ABSTRACT
Background: Covid-19 impacted older peoples’ confidence and mobility. Restrictions from March 2020 on our cohort of patients (> 65 years) reduced movement and social interactions leading to deconditioning and brain health implications. In our falls assessment service the clinical nurse specialist conducts a multifactorial assessment. We aimed to see if a difference existed in assessments of similar cohorts of patients’ pre and post restrictions. Methods: A retrospective review of assessment measures for patients attending the falls service between October – December 2019 and 2021. Measures compared included gender, age, Fear-of-Falling (FOF), Timed Up and Go (TUG), Fracture Risk Assessment tool (FRAX), Vitamin D levels, grip strength and Body Mass Index (BMI). Results: Twenty-two patient charts were reviewed from 2019 and 2021. Both years had similar female and male patient data reviewed (14/22 female 2019, 15/22 female 2021). FOF was noted in 38% (8/21) of patients in 2019, versus 45% (10/22) in 2021. In 2021 the average age of our patient cohort had decreased by three years. The TUG average time increased by 2 seconds in 2021 (median time decreased by 2.5 seconds). The major osteoporotic average percentage decreased in 2021 by 1.1%, (median drop 9%), the hip fracture percentage decreased by 2.5% in 2021 (median drop 10.5%). The average vitamin D level decreased by 1mmol in 2021 (median decreased 54mmol), while BMI average increased by 2kg/m² (median increased by 6kg/m²). The average grip strength results in 2021 dropped by 11.5kg (median decreased by 10.5kg). Conclusion: Potential trends are observed in this data. We intend to examine a larger timeline/number of patients to be able to validate these findings, particularly FOF.
ABSTRACT
Introduction Older nursing home residents are the population at greatest risk of morbidity and mortality from SARS-CoV-2 infection. No studies have examined the determinants of long-term antibody responses post-vaccination in this group. Method Longitudinal cohort study in residents of 5 nursing homes assessed prior to vaccination and at both 5-weeks and 6-months post SARS-CoV2 vaccine (BNT162b2). Comprehensive clinical assessment was performed, including assessment for comorbidity, frailty (NH-FRAIL) and SARS-CoV-2 infection history. Serum Nucleocapsid and Anti-Spike Receptor Binding Domain (RBD) antibodies were analysed at all timepoints and an in vitro Angiotensin Converting Enzyme (ACE2) Receptor-Spike RBD neutralisation assay used to assess serum neutralisation capacity. Results Of 86 participants (81.1 ± 10.8 years;65% female), just-under half (45.4%;39/86) had evidence of previous SARS-CoV-2 infection. All participants demonstrated a significant antibody response to vaccination at 5-weeks and a significant decline in this response by 6-months. SARS-CoV-2 infection history was the strongest predictor of antibody titre (log-transformed) at both 5-weeks (β: 3.00;95% CI [Confidence Interval]: 2.32, 3.70;p < 0.001) and 6-months (β: 3.59;95% CI: 2.89, 4.28;p < 0.001). Independent of SARS-CoV-2 infection history, both age in years (β: -0.05;95% CI: −0.08, −0.02;p < 0.001) and frailty (β: -0.22;95% CI: −0.33, −0.11;p < 0.001) were associated with a lower antibody titre at 6-months. Antibody titres at both 5-weeks and 6-months significantly correlated with in vitro neutralisation capacity. Conclusion and Implications In older nursing home residents, SARS-CoV-2 infection history was the strongest predictor of anti-spike antibody titres at 6-months, whilst age and frailty were independently associated with lower titres at 6-months. Antibody titres significantly correlated with in vitro neutralisation capacity. Whilst older SARS-CoV-2 naïve nursing home residents may be particularly vulnerable to breakthrough SARS-CoV-2 infection, the relationship between antibody titres, SARS-CoV-2 infection and clinical outcomes remains to be fully elucidated in this cohort.