Long COVID-19: The Need for an Interdisciplinary Approach.

Long coronavirus disease 2019 (COVID-19) is characterized by persistent COVID-19 symptoms that last for at least 2 months. In the elderly population, apart from the typical symptoms (fatigue, cough, or dyspnea), unspecific symptoms coexist (functional deterioration, cognitive impairment, or delirium) that can mitigate the prevalence of this syndrome in this age group. Its main consequence is the functional decline, leading to sarcopenia, frailty, and disability, in addition to the nutritional and cognitive disorders. Thus, a multicomponent and individualized program (exercise, diet, cognitive stimulation) should be designed for older people with persistent COVID, where new technologies could be useful.

Recommendations and Effects of Rehabilitation Programs in Older Adults After Hospitalization for COVID-19: A Scoping Review.

ABSTRACT: The aims of this review were to identify studies on physical rehabilitation programs and describe the potential effects on functional outcomes in patients older than 60 yrs at discharge from acute care post-COVID-19. The literature search was conducted in the MEDLINE, Cochrane CENTRAL, EMBASE, PEDro, LILACS, CINAHL, SPORTDiscus, Web of Science, and The Living OVerview of Evidence (L-OVE) COVID-19 databases. Studies with patients older than 60 yrs, hospitalized with COVID-19, and admitted to a rehabilitation program after discharge from acute care were included. Ten studies were included with a total of 572 patients. The prevalence of patients who received post-intensive care rehabilitation was 53% (95% confidence interval, 0.27-0.79; P = 0.001). The rehabilitation program included physiotherapy in nine studies, occupational therapy in three studies, and psychotherapy in two studies. The rehabilitation programs increased aerobic capacity, functional independence in basic activities of daily living, muscle strength, muscle mass, dynamic balance, physical performance, pulmonary function, quality of life, cognitive capacity and mental health. Multidisciplinary rehabilitation programs are necessary for older adults after hospitalization for COVID-19, especially those coming from intensive care units, as rehabilitation has a positive effect on important clinical outcomes.

The medium-term consequences of a COVID-19 lockdown on lifestyle among Spanish older people with hypertension, pulmonary disease, cardiovascular disease, musculoskeletal disease, depression, and cancer.

OBJECTIVES: This study investigated the associations of chronic diseases with changes in lifestyle and health behaviours in older people following the coronavirus disease 2019 (COVID-19) lockdown in Spain and compared the differences in changes over time. METHODS: 1,092 participants (80.3±5.6 years; 66.5% female) from 2 Spanish cohorts were included. Telephone-based questionnaires were conducted to evaluate lifestyle and health risk behaviours at the end of lockdown and 7 months post-lockdown. Participants were classified as having physician-diagnosed chronic diseases based on self-reported data. Cox proportional models adjusted for major confounders were used. RESULTS: Compared to those without the corresponding chronic diseases, older people with hypertension were less likely to report increased alcohol consumption (hazard ratio [HR], 0.73; 95% confidence interval [CI], 0.55 to 0.99). Pulmonary diseases were associated with lower risks of increased sedentary time (HR, 0.58; 95% CI, 0.39 to 0.86) and worsened sleep quality (HR, 0.56; 95% CI, 0.36 to 0.87), while cardiovascular diseases were associated with a lower risk of decreased sedentary time (HR, 0.58; 95% CI, 0.38 to 0.88). Depression was linked to a higher likelihood of improved diet quality (HR, 1.53; 95% CI, 1.00 to 2.36). Cancer pacients were less likely to have worsened sleep quality (HR, 0.44; 95% CI, 0.22 to 0.89) but more likely to have reduced their frequency of social contact (HR, 2.05; 95% CI, 1.05 to 3.99). CONCLUSIONS: Older people with chronic diseases showed beneficial changes in lifestyle and health risk behaviours after the COVID-19 lockdown. In particular, older people with hypertension, pulmonary disease, and cancer tended to make beneficial lifestyle and health behaviour changes. However, older people with cardiovascular disease and depression engaged in more health risk behaviours.

Long COVID-19: The Need for an Interdisciplinary Approach

Synopsis Long COVID-19 is characterized by persistent COVID-19 symptomatology that lasts for, at least, two months. In old population, apart from the typical symptoms (fatigue, cough, or dyspnea), coexist unspecific symptoms (functional deterioration, cognitive impairment, or delirium) that could apparently mitigate the prevalence of this syndrome in this age group. Its main consequence is the functional decline, leading to a development of sarcopenia, frailty, and disability, without forgetting the nutritional and cognitive disorders. Thus, a multicomponent and individualized program (exercise, diet, cognitive stimulation) should be designed for older people suffering from persistent COVID, where new technologies could be useful.

Automatic and Real-Time Computation of the 30-Seconds Chair-Stand Test without Professional Supervision for Community-Dwelling Older Adults.

The present paper describes a system for older people to self-administer the 30-s chair stand test (CST) at home without supervision. The system comprises a low-cost sensor to count sit-to-stand (SiSt) transitions, and an Android application to guide older people through the procedure. Two observational studies were conducted to test (i) the sensor in a supervised environment (n = 7; m = 83.29 years old, sd = 4.19; 5 female), and (ii) the complete system in an unsupervised one (n = 7; age 64-74 years old; 3 female). The participants in the supervised test were asked to perform a 30-s CST with the sensor, while a member of the research team manually counted valid transitions. Automatic and manual counts were perfectly correlated (Pearson's r = 1, p = 0.00). Even though the sample was small, none of the signals around the critical score were affected by harmful noise; p (harmless noise) = 1, 95% CI = (0.98, 1). The participants in the unsupervised test used the system in their homes for a month. None of them dropped out, and they reported it to be easy to use, comfortable, and easy to understand. Thus, the system is suitable to be used by older adults in their homes without professional supervision.

Changes in Health Behaviors, Mental and Physical Health among Older Adults under Severe Lockdown Restrictions during the COVID-19 Pandemic in Spain.

We used data from 3041 participants in four cohorts of community-dwelling individuals aged ≥65 years in Spain collected through a pre-pandemic face-to-face interview and a telephone interview conducted between weeks 7 to 15 after the beginning of the COVID-19 lockdown. On average, the confinement was not associated with a deterioration in lifestyle risk factors (smoking, alcohol intake, diet, or weight), except for a decreased physical activity and increased sedentary time, which reversed with the end of confinement. However, chronic pain worsened, and moderate declines in mental health, that did not seem to reverse after restrictions were lifted, were observed. Males, older adults with greater social isolation or greater feelings of loneliness, those with poorer housing conditions, as well as those with a higher prevalence of chronic morbidities were at increased risk of developing unhealthier lifestyles or mental health declines with confinement. On the other hand, previously having a greater adherence to the Mediterranean diet and doing more physical activity protected older adults from developing unhealthier lifestyles with confinement. If another lockdown were imposed during this or future pandemics, public health programs should specially address the needs of older individuals with male sex, greater social isolation, sub-optimal housing conditions, and chronic morbidities because of their greater vulnerability to the enacted movement restrictions.

The Structural and Intercultural Competence for Epidemiological Studies (SICES) guidelines: a 22-item checklist.

Structural and intercultural competence approaches have been widely applied to fields such as medical training, healthcare practice, healthcare policies and health promotion. Nevertheless, their systematic implementation in epidemiological research is absent. Based on a scoping review and a qualitative analysis, in this article we propose a checklist to assess cultural and structural competence in epidemiological research: the Structural and Intercultural Competence for Epidemiological Studies guidelines. These guidelines are organised as a checklist of 22 items and consider four dimensions of competence (awareness and reflexivity, cultural and structural validation, cultural and structural sensitivity, and cultural and structural representativeness), which are applied to the different stages of epidemiological research: (1) research team building and research questions; (2) study design, participant recruitment, data collection and data analysis; and (3) dissemination. These are the first guidelines addressing structural and cultural competence in epidemiological inquiry.

Dexamethasone and oxygen therapy in care home residents with diabetes: a management guide and algorithm for treatment: a rapid response action statement from the European Diabetes Working Party for Older People (EDWPOP) and European Geriatric Medicine Society (EuGMS).

This statement addresses the need to provide clinically relevant and practical guidance for long-term care staff working in care homes and other stakeholders engaged in the care of residents who require consideration for dexamethasone and oxygen therapy. It had been provided following a series of consensus discussions between the EDWPOP and the EuGMS in January and February 2021. Its main aim is to minimise morbidity and mortality from serious acute illnesses including COVID-19 requiring these treatments within the long-term care sector.

Rapid Assessment at Hospital Admission of Mortality Risk From COVID-19: The Role of Functional Status.

OBJECTIVE: To evaluate the role of functional status along with other used clinical factors on the occurrence of death in patients hospitalized with COVID-19. DESIGN: Prospective cohort study. SETTING: Public university hospital (Madrid). PARTICIPANTS AND METHODS: A total of 375 consecutive patients with COVID-19 infection, admitted to a Public University Hospital (Madrid) between March 1 and March 31, 2020, were included in the Prospective Cohort study. Death was the main outcome. The main variable was disability in activities of daily living (ADL) assessed with the Barthel Index. Covariates included sex, age, severity index (Quick Sequential Organ Failure Assessment, qSOFA), polypharmacy (≥5 drugs in the month before admission), and comorbidity (≥3 diseases). Multivariable logistic regression was used to identify risk factors for adverse outcomes. Estimated model coefficients served to calculate the expected probability of death for a selected combination of 5 variables: Barthel Index, sex, age, comorbidities, and severity index (qSOFA). RESULTS: Mean age was 66 years (standard deviation 15.33), and there were 207 (55%) men. Seventy-four patients died (19.8%). Mortality was associated with low Barthel Index (odds ratio per 5-point decrease 1.11, 95% confidence interval 1.03-1.20), male sex (0.23, 0.11-0.47), age (1.07, 1.03-1.10), and comorbidity (2.15, 1.08-4.30) but not with qSOFA (1.29, 0.87-1.93) or polypharmacy (1.54, 0.77-3.08). Calculated mortality risk ranged from 0 to 0.78. CONCLUSIONS AND IMPLICATIONS: Functional status predicts death in hospitalized patients with COVID-19. Combination of 5 variables allows to predict individual probability of death. These findings provide useful information for the decision-making process and management of patients.

Use of renin angiotensin aldosterone system inhibitors and risk of COVID-19 requiring admission to hospital: a case-population study

BackgroundConcerns have been raised about the possibility that inhibitors of the renin?angiotensin?aldosterone system (RAAS) could predispose individuals to severe COVID-19;however, epidemiological evidence is lacking. We report the results of a case-population study done in Madrid, Spain, since the outbreak of COVID-19.