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Frailty Syndrome and Nutrition in the Elderly

Year 2025, Volume: 11 Issue: 1, 149 - 156

Abstract

ABSTRACT
Aging is the name given to a wide range of biological, physiological and psychological changes that an individual undergoes over the years. The World Health Organization (WHO) defines aging as individuals aged 65 and older and characterizes it as a continuous loss of vital functions, with a noticeable decrease in overall efficiency of the organism and its ability to adapt to environmental factors. It is well known that the elderly population is increasing worldwide over time. Due to this increase in the elderly population, the importance of geriatric syndromes is also increasing. Frailty syndrome is a multidimensional concept that affects many physiological systems of the individual throughout life and can be defined by effects such as weight loss, slowing of walking speed, limitation of physical activities, inability to resist, and vulnerability. The most common geriatric syndromes are malnutrition, sarcopenia and frailty. In Turkey, 44.5% of women and 29% of men were found to be frail. Studies have shown that frailty increases with age and is often observed in people with low levels of education and chronic diseases. It is known that early diagnosis of frailty increases the chance of treatment, prevents fractures, reduces the duration of illness and improves quality of life. There are many assessment criteria and scales available for diagnosing frailty syndrome. After diagnosis, a treatment plan should be organized, including nutritional support, exercise plan, and social support specific to the patient's medical condition. Studies have shown that adequate protein intake, a diet rich in antioxidants, and nutritional supplements such as vitamin B12, vitamin D, and omega-3 have a positive effect on the course of the disease. The aim of this traditional review is to review the current knowledge on the definition of frailty syndrome, assessment tests and its relationship with nutrition.

Project Number

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References

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  • 2. World Health Organization (WHO) Definition of older or an elderly person (2020). http://www.who.int/healthinfo/survey/ageingdefnolder/en/Erişim: 14.08.2023).
  • 3. López PM, Fernández-Ballesteros R, Zamarrón MD, López SR. Anthropometric, body composition and health determinants of active ageing: a gender approach. J Biosoc Sci 2011; 43(5): 597-610.
  • 4. TÜİK (2020) İstatistiklerle Yaşlılar. Türkiye İstatistik Kurumu Haber Bülteni.:https://data.tuik.gov.tr/Bulten/Index?p=Elderly-Statistics-2020-37227 ( Erişim Tarihi: 19/08/2023).
  • 5. Aslan R. Sarkopeni: Yaşlanmaya Bağlı Kas Kitlesi Kaybı, Göller Bölgesi Aylık Ekonomi ve Kültür Dergisi 2021; 8(94): 63-7.
  • 6. Anpalahan M, Gibson SJ. Geriatric syndromes as predictors of adverse outcomes of hospitalization. Intern Med J 2008; 38(1): 16-23.
  • 7. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people [published correction appears in Lancet 2013; 382(9901):1328. Lancet 2013; 381(9868): 752-62.
  • 8. Chen X, Mao G, Leng SX. Frailty Syndrome: an overview, Clin Interv Aging 2014; 9:433-41.
  • 9. Sökmen ÜN, Dişçigil G. Yaşlılıkta Sarkopeni, Journal Turkish Family Physician 2017; 8(2): 49-54.
  • 10. Atbaş C, Balcı C. COVID-19 ve yaşlılarda kırılganlık. Sain Güven G, Yıldız P, Uyaroğlu OA, editörler. İç Hastalıkları ve COVID-19 1. Baskı. Ankara: Türkiye Klinikleri 2021: 102-6.
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  • 17. Dent E, Morley JE, Cruz-Jentoft AJ, Woodhouse L, Rodríguez-Mañas L, Fried LP, Woo J, Aprahamian I, Sanford A, Lundy J, Landi F, Beilby J, Martin FC, Bauer JM, Ferrucci L, Merchant RA, Dong B, Arai H, Hoogendijk EO, Won CW, Abbatecola A, Cederholm T, Strandberg T, Gutiérrez Robledo LM, Flicker L, Bhasin S, Aubertin-Leheudre M, Bischoff-Ferrari HA, Guralnik JM, Muscedere J, Pahor M, Ruiz J, Negm AM, Reginster JY, Waters DL, Vellas B. Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management. J Nutr Health Aging 2019; 23(9):771-7.
  • 18. Kurkcu M, Meijer RI, Lonterman S, Muller M, van der Schueren MAE. The Association Between Nut- ritional Status and Frailty Characteristics Among Geriatric Outpatients. Clinical nutrition ESPEN 2018; 23:112-6.
  • 19. Mıjnarends DM, Schols, JM, Meıjers, JM, Tan FE, Verlaan S, Luıkıng Y C, Morley JE, Halfens RJ. Instruments to Assess Sarcopenia and Physical Frailty in Older People Living in a Community (care) Setting: similarities and discrepancies, Journal of the American Medical Directors Association 2015; 16(4): 301–8.
  • 20. Bledsoe L, Alessi K, Toro JB, Giordano B, Hanypsiak BT. Fragility Fractures: Diagnosis and Treatment. Am J Orthop (Belle Mead NJ). 2018; 47(12):10.12788/ajo.2018.0112.
  • 21. Feng Z, Lugtenberg M, Franse C, Fang X, Hu S, Jin C, Raat H. Risk Factors and Protective Factors Associated with Incident or Increase of Frailty Among Community- Dwelling Older Adults: A Systematic Review of Longitudinal Studies. PLoS One 2017; 12(6): e0178383.
  • 22. Lee JS, Auyeung TW, Leung J, Kwok T, Woo J. Transitions in Frailty States Among Community-Living Older Adults and Their Associated Factors, J Am Med Dir Assoc 2014; 15(4): 281-6.
  • 23. Cawthon PM, Marshall LM, Michael Y, Dam TT, Ensrud KE, Barrett‐Connor E, Orwoll E. Frailty in Older Men: Prevalence, Progression, and Relationship With Mortality, Journal of the American Geriatrics Society 2007; 55(8): 1216-23.
  • 24. Cruz-Jentoft A, Woo J. Nutritional İnterventions to Prevent and Treat Frailty, Current Opinion in Clinical Nutrition and Metabolic Care 2019; 22(3): 191-5.
  • 25. WHO. [Internet]. Ageing and health. Erişim: http://www.who.int/ mediacentre/factsheets/fs404/en/ (Erişim tarihi: 05.01.2024).
  • 26. Eyigor S, Kutsal YG, Duran E, Huner B, Paker N, Durmus B, Şahin N, Civelek GM, Gokkaya K, Doğan A, Günaydın R, Toraman F, Çakır T, Evcik D, Aydeniz A, Yıldırım AG, Borman P, Okumuş M, Ceceli E. Frailty Prevalence and Related Factors in the Older Adult, FrailTURK Project, Age (Dordr) 2015; 37(3):9791.
  • 27. Collard RM, Boter H, Schoevers RA, Oude Voshaar RC. Prevalence of Frailty in Community-dwelling Older Persons: A systematic review, J Am Geriatr Soc 2012; 60(8): 1487-92.
  • 28. Davinelli S, Corbi G, Scapagnini G. Frailty syndrome: A target for functional nutrients?. Mech Ageing Dev 2021; 195:111441.
  • 29. Marzetti E, Picca A, Marini F, Biancolillo A, Coelho-Junior HJ, Gervasoni J, Bosolla M, Cesari M, Onder G, Landi F, Bernabei R, Calvani R. Inflammatory Signatures in Older Persons With Physical Frailty and Sarcopenia: The frailty “cytokinome” at its core, Experimental Gerontology 2019; 122: 129-38.
  • 30. Artaza-Artabe I, Saez-Lopez P, Sanchez- Hemandez N, Fernandez-Gutierrez N, Malafarina V. The Relationship Between Nutrition and Frailty: Effects of protein intake, nutritional supplementation, vitamin D and exercise on muscle metabolism in the elderly, A systematic review. Maturitas 2016; 93: 89-99.
  • 31. Canbolat Seyman Ç. Kırılganlık, Sarkopeni ve Düşmeler, Yaşlı Hastalarda Hemşirelik Bakım ve Yönetimine Genel Bakış, Kırılganlık Kırığında Hemşirelik- Ortogeriatrik Hastalarda Bütüncül Bakım ve Yönetim Kitabı, Ankara 2021:15-26.
  • 32. Morley JE, Argiles JM, Evans WJ, Bhasin S, Cella D, Deutz NE, Doehne W, Fearon K, Ferruci L, Hellerstein M, Kalantar-Zadeh K, Lochs H, MacDonals N, Mulligan K, Muscaritoli M, Ponikowski P, Posthauer ME, Fanelli FR, Schambelan M, Schols A, Schuster MW, Anker SD, Society for Sarcopenia, Cachexia, and Wasting Disease. Nutritional recommendations for the management of sarcopenia. J Am Med Dir Assoc 2010; 11: 391- 6.
  • 33. Theou O, Brothers TD, Mitnitski A, Rockwood K. Operationalization of Frailty Using Eight Commonly Used Scales and Comparison of Their Ability to Predict All‐Cause Mortality, Journal of the American Geriatrics Society 2013; 61(9):1537-51.
  • 34. Bouillon K, Kivimaki M, Hamer M, Sabia S, Fransson EI, Singh-Manoux A, Gale CR, Batty GD, Measures of Frailty in Population- based studies: An overview. BMC Geriatr 2013; 13(1): 64.
  • 35. Yannakoulia M, Ntanasi E, Anastasiou CA, Scarmeas N. Frailty and Nutrition: From epidemiological and clinical evidence to potential mechanisms, Metabolism 2017; 68:64-76.
  • 36. Elfert P, Berndt J, Dierkes L, Eichelberg M, Rösch N, Hein A, Diekmann R. Kırılganlık Sendromu Yüksek Risk Altındaki Geriatrik Hastalar için Yeni Bir Dijital Beslenme Günlüğü, Besinler 2022; 14(3):400.
  • 37. Lorenzo-Lopez L, Maseda A, de Labra C, Regueiro-Folgueira L, Rodriguez- Villamil JL, Millan-Calenti JC. Nutritional Determinants of Frailty in Older Adults: A systematic review, BMC Geriatr 2017; 17: 108.
  • 38. Eyigor S, Kutsal YG. Kırılgan Yaşlıya Yaklaşım, Türkiye Fiziksel Tıp ve Rehabilitasyon Dergisi 2010; 56:135-40.
  • 39. Li X, Wang Q, Ma T, Chang X, Xue Y, Zhang Y, Liu W, Zhang Y, Zhao Y. Dietary inflammatory index, dietary total antioxidant capacity, and frailty among older Chinese adults. J Nutr Health Aging 2024; 28(4):100168.
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Yaşlılarda Kırılganlık Sendromu ve Beslenme

Year 2025, Volume: 11 Issue: 1, 149 - 156

Abstract

ÖZ
Yaşlanma, bireyin seneler içerisinde geçirdiği çok çeşitli biyolojik, fizyolojik ve psikolojik değişimlerin tümüne verilen isimdir. Dünya Sağlık Örgütü (DSÖ) yaşlılık kavramını 65 yaş ve üstü bireyler olarak belirlemiştir ve yaşlılığı; yaşamsal fonksiyonların sürekli kaybı, organizmanın tüm verimliliğinde ve çevresel faktörlere uyum sağlamada fark edilir seviyede azalma olarak tanımlamıştır. Yaşlı popülasyonunun küresel olarak zaman içerisinde arttığı bilinmektedir. Yaşlı popülasyonundaki bu artış sebebiyle geriatrik sendromların önemi de artmaktadır. En yaygın görülen geriatrik sendromların başında malnütrisyon, sarkopeni ve kırılganlık gelmektedir. Kırılganlık sendromu, yaşam süresince bireyin birçok fizyolojik sistemi üzerinde etkisi olan, ağırlık kaybı, yürüme hızında yavaşlama, fiziksel aktivitelerde kısıtlanma, direnç gösterememe ve savunmasızlık hali gibi etkiler ile tanımlanabilen çok boyutlu bir kavramdır. Türkiye’de kadınların %44,5’inin ve erkeklerin %29’unun kırılgan olduğu belirlenmiştir. Çalışmalar sonucunda kırılganlığın yaşla birlikte arttığı, eğitim düzeyinin düşük ve kronik hastalığı olan bireylerde sık gözlemlendiği kanıtlanmıştır. Kırılganlığın erken dönemde teşhis edilmesi ile tedavi şansının arttığı, kırık oluşumunun önlendiği, hastalık süresinin azaldığı, yaşam kalitesinin yükseldiği bilinmektedir. Kırılganlık sendromu tanısının konulması için birçok değerlendirme kriteri ve ölçekler bulunmaktadır. Tanı sonrasında hastanın tıbbi durumuna özgü beslenme desteği, egzersiz planı ve sosyolojik desteklerle birlikte tedavi planı düzenlenmelidir. Yapılan çalışmalar sonucunda; yeterli protein alımının, antioksidan kaynaklardan zengin beslenmenin, B12, D vitamini ve omega-3 gibi besin ögesi desteklerinin hastalık seyri üzerinde olumlu etki gösterdiği belirlenmiştir. Bu geleneksel derlemenin amacı, kırılganlık sendromunu tanımlamak, değerlendirme testleri ile ilgili güncel bilgileri incelemek ve beslenme ile ilişkisini ortaya koymaktır.

Ethical Statement

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Supporting Institution

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Project Number

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Thanks

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References

  • 1. Alkan ŞB, Rakıcıoğlu N, Kırılgan Yaşlılarda Beslenme, Süleyman Demirel Üniversitesi, Sağlık Bilimleri Dergisi 2019; 10(2): 184-9.
  • 2. World Health Organization (WHO) Definition of older or an elderly person (2020). http://www.who.int/healthinfo/survey/ageingdefnolder/en/Erişim: 14.08.2023).
  • 3. López PM, Fernández-Ballesteros R, Zamarrón MD, López SR. Anthropometric, body composition and health determinants of active ageing: a gender approach. J Biosoc Sci 2011; 43(5): 597-610.
  • 4. TÜİK (2020) İstatistiklerle Yaşlılar. Türkiye İstatistik Kurumu Haber Bülteni.:https://data.tuik.gov.tr/Bulten/Index?p=Elderly-Statistics-2020-37227 ( Erişim Tarihi: 19/08/2023).
  • 5. Aslan R. Sarkopeni: Yaşlanmaya Bağlı Kas Kitlesi Kaybı, Göller Bölgesi Aylık Ekonomi ve Kültür Dergisi 2021; 8(94): 63-7.
  • 6. Anpalahan M, Gibson SJ. Geriatric syndromes as predictors of adverse outcomes of hospitalization. Intern Med J 2008; 38(1): 16-23.
  • 7. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people [published correction appears in Lancet 2013; 382(9901):1328. Lancet 2013; 381(9868): 752-62.
  • 8. Chen X, Mao G, Leng SX. Frailty Syndrome: an overview, Clin Interv Aging 2014; 9:433-41.
  • 9. Sökmen ÜN, Dişçigil G. Yaşlılıkta Sarkopeni, Journal Turkish Family Physician 2017; 8(2): 49-54.
  • 10. Atbaş C, Balcı C. COVID-19 ve yaşlılarda kırılganlık. Sain Güven G, Yıldız P, Uyaroğlu OA, editörler. İç Hastalıkları ve COVID-19 1. Baskı. Ankara: Türkiye Klinikleri 2021: 102-6.
  • 11. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56(3): M146-56.
  • 12. Cigolle CT, Langa KM, Kabeto MU, Tian Z, Blaum CS, Geriatric Conditions and Disability: the Health and Retirement Study, Ann Intern Med 2007; 147(3): 156-64.
  • 13. Kim S, Park J, Ahn H, Lee S, Yoo HJ, Yoo J, Wonwon C. Risk Factors of Geriatric Syndromes in Korean Population, Annals of Geriatric Medicine and Research 2017; 21(3): 123-30.
  • 14. Ateş Bulut E, Soysal P, Işık AT. Frequency and Coincidence of Geriatric Syndromes According to Age Groups: Single-center experience in Turkey between 2013 and 2017, Clinical Interventions in Aging 2018; 13: 1899–905.
  • 15. Meyer AM, Becker I, Siri G, Brinkköter PT, Benzing T, Pilotto A, Polidori MC. The Prognostic Significance of Geriatric Syndromes and Resources, Aging Clinical and Experimental Research 2020; 32(1): 115–24.
  • 16. Irgat Sİ, Kızıltan G, Yaşlı Bireylerde Kırılganlık ile Malnütrisyon İlişkisi, Başkent Üniversitesi Sağlık Bilimleri Fakültesi Dergisi-BÜSBİD 2021; 6(Özel Sayı),88-100.
  • 17. Dent E, Morley JE, Cruz-Jentoft AJ, Woodhouse L, Rodríguez-Mañas L, Fried LP, Woo J, Aprahamian I, Sanford A, Lundy J, Landi F, Beilby J, Martin FC, Bauer JM, Ferrucci L, Merchant RA, Dong B, Arai H, Hoogendijk EO, Won CW, Abbatecola A, Cederholm T, Strandberg T, Gutiérrez Robledo LM, Flicker L, Bhasin S, Aubertin-Leheudre M, Bischoff-Ferrari HA, Guralnik JM, Muscedere J, Pahor M, Ruiz J, Negm AM, Reginster JY, Waters DL, Vellas B. Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management. J Nutr Health Aging 2019; 23(9):771-7.
  • 18. Kurkcu M, Meijer RI, Lonterman S, Muller M, van der Schueren MAE. The Association Between Nut- ritional Status and Frailty Characteristics Among Geriatric Outpatients. Clinical nutrition ESPEN 2018; 23:112-6.
  • 19. Mıjnarends DM, Schols, JM, Meıjers, JM, Tan FE, Verlaan S, Luıkıng Y C, Morley JE, Halfens RJ. Instruments to Assess Sarcopenia and Physical Frailty in Older People Living in a Community (care) Setting: similarities and discrepancies, Journal of the American Medical Directors Association 2015; 16(4): 301–8.
  • 20. Bledsoe L, Alessi K, Toro JB, Giordano B, Hanypsiak BT. Fragility Fractures: Diagnosis and Treatment. Am J Orthop (Belle Mead NJ). 2018; 47(12):10.12788/ajo.2018.0112.
  • 21. Feng Z, Lugtenberg M, Franse C, Fang X, Hu S, Jin C, Raat H. Risk Factors and Protective Factors Associated with Incident or Increase of Frailty Among Community- Dwelling Older Adults: A Systematic Review of Longitudinal Studies. PLoS One 2017; 12(6): e0178383.
  • 22. Lee JS, Auyeung TW, Leung J, Kwok T, Woo J. Transitions in Frailty States Among Community-Living Older Adults and Their Associated Factors, J Am Med Dir Assoc 2014; 15(4): 281-6.
  • 23. Cawthon PM, Marshall LM, Michael Y, Dam TT, Ensrud KE, Barrett‐Connor E, Orwoll E. Frailty in Older Men: Prevalence, Progression, and Relationship With Mortality, Journal of the American Geriatrics Society 2007; 55(8): 1216-23.
  • 24. Cruz-Jentoft A, Woo J. Nutritional İnterventions to Prevent and Treat Frailty, Current Opinion in Clinical Nutrition and Metabolic Care 2019; 22(3): 191-5.
  • 25. WHO. [Internet]. Ageing and health. Erişim: http://www.who.int/ mediacentre/factsheets/fs404/en/ (Erişim tarihi: 05.01.2024).
  • 26. Eyigor S, Kutsal YG, Duran E, Huner B, Paker N, Durmus B, Şahin N, Civelek GM, Gokkaya K, Doğan A, Günaydın R, Toraman F, Çakır T, Evcik D, Aydeniz A, Yıldırım AG, Borman P, Okumuş M, Ceceli E. Frailty Prevalence and Related Factors in the Older Adult, FrailTURK Project, Age (Dordr) 2015; 37(3):9791.
  • 27. Collard RM, Boter H, Schoevers RA, Oude Voshaar RC. Prevalence of Frailty in Community-dwelling Older Persons: A systematic review, J Am Geriatr Soc 2012; 60(8): 1487-92.
  • 28. Davinelli S, Corbi G, Scapagnini G. Frailty syndrome: A target for functional nutrients?. Mech Ageing Dev 2021; 195:111441.
  • 29. Marzetti E, Picca A, Marini F, Biancolillo A, Coelho-Junior HJ, Gervasoni J, Bosolla M, Cesari M, Onder G, Landi F, Bernabei R, Calvani R. Inflammatory Signatures in Older Persons With Physical Frailty and Sarcopenia: The frailty “cytokinome” at its core, Experimental Gerontology 2019; 122: 129-38.
  • 30. Artaza-Artabe I, Saez-Lopez P, Sanchez- Hemandez N, Fernandez-Gutierrez N, Malafarina V. The Relationship Between Nutrition and Frailty: Effects of protein intake, nutritional supplementation, vitamin D and exercise on muscle metabolism in the elderly, A systematic review. Maturitas 2016; 93: 89-99.
  • 31. Canbolat Seyman Ç. Kırılganlık, Sarkopeni ve Düşmeler, Yaşlı Hastalarda Hemşirelik Bakım ve Yönetimine Genel Bakış, Kırılganlık Kırığında Hemşirelik- Ortogeriatrik Hastalarda Bütüncül Bakım ve Yönetim Kitabı, Ankara 2021:15-26.
  • 32. Morley JE, Argiles JM, Evans WJ, Bhasin S, Cella D, Deutz NE, Doehne W, Fearon K, Ferruci L, Hellerstein M, Kalantar-Zadeh K, Lochs H, MacDonals N, Mulligan K, Muscaritoli M, Ponikowski P, Posthauer ME, Fanelli FR, Schambelan M, Schols A, Schuster MW, Anker SD, Society for Sarcopenia, Cachexia, and Wasting Disease. Nutritional recommendations for the management of sarcopenia. J Am Med Dir Assoc 2010; 11: 391- 6.
  • 33. Theou O, Brothers TD, Mitnitski A, Rockwood K. Operationalization of Frailty Using Eight Commonly Used Scales and Comparison of Their Ability to Predict All‐Cause Mortality, Journal of the American Geriatrics Society 2013; 61(9):1537-51.
  • 34. Bouillon K, Kivimaki M, Hamer M, Sabia S, Fransson EI, Singh-Manoux A, Gale CR, Batty GD, Measures of Frailty in Population- based studies: An overview. BMC Geriatr 2013; 13(1): 64.
  • 35. Yannakoulia M, Ntanasi E, Anastasiou CA, Scarmeas N. Frailty and Nutrition: From epidemiological and clinical evidence to potential mechanisms, Metabolism 2017; 68:64-76.
  • 36. Elfert P, Berndt J, Dierkes L, Eichelberg M, Rösch N, Hein A, Diekmann R. Kırılganlık Sendromu Yüksek Risk Altındaki Geriatrik Hastalar için Yeni Bir Dijital Beslenme Günlüğü, Besinler 2022; 14(3):400.
  • 37. Lorenzo-Lopez L, Maseda A, de Labra C, Regueiro-Folgueira L, Rodriguez- Villamil JL, Millan-Calenti JC. Nutritional Determinants of Frailty in Older Adults: A systematic review, BMC Geriatr 2017; 17: 108.
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There are 50 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences (Other)
Journal Section Collection
Authors

Ceren Nida Görey 0009-0002-2500-5193

Sevde Kahraman 0000-0003-4562-1081

Fatma Çelik 0000-0002-7553-8687

Project Number -
Early Pub Date January 20, 2025
Publication Date
Submission Date February 29, 2024
Acceptance Date August 2, 2024
Published in Issue Year 2025 Volume: 11 Issue: 1

Cite

Vancouver Görey CN, Kahraman S, Çelik F. Yaşlılarda Kırılganlık Sendromu ve Beslenme. Akd Med J. 2025;11(1):149-56.