdap) is recommended for older adults. Data on vaccination rates in older adults are limited for our country. We aimed to investigate the prevalence of vaccination in community-dwelling older adults.Methods:Patients >= 65 years admitted to Dr. Ersin Arslan Research and Training Hospital geriatric outpatient clinic between September 2017 and May 2018 in Gaziantep were included. Demographic data and number of medicines were recorded. Frailty was assessed by the FRAIL scale. The patients were asked about their vaccination status against pneumococcal disease (conjugate vaccine in any period of life, polysaccharide vaccine in the past five years), influenza virus (for current year) and Tdap (in the past 10 years).Results:A total of 268 patients with the mean age of 76.7±7.2 years were included. Two hundred and four (76.1%) were female and 64 (23.9%) were male. The median number of drugs was 4 (0-16). Twenty one (7.8%) were robust and the remaining subjects were frail or prefrail. The prevalence of influenza vaccination was 8.2% (n=22) and pneumococcal vaccination was 0.7% (n=2, polysaccharide vaccine). There were no patients with herpes zoster or Tdap vaccines.Conclusion:In our study, we observed quite lower vaccination prevalence in older adults. Reporting vaccination rates in older adults may help draw health professionals’ attention to this issue, thereby increase vaccination rates

An under-diagnosed geriatric syndrome: sleep disorders among older adults.

Introduction: Sleep disorders are commonly under-diagnosed in the geriatric population. We aimed to determine the prevalence of sleep problems among older adults admitted to the geriatrics out-patient clinic. Methods: Two hundred and three patients (136 female) older than 75 years of age were included in the study. Patients underwent comprehensive geriatric assessment, including identification of sleep problems using the Sleep Disturbance Scale, Rapid eye movement (REM) sleep behavior disorder (RBD) Single-Question Screen questionnaire (RBD1Q) and The Johns Hopkins Restless Leg Syndrome Severity Scale. Demographic and clinical data including age, sex, medications, comorbid diseases, body mass index and functional scores was noted. Results: The mean age of the patients was 80.92\ub14.3 years. 35.5% of the patients had findings of REM-SBD and 32.5% of the patients had restless legs syndrome. Ninety-seven percent of the patients answered \u2018yes\u2019 to at least one of the sleep disturbance scale questions. There was no significant difference between male and female groups. Conclusion: We observed that sleep disorders were common among older adults. For this reason, the course and quality of sleep should be examined in all patients as a routine part of comprehensive geriatric assessment

Deprescribing tool for STOPPFall (screening tool of older persons prescriptions in older adults with high fall risk) items

Background: Health care professionals are often reluctant to deprescribe fall-risk-increasing drugs (FRIDs). Lack of knowledge and skills form a significant barrier. To support clinicians in the management of FRIDs and to facilitate the deprescribing process, a deprescribing tool was developed by a European expert group for STOPPFall (Screening Tool of Older Persons Prescriptions in older adults with high fall risk) items. Methods: STOPPFall was created using an expert Delphi consensus process in 2019 and in 2020, 24 panellists from EuGMS SIG on Pharmacology and Task and Finish on FRIDs completed deprescribing tool questionnaire. To develop the questionnaire, a Medline literature search was performed. The panellists were asked to indicate for every medication class a possible need for stepwise withdrawal and strategy for withdrawal. They were asked in which situations withdrawal should be performed. Furthermore, panellists were requested to indicate those symptoms patients should be monitored for after deprescribing and a possible need for follow-ups. Results: Practical deprescribing guidance was developed for STOPPFall medication classes. For each medication class, a decision tree algorithm was developed including steps from medication review to symptom monitoring after medication withdrawal. Conclusion: STOPPFall was combined with a practical deprescribing tool designed to optimize medication review. This practical guide can help overcome current reluctance towards deprescribing in clinical practice by providing an up-to-date and straightforward source of expert knowledge

Optimizing pharmacotherapy and deprescribing strategies in older adults living with multimorbidity and polypharmacy: EuGMS SIG on pharmacology position paper

Key summary points: Aim: To summarize the literature on medication review and deprescribing in older adults, and formulate recommendations to improve prescribing medications in older, multimorbid adults with polypharmacy. Findings: Current evidence demonstrates a need for a multifaceted and wide-scale change in education, guidelines, research, advocacy, and policy to improve the management of polypharmacy in older people, and to make deprescribing part of routine care for the ageing generations to come. Message: By implementing the recommendations in this paper, healthcare professionals will be better prepared to address the challenges associated with an ageing population and provide high-quality care to older patients with complex health and social care needs

STOPPFall (Screening Tool of Older Persons Prescriptions in older adults with high fall risk): a Delphi study by the EuGMS Task and Finish Group on Fall-Risk-Increasing Drugs.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadBackground: Healthcare professionals are often reluctant to deprescribe fall-risk-increasing drugs (FRIDs). Lack of knowledge and skills form a significant barrier and furthermore, there is no consensus on which medications are considered as FRIDs despite several systematic reviews. To support clinicians in the management of FRIDs and to facilitate the deprescribing process, STOPPFall (Screening Tool of Older Persons Prescriptions in older adults with high fall risk) and a deprescribing tool were developed by a European expert group. Methods: STOPPFall was created by two facilitators based on evidence from recent meta-analyses and national fall prevention guidelines in Europe. Twenty-four panellists chose their level of agreement on a Likert scale with the items in the STOPPFall in three Delphi panel rounds. A threshold of 70% was selected for consensus a priori. The panellists were asked whether some agents are more fall-risk-increasing than others within the same pharmacological class. In an additional questionnaire, panellists were asked in which cases deprescribing of FRIDs should be considered and how it should be performed. Results: The panellists agreed on 14 medication classes to be included in the STOPPFall. They were mostly psychotropic medications. The panellists indicated 18 differences between pharmacological subclasses with regard to fall-risk-increasing properties. Practical deprescribing guidance was developed for STOPPFall medication classes. Conclusion: STOPPFall was created using an expert Delphi consensus process and combined with a practical deprescribing tool designed to optimise medication review. The effectiveness of these tools in falls prevention should be further evaluated in intervention studies. Keywords: accidental falls; adverse effects; aged; deprescribing; fall-risk-increasing drugs; older people.Amsterdam Public Health Aging and Later Life Innovation Price and Clementine Brigitta Maria Dalderup fund Amsterdam University fun

Sistemik lupus eritematoz, behçet, takayasu arteriti ve romatoid artrit hastalarında yorgunluğun değerlendirilmesi ve hastalık aktivitesi ile ilişkisi

ÖZETAMAÇ: Yorgunluk, romatolojik hastalıklar başta olmak üzere kronik hastalıklarda sıkça rastladığımız bir yakınmadır. Sistemik Lupus Eritematoz (SLE), Behçet (BH), Romatoid Artrit (RA) ve Takayasu Arteriti (TA) hastalarında yorgunluğu değerlendirmek ve yorgunluğun hastalık aktivitesi, yaşam kalitesi, depresyon, anksiyete ve fonksiyonel kayıp ile ilişkisini araştırmak çalışmanın amacını oluşturmaktadır.GEREÇ VE YÖNTEM: Çalışmaya Romatoloji polikliniğimize başvuran 99 SLE, 123 BH, 100 RA, 58 TA hastası ve 71 adet sağlıklı kontrol dahil edildi. Tüm hastalar ve sağlıklı kontroller Yorgunluğu Çok Boyutlu Değerlendirme Ölçeği (MAF), Kısa Form-36 (SF-36), Sağlık Değerlendirme Anketi (HAQ) ve Hastane Anksiyete ve Depresyon Ölçeği’ni (HAD) doldurdular. Her bir hasta grubunda hastalık aktivitesini değerlendirmek için doktor globali ve sırasıyla SLE için SLEDAI, BH için BSAS, RA için DAS28, TA için ITAS2010 ölçekleri kullanıldı. Ortalama MAF skorları hasta grupları ve sağlıklı kontroller arasında ve ayrıca her gruptaki hastalığı aktif ve inaktif olan hastalar arasında T-test ile karşılaştırıldı. MAF’ın hastalık aktivite ölçekleri ve yukarıda adı geçen diğer hasta kökenli ölçütler ile ilişkisini değerlendirmek için pearson korelasyonu ve regresyon analizi yapıldı.SONUÇ VE TARTIŞMA: Dört hasta grubunda da ortalama MAF skorları sağlıklı kontrollere kıyasla istatistiksel olarak anlamlı yüksek idi (p<0.05) (yüksek MAF skoru artmış yorgunluğu göstermektedir). Yorgunluğun hastalık aktivitesi ile ilişkisi her grup içinde değişkenlik gösterirken bütün gruplarda MAF skorunun depresyon, anksiyete, fonksiyonel yetersizlik ve yaşam kalitesinde düşüş ile güçlü birlikteliği olduğu görüldü (p<0,05). MAF yorgunluk ölçeğinin özellikle RA ve BH’da hastalık aktivitesi ile korelasyon göstermesi sebebiyle DAS 28 ve BSAS ile birlikte kullanılabileceğini öngörüyoruz. Ayrıca her 4 hasta grubunda klinik pratikte yaşam kalitesi, duygu durum bozukluğu ve fonksiyonel yeterliliği değerlendirmek için sıklıkla kullandığımız SF-36, HAQ ve HAD’a ek olarak yorgunluğun da dikkate alınmasını ve bu sebeple MAF vb. ölçeklerin daha yaygın kullanılması gerektiğini düşünüyoruz. ABSTRACTINTRODUCTION: Fatigue is a common symptom seen in chronic diseases especially in rheumatological disorders. The objective of this study is to investigate fatigue in Systemic Lupus Eritematosus (SLE), Behcet (BD), Rheumatoid Arthrithis (RA) and Takayasu Arteritis (TA) patients and to examine the relationship between fatigue and disease activity, quality of life (QoL), depression, anxiety and functional disability.MATERIALS AND METHODS: 99 SLE, 123 BD, 100 RA, 58 TA patients and 71 healthy controls were enrolled to this study in Marmara University Rheumatology outpatient clinic. All subjects were asked to complete the Multidimensional Assessment of Fatigue (MAF) questionnaire, Short Form-36 (SF-36), Hospital Anxiety and Depression Scale (HADS) and Health Assessment Questionnaire (HAQ). The clinical activity scores among each patient group were determined by SLEDAI for SLE, BSAS for BD, DAS28 for RA and ITAS2010 for TA. Physician’s global assessment score is also used to assess the disease activity. We performed T-test to compare MAF scores in both patients groups versus healthy controls and patients with active disease versus inactive disease. We also performed Pearson’s correlations and regression analyses to identify the associations between MAF and other patient reported outcomes above.RESULTS AND CONCLUSION: Mean MAF scores were significantly higher in all patient groups compared with healthy controls (p<0.05) (higher MAF scores show increased fatigue). The relationship between MAF and disease activity showed differences for each patient group. However, we observed that there is statistically significant association between increased fatigue and depression, anxiety, disability and lower QoL in all groups (p<0.05). In conclusion, MAF scale might be used with DAS 28 and BSAS in RA and BD patients who have significant correlations between fatigue scale and disease activity scores, as seen in this study. We assume that fatigue should be considered in SLE, BD, RA and TA patients and MAF scale might be used in clinical practice as well as SF-36, HAQ and HAD scales which the physicians perform to assess QoL, disability and mood disturbances for rheumatoid patients commonly.