ABSTRACT
The COVID-19 pandemic has had an important impact on older adults, conferring a worse prognosis. Older adults may have atypical presentations, which can delay the diagnosis of the disease, making its evolution more unfavorable. In addition to the cardiovascular damage mechanisms conferred by SARS-CoV-2 infection, the changes inherent in the aging cardiovascular and immune system favor the appearance of cardiovascular complications in a more relevant way in this population. The objective of this article will be to summarize the knowledge about cardiovascular involvement in older adults and explain its pathophysiological mechanisms, to alert about the early recognition and timely treatment of these complications.
La pandemia por COVID-19 ha impactado de forma importante en los adultos mayores, confiriéndoles un peor pronóstico. Los adultos mayores pueden tener presentaciones atípicas, las cuales pueden retrasar el diagnóstico de la enfermedad, haciendo su evolución más desfavorable. Además de los mecanismos de daño cardiovascular conferidos por la infección por SARS-CoV-2, los cambios inherentes al sistema cardiovascular e inmune ya envejecido, favorecen la aparición de complicaciones cardiovasculares de forma más relevante en esta población. El objetivo de este artículo será resumir los conocimientos sobre el involucro cardiovascular en adultos mayores y explicar los mecanismos fisiopatológicos de este, para alertar sobre el reconocimiento temprano y tratamiento oportuno de estas complicaciones.
Subject(s)
COVID-19 , Cardiovascular Diseases/virology , Cardiovascular System , Aged , COVID-19/complications , Humans , PandemicsABSTRACT
Resumen La nutrición cumple un valioso papel ante la infección por el nuevo coronavirus 2019 (covid-19), tanto para la prevención como para el tratamiento, y en particular en los pacientes adultos mayores, debido a que tienen un alto riesgo de desarrollar desnutrición, la cual podría desencadenar diversas complicaciones relacionadas a la enfermedad, sobre todo durante el periodo de hospitalización o en la unidad de cuidados intensivos. El manejo nutricional, además del manejo farmacológico, debe ser implementado de manera adecuada y oportuna por el personal de salud. El objetivo de la presente revisión es brindar información sobre la intervención nutricional para el manejo de personas adultas mayores con infección de covid-19.
Abstract Nutrition plays a valuable role in the face of infection by the new coronavirus 2019 (covid-19) both for prevention and treatment, particularly in older adult patients due to their increased risk of developing malnutrition, which could cause various complications related to covid-19, especially during the hospitalization period or, where appropriate, in the Intensive Care Unit. Nutritional therapy must be considered and implemented by health personnel in an appropriate way. The objective of this review is to provide relevant information regarding nutritional intervention in different clinical fields for the management of older adults with covid-19 infection.
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INTRODUCTION: BNT162b2 (BioNTech and Pfizer) is a nucleoside-modified mRNA vaccine that provides protection against SARS-CoV-2 infection and is generally well tolerated. However, data about its efficacy, immunogenicity and safety in people of old age or with underlying chronic conditions are scarce. PURPOSE: To describe BNT162b2 (BioNTech and Pfizer) COVID-19 vaccine immunogenicity, effectiveness and reactogenicity after complete vaccination (two doses), and immunogenicity and reactogenicity after one booster, in elders residing in nursing homes (NH) and healthy NH workers in real-life conditions. METHODS: Observational, ambispective, multicenter study. Older adults and health workers were recruited from three nursing homes of a private hospital corporation located in three Spanish cities. The primary vaccination was carried out between January and March 2021. The follow-up was 13 months. Humoral immunity, adverse events, SARS-CoV-2 infections, hospitalizations and deaths were evaluated. Cellular immunity was assessed in a participant subset. RESULTS: A total of 181 residents (mean age 84.1 years; 89.9% females, Charlson index ≥2: 45%) and 148 members of staff (mean age 45.2 years; 70.2% females) were surveyed (n:329). After primary vaccination of 327 participants, vaccine response in both groups was similar; ≈70% of participants, regardless of the group, had an antibody titer above the cut-off considered currently protective (260BAU/ml). This proportion increased significantly to ≈ 98% after the booster (p<0.0001 in both groups). Immunogenicity was largely determined by a prior history of COVID-19 infection. Twenty residents and 3 workers were tested for cellular immunity. There was evidence of cellular immunity after primary vaccination and after booster. During the study, one resident was hospitalized for SARS-CoV-2. No SARS-CoV-2-related deaths were reported and most adverse events were mild. CONCLUSIONS: Our results suggest that the BNT162b2 mRNA COVID-19 vaccine is immunogenic, effective and safe in elderly NH residents with underlying chronic conditions.
Subject(s)
COVID-19 Vaccines , COVID-19 , Aged , Female , Humans , Aged, 80 and over , Male , COVID-19 Vaccines/adverse effects , BNT162 Vaccine , COVID-19/prevention & control , SARS-CoV-2 , Nursing Homes , Hospitals, PrivateABSTRACT
OBJECTIVES: To estimate the magnitude and importance of a process of stratification and advance care planning and the use of health resources, among patients in an integrated health care program for frail elderls in nursing homes,that were referred to the hospital with COVID-19. MATERIAL AND METHODS: Prospective cohort study of patients >64 years old with COVID-19 infection, in a health care program in nursing homes (from 3/15/2020 to 9/15/2020). The identification of patients with palliative needs, the performing and visible registration in electronic health records of the advance care planning and the use of intensive care were assessed. RESULTS: We included 374 COVID-19 patients. 88% were women, the median age was 88 years old. The 79% were patients with palliative needs, of which 68% had the advance care planning (P<.001) registered in the electronic health record. Only 1% of patients with palliative needs and severity criteria were admitted to the intensive care unit. Overall mortality was 25%. Of those who died, 74% had severity criteria (P<.001) and 90% had palliative needs (P<.001). CONCLUSIONS: Carrying out a care process based on identification of patients with palliative needs and advance care planning and a central and visible registration of advance care planning in health records, could improve the quality and safety of care and optimize the use of intensive care health resources at all times and especially in public health emergencies.
Subject(s)
Advance Care Planning , COVID-19 , Humans , Female , Aged , Aged, 80 and over , Male , Frail Elderly , Prospective Studies , COVID-19/epidemiology , Nursing Homes , Delivery of Health Care , Health Resources , Palliative CareABSTRACT
The purpose of this article is to understand the meaning given by elderly adults in central Chile to the period of the Covid-19 pandemic concerning health and physical exercise. From the methodological perspective, the research is inscribed in the perspective of the interpretative-comprehensive paradigm, through the qualitative methodology. Seventeen seniors were interviewed on two occasions;the year 2020, the year 2021, the interviews were performed via Skype or video call due to the restrictions imposed by the sanitary authority, to avoid physical contact with the interviewees. The results of the study are related to the adverse effects in psychosocial terms that the elderly population has experienced as a result of the confinement, oppositely, despite the pandemic, the seniors have maintained healthy lifestyles. In conclusion, this study proposes further studies to show the negative impact of confinement on elderly adults and, as follows, influence the State to assume a better direction in public policies aimed at this age group. Alternate : El propósito de este artículo es comprender el significado que le otorgan adultos mayores de la zona central de Chile al periodo de la pandemia Covid-19 respecto a la salud y al ejercicio físico. Desde el punto de vista metodológico, la investigación se inscribe en la perspectiva del paradigma interpretativo-comprensivo, a través de metodología cualitativa. Se entrevistó a 17 adultos mayores en dos ocasiones, año 2020 año 2021, las entrevistas se realizaron vía Skipe o video llamada producto de las restricciones impuestas por la autoridad sanitaria, para evitar el contacto físico con los entrevistados. Los hallazgos del estudio dicen relación con los efectos adversos en términos psicosociales, que ha experimentado la población de adultos mayores producto del confinamiento, por otro lado, a pesar de la pandemia, los adultos mayores han mantenido hábitos saludables. En conclusión, se propone profundizar en estudios que permitan mostrar el impacto negativo del encierro en los adultos mayores y de esta manera influir para que el Estado asuma una mejor dirección en las políticas públicas dirigidas a este grupo etario.Alternate :O objectivo deste artigo é compreender o significado dado pelos adultos mais velhos da zona central do Chile ao período da pandemia de Covid-19, durante a segunda parte do ano 2020 e o primeiro semestre do ano 2021. Do ponto de vista metodológico, a investigação está inscrita na perspectiva do paradigma interpretativo-compreensivo, através da metodologia qualitativa. Numa primeira fase, 17 adultos mais velhos foram entrevistados em 2020 e depois 10 deles foram novamente entrevistados em 2021, via Skype ou videochamada devido às restrições impostas pela autoridade sanitária, a fim de evitar o contacto físico com os entrevistados. Os resultados do estudo estão relacionados com os efeitos adversos em termos psicossociais, que os idosos experimentaram como resultado do confinamento, por outro lado, apesar da pandemia, os adultos mais velhos mantiveram hábitos saudáveis e fizeram exercício como caminhar e dançar, individualmente ou acompanhados por um membro da família. Em conclusão, propõe-se aprofundar em estudos desta natureza e que o Estado assuma uma melhor orientação nas políticas públicas dirigidas a este grupo etário. Traduzido com a versão gratuita do tradutor - www.DeepL.com/Translator
ABSTRACT
BACKGROUND AND OBJECTIVE: The Coronavirus Anxiety Scale (CAS) is an instrument that measures the severity of anxiety due to COVID-19 or coronaphobia. In the context of the COVID-19 pandemic, older adults are the most vulnerable age group; therefore, the aim of the study was to evaluate the psychometric properties of the CAS in this group. MATERIALS AND METHOD: 274 Peruvian older adults participated (Mage=67.86; SD=6.34, 64.6% women). In addition to the CAS, the 2-item Patient Health Questionnaire (PHQ-2), and 2-item Generalized Anxiety Disorder Scale (GAD-2) were applied. Confirmatory Factor Analysis (CFA) was used to assess the factor structure of the CAS and Item Response Theory was used to analyze item characteristics. A sequence of hierarchical variance models was used to evaluate the measurement invariance of the CAS according to age. To assess reliability, Cronbach's alpha coefficient (α) and the omega coefficient (ω) were used. The correlations between the CAS score and the scores of the PHQ-2 and GAD-2 scales were calculated with Pearson's correlation coefficient (r). RESULTS: The results of the CFA indicated that the unidimensional model of the CAS fitted the data adequately and showed very good reliability (α and ω≥.83). Likewise, all items provided high information and adequate discrimination, which allowed for better detection of average and high levels of coronaphobia in the older adult population. However, the CAS did not show evidence of being strictly invariant between older adults aged 60-65 years and 66-86 years. The CAS showed significant correlations with anxiety (r=.72; [95%CI: .66, .87] p<.01) and depression (r=.53; [95%CI: .43, .76] p<.01). CONCLUSION: The CAS in Spanish shows evidence of validity based on internal structure, convergent and divergent validity, as well as an adequate reliability estimate to assess coronaphobia in older adults. The CAS can be used to detect average and high levels of coronaphobia in the older adult population.
Subject(s)
COVID-19 , Pandemics , Aged , Anxiety/diagnosis , Female , Humans , Male , Psychometrics , Reproducibility of Results , SARS-CoV-2 , Surveys and QuestionnairesABSTRACT
Los Adultos Mayores (AM+65) corresponden al grupo etario más afectado ante la acción del SARS-CoV-2, por lo que resulta relevante analizar la percepción de los Adultos Mayores de 65 años o más que asisten a la Confraternidad Lupita Nolvios (CLN) a la adherencia de los mecanismos de autocuidado ante el Covid-19 con énfasis en el acompañamiento del personal de enfermería (PE) de acuerdo al modelo de Dorothea Orem. Estudio cuantitativo de campo de enfoque descriptivo de cohorte transversal abarcando el periodo marzo-2020 a septiembre-2020. Los resultados indican que en el 08 de julio 2020 se alcanzó un pico de 21,88% de casos confirmados Covid-19 en AM+65 y un porcentaje acumulado de fallecimientos de 59,51% para el periodo del estudio. Se evidencia que los AM+65 conocen la importancia de su autocuidado aplicando en un 75,76% de las mismas, haciendo énfasis para Covid-19 en el uso de las mascarillas (64%; n=32/50). Resaltando finalmente, el papel de PE con un 64% que inciden en la formación del AM+65, en su autocuidado de acuerdo a su patología (74%) y un 68% perciben como influye el PE en subir la autoestima del AM+65 ante el Covid-19(AU)
Older Adults (AM+65) correspond to the age group most affected by the action of SARS-CoV-2, so it is relevant to analyze the perception of Older Adults aged 65 or over who attend the Lupita Nolvios Confraternity (CLN ) to adherence to self-care mechanisms in the face of Covid-19 with an emphasis on the support of nursing staff (NP) according to the Dorothea Orem model.Quantitative cross-sectional cohort descriptive field study covering the period March-2020 to September-2020. The results indicate that on July 8, 2020, a peak of 21.88% of confirmed Covid-19 cases in AM+65 was reached and a cumulative death rate of 59.51% for the study period. It is evident that AM+65 know the importance of their self-care by applying 75.76% of them, emphasizing for Covid-19 in the use of masks (64%; n=32/50). Finally, the role of PE with 64% that affect the formation of AM+65, in its self-care according to its pathology (74%) and 68% perceive how the PE influences in raising the self-esteem of AM+65 before the Covid-19(AU)
Subject(s)
Humans , Male , Aged , Aged, 80 and over , Self Care , COVID-19 , Perception , Nursing Theory , Cross-Sectional Studies , Ecuador/epidemiology , Age Groups , Nursing StaffABSTRACT
Abstract Introduction Older adults are not only at a higher medical risk during the COVID-19 pandemic, but they may also be a group particularly vulnerable to mental health diminishing. Objective To analyze the effect of some sociodemographic factors (sex and age) and medical conditions (diabetes and hypertension) on mental health and concerns about COVID-19 in a sample of older adults. Method A non-probabilistic sample of 2,992 older adults (37.7% men and 62.3% women) was selected, with an average age of 70.45 years (SD = 7.31). Participants were given the Impact of Event Scale-6 (IES-6), the Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder-7 (GAD-7), a questionnaire of concerns about COVID-19, and a sociodemographic questionnaire. Participants' answers were captured via Google Forms. Results The results showed that women had greater concerns about COVID-19 than men. The findings in general showed significant effects, with women showing higher scores in depressive symptoms, anxiety, and greater stress generated in addition by the impact of the event. Differences concerning event-related stress and depression were found in relation to subgroups by age. Discussion and conclusion These finding could serve for the planning and development of strategies that provide attention to the mental health of this population group.
Resumen Introducción Los adultos mayores no sólo presentan un mayor riesgo médico durante la pandemia de COVID-19, sino que también pueden ser particularmente vulnerables a la disminución de la salud mental. Objetivo Analizar el efecto de algunos factores sociodemográficos (sexo y edad) y condiciones médicas (diabetes e hipertensión) sobre la salud mental y las preocupaciones sobre COVID-19 en una muestra de adultos mayores. Método Se seleccionó una muestra no probabilística de 2,992 adultos mayores (37.7% hombres y 62.3% mujeres), con una edad promedio de 70.45 años (DE = 7.31). Los participantes recibieron la Estala de Impacto de Evento-6, el Cuestionario de Salud del Paciente-9, el Trastorno de Ansiedad Generalizada-7, un cuestionario de preocupaciones sobre COVID-19 y un cuestionario sociodemográfico. Resultados Las mujeres presentaron mayores preocupaciones por COVID-19 que los hombres. Las respuestas de los participantes se capturaron en Google Forms. Resultados En general, los hallazgos mostraron efectos significativos, siendo las mujeres quienes presentaron puntuaciones más altas en síntomas depresivos y ansiedad, así como mayor estrés asociado a evento. Además, se encontraron efectos diferenciados por subgrupos de edad en relación con estrés asociado a evento y síntomas depresivos. Discusión y conclusión Estos hallazgos pudieran ser útiles para planificar y desarrollar estrategias que brinden atención a la salud mental de este grupo de población.
ABSTRACT
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.
Subject(s)
COVID-19/therapy , Cytokine Release Syndrome , Dietary Supplements , Geriatrics , Vitamin D Deficiency/therapy , Vitamin D/administration & dosage , Vitamins/administration & dosage , Aged , COVID-19/complications , COVID-19/immunology , COVID-19/prevention & control , Cytokine Release Syndrome/prevention & control , Humans , Receptors, Calcitriol/metabolism , Societies, Medical , Spain , Vitamin D/immunology , Vitamin D Deficiency/complications , Vitamins/immunologyABSTRACT
INTRODUCTION: Older adults constitute the most vulnerable population group to the COVID-19 pandemic. In Mexico, their biopsychosocial conditions might intensify their vulnerability. METHOD: Affiliation to health systems, health conditions and gerontological evaluation of 3,218 older adults were analyzed following the methodology of the PAHO-Mexico Health, Well-being and Aging Survey. RESULTS: 88.6 % of older adults referred being affiliated to health systems; 30.2 %, 52.4 %, 10.3 %, 4.1 % and 5.6 % referred suffering from diabetes mellitus, high blood pressure, chronic obstructive pulmonary disease, heart disease and cerebrovascular disease, respectively; 15.6 % reported urinary incontinence, and 11.3%, fecal incontinence; 12.1 % of the women referred having suffered from breast cancer at some point, and 6.3 %, cervical cancer. The habit of smoking tobacco was observed in 11.1 %, risk of malnutrition in 32.8 %, established malnutrition in 4.1 %, functional dependence for basic and instrumental activities of daily life in 16.3 % and 17.6 %, respectively. CONCLUSION: Comprehensive gerontological evaluation is essential for efficient care of older adults who suffer from COVID-19, and for adequate care of the effects or health conditions at the conclusion of the confinement imposed by the pandemic.
INTRODUCCIÓN: Los adultos mayores constituyen el grupo más vulnerable ante la pandemia por COVID-19; en México, sus condiciones biopsicosociales podrían potenciar su vulnerabilidad. MÉTODO: Se analizó afiliación a sistemas de salud, condiciones de salud y evaluación gerontológica de 3218 adultos mayores conforme a la metodología de la Encuesta Salud, Bienestar y Envejecimiento OPS-México. RESULTADOS: 88.6 % de los adultos mayores refirió afiliación a un sistema de salud; 30.2, 52.4, 10.3, 4.1 y 5.6 % indicaron padecer diabetes mellitus, hipertensión arterial, enfermedad pulmonar obstructiva crónica, enfermedad cardiaca y evento vascular cerebral, respectivamente; 15.6 % reportó incontinencia urinaria y 11.3 %, fecal; 12.1 % de las mujeres indicó haber padecido en algún momento cáncer de mama y 6.3 %, cáncer cervicouterino. Se observó hábito de fumar tabaco en 11.1 %, riesgo de malnutrición en 32.8 %, malnutrición establecida en 4.1 %, dependencia funcional para las actividades básicas en 16.3 % e instrumentales de la vida diaria en 17.6 %. CONCLUSIÓN: La evaluación gerontológica integral es fundamental para la atención eficiente de los adultos mayores que padecen COVID-19 y para la adecuada atención por los efectos o condiciones de salud al terminar el confinamiento por la pandemia.