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    Jaw Bite Force to Predict Masseter Muscle Thickness and Swallowing Functions
    (2021) Aycıcek, Gozde Sengul; Arık, Güneş; Kızılarslanoğlu, Muhammet Cemal; Can, Büşra; Yıkılgan, İhsan; Duymuş, Mahmut; Ulger, Zekeriya
    Objectives: The age-related changes in the masticatory muscles and teeth lead to large spectrum of problems from malnutrition to death in the elderly. The aim of this study is to investigate the relationship among bite strength, chewing muscle thickness, and swallowing difficulty. Materials and Methods: A total of 58 patients (47 over 65 years old and 11 young) were included in the study. After a comprehensive geriatric assessment of the older adults, the jaw bite force was assessed with pressure sensitive sensor and chewing muscles thicknesses were measured with ultrasound in both groups. The swallowing difficulty was determined by the eating assessment tool (EAT-10). Results: The median age was 71 years (minimum-maximum: 21-85) and 48.3% of the participants were women. Bilateral jaw bite force scores and masseter muscles thicknesses were lower in the elderly than in the young patients and in the patients with tooth prosthesis than in those without prosthesis (p<0.05, p<0.01, respectively). There was a positive correlation between jaw bite force and masseter muscle thicknesses (p<0.05). Jaw bite force was positively correlated with handgrip strength (right r=0.428, p=0.002 and left r=0.347, p=0.007). Both right and left jaw bite forces were negatively correlated with EAT-10 scores (r=-0.342, p=0.017 and r=-0.383, p=0.005, respectively). Conclusion: Decreasing of the jaw bite force and masseter muscle thickness with age may be the reporter of malnutrition and swallowing difficulty. Further studies are needed with larger number of patients to determine if these parameters predict jaw bite force and swallowing dysfunction in older adults.
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    Turkish inappropriate medication use in the elderly (TIME) criteria to improve prescribing in older adults: TIME-to-STOP/TIME-to-START
    (SPRINGER, 2020) Bahat, Gulistan; Ilhan, Birkan; Erdogan, Tugba; Halil, Meltem; Savas, Sumru; Ulger, Zekeriya; Akyuz, Filiz
    Key summary pointsAim To meet the current need in different European countries for improving prescribing in older adults, we aimed to create an update screening tool getting origin from the two user friendly criterion sets: the STOPP/STARTv2 criteria and CRIME criteria. Findings Based on thorough literature review, 55 criteria were added, 17 criteria were removed, and 60 criteria were modified. As a result, 153 TIME criteria composed of 112 TIME-to-STOP and 41 TIME-to-START criteria were introduced. Message TIME criterion set is an update screening tool reported from Eastern Europe that included experts from geriatrics and other specialties frequently giving care to older adults and some additional practical explanations for clinical use. Purpose To improve prescribing in older adults, criterion sets have been introduced from different countries. While current criterion sets are useful to some extent, they do not meet the need in some European countries. Turkish inappropriate medication use in the elderly (TIME) criteria was planned to meet this need. Methods In phase 1, the user friendly sets: STOPP/START version2 and CRIME criteria were combined. National experts composed of geriatricians and non-geriatricians were invited to review and comment. In phase 2, thorough literature review was performed and reference-based revisions, omissions, and additions were made. Explanatory additions were added to some criteria to improve application in practice. In phase 3, all working group members reviewed the criteria/explanations and agreed on the final content. Results Phase 1 was performed by 49 expert academicians between May and October 2016. Phase 2 was performed by 23 working group academicians between October 2016 and November 2018 and included face-to-face interviews between at least two geriatrician members and one criterion-related specialist. Phase 3 was completed between November 2018-March 2019 with review and approval of all criteria by working group academicians. As a result, 55 criteria were added, 17 criteria were removed, and 60 criteria were modified from the first draft. A total of 153 TIME criteria composed of 112 TIME-to-STOP and 41 TIME-to-START criteria were introduced. Conclusion TIME criteria is an update screening tool that differs from the current useful tools by the interactive study of experts from geriatrics and non-geriatrics, inclusion of practical explanations for some criteria and by its eastern European origin. TIME study respectfully acknowledges its roots from STOPP/START and CRIME criteria. Studies are needed whether it would lead improvements in older adults' health.