Healthcare for Older Adults, Where Are We Moving towards?

Since the end of World War II, science has not stopped progressing [...].

VitaminD supplementation for the prevention and treatment of COVID-19: a position statement from the Spanish Society of Geriatrics and Gerontology.

The coronavirus disease 2019 (COVID-19) produces severe respiratory symptoms such as bilateral pneumonia associated to a high morbidity and mortality, especially in patients of advanced age. Vitamin D deficiency has been reported in several chronic conditions associated with increased inflammation and dysregulation of the immune system. Vitamin D in modulates immune function too. Vitamin D receptor (VDR) is expressed by most immune cells, including B and T lymphocytes, monocytes, macrophages, and dendritic cells and the signalling of vitamin D and VDR together has an anti-inflammatory effect. Some studies have reported that vitamin D treatment could be useful for the prevention and treatment of COVID-19 because vitamin D plays an important role as a modulator of immunocompetence. Over the last few months, some studies have hypothesized the possible beneficial effect of vitamin D supplementation in patients with COVID-19 in order to improve the immune balance and prevent the hyperinflammatory cytokine storm. Some preliminary studies have already shown promising results with vitamin D supplementation in hospitalized COVID-19 patients. Vitamin D should be administered daily until adequate levels are achieved due to vitamin D behaves as a negative acute phase reactant (APR). Despite the lack of evidence on specific doses of vitamin D to treat COVID-19 in older adults, authors consider it is necessary to standardize the use in clinical practice. These recommendations advice supplement vitamin D in a protocoled fashion based on expert opinions, level of evidence 5.

[Coronavirus: the geriatric emergency of 2020. Joint document of the Section on Geriatric Cardiology of the Spanish Society of Cardiology and the Spanish Society of Geriatrics and Gerontology]. / Coronavirus: la emergencia geriátrica de 2020. Documento conjunto de la Sección de Cardiología Geriátrica de la Sociedad Española de Cardiología y la Sociedad Española de Geriatría y Gerontología.

SARS-CoV-2 infection, also known as COVID-19 (coronavirus infectious disease-19), was first identified in December 2019. In Spain, the first case of this infection was diagnosed on 31 January, 2020 and, by 15 April 2020, has caused 18 579 deaths, especially in the elderly. Due to the rapidly evolving situation regarding this disease, the data reported in this article may be subject to modifications. The older population are particularly susceptible to COVID-19 infection and to developing severe disease. The higher morbidity and mortality rates in older people have been associated with comorbidity, especially cardiovascular disease, and frailty, which weakens the immune response. Due to both the number of affected countries and the number of cases, the current situation constitutes an ongoing pandemic and a major health emergency. Because Spain has one of the largest older populations in the world, COVID-19 has emerged as a geriatric emergency. This document has been prepared jointly between the Section on Geriatric Cardiology of the Spanish Society of Cardiology and the Spanish Society of Geriatrics and Gerontology.

Selección de lo mejor del año 2020 en cardiología geriátrica

Resumen Durante el último año se han publicado numerosos trabajos centrados en el paciente mayor con enfermedad cardiovascular. En este texto repasamos algunos de los principales trabajos relacionados con el abordaje del paciente mayor con cardiopatía, incluyendo escenarios clínicos tan complejos como la situación de la pandemia de enfermedad por coronavirus de 2019 (COVID-19) que vivimos. Hemos querido resaltar y prestar especial atención a aspectos de gran relevancia clínica, dado su impacto pronóstico, como son los síndromes geriátricos y la comorbilidad, entidades prevalentes en el paciente mayor con cardiopatía, y que conviene conocer para mejorar la atención que proporcionamos a nuestros pacientes en distintos ámbitos (urgencias, hospitalización, ambulatorio). Analizamos también algunos de los principales estudios y trabajos impulsados desde la Sección de Cardiología Geriátrica de la Sociedad Española de Cardiología. During last year several papers focusing on elderly patients with cardiovascular disease have been published. In this article, we review some of the most important studies focused on the management of elderly patients with heart disease, also including complex clinical scenarios such as the COVID-19 pandemic. We highlight some aspects of great clinical relevance, given their prognostic impact, such as geriatric syndromes and comorbidity, all of them prevalent in the elderly. We also emphasize on how to improve the care we provide to our patients in different scenarios (emergency, hospitalization, outpatients). Finally, we analyze some of the main studies promoted by the Geriatric Cardiology Section of the Spanish Society of Cardiology.

[Coronavirus disease 2019 (COVID-19) and ageism: a narrative review of the literature]. / Enfermedad por coronavirus 2019 (COVID-19) y edadismo: revisión narrativa de la literatura.

Ageism is defined as stereotypes, prejudices and discrimination towards people due to their age. The present review analyzed the age-related attitudes, and the responses to them, produced during the COVID-19 pandemic. We searched for publications related to ageism during the COVID-19 pandemic in Pubmed, Medline, and Embase. Fourteen manuscripts were included. The works highlighted the civic and social sense of older adults, their capacity for help community, despite the risk of infection. This attitude contrasted with her vulnerability to illness and ageism. Specific interventions are necessary to support older adults during the pandemic, guaranteeing financial support, protection in the residential environment, access to information, and solving barriers to accessing health services. Likewise, chronological age should not be an independent criterion for clinical decision making.

The Effect of Age on Mortality in Patients With COVID-19: A Meta-Analysis With 611,583 Subjects.

OBJECTIVES: Initial data on COVID-19 infection has pointed out a special vulnerability of older adults. DESIGN: We performed a meta-analysis with available national reports on May 7, 2020 from China, Italy, Spain, United Kingdom, and New York State. Analyses were performed by a random effects model, and sensitivity analyses were performed for the identification of potential sources of heterogeneity. SETTING AND PARTICIPANTS: COVID-19-positive patients reported in literature and national reports. MEASURES: All-cause mortality by age. RESULTS: A total of 611,1583 subjects were analyzed and 141,745 (23.2%) were aged ≥80 years. The percentage of octogenarians was different in the 5 registries, the lowest being in China (3.2%) and the highest in the United Kingdom and New York State. The overall mortality rate was 12.10% and it varied widely between countries, the lowest being in China (3.1%) and the highest in the United Kingdom (20.8%) and New York State (20.99%). Mortality was <1.1% in patients aged <50 years and it increased exponentially after that age in the 5 national registries. As expected, the highest mortality rate was observed in patients aged ≥80 years. All age groups had significantly higher mortality compared with the immediately younger age group. The largest increase in mortality risk was observed in patients aged 60 to 69 years compared with those aged 50 to 59 years (odds ratio 3.13, 95% confidence interval 2.61-3.76). CONCLUSIONS AND IMPLICATIONS: This meta-analysis with more than half million of COVID-19 patients from different countries highlights the determinant effect of age on mortality with the relevant thresholds on age >50 years and, especially, >60 years. Older adult patients should be prioritized in the implementation of preventive measures.