Impact of early rehabilitation on the functional quality of life of the critically ill at one year

Introduction: ICU-acquired weakness (ICUAW) is a long-recognised phenomenon, featuring a prevalence of 25-80%. Early mobilisation is anaccepted intervention that may attenuate ICUAW and improve outcomes [1, 2]. Method(s): Prospective observational study in polyvalent ICU analysing the effect of early rehabilitation (eRHB) on quality of life one year after discharge (D/C).Patients who required invasive mechanical ventilation > 24 h and survived SARS-CoV2 respiratory infection between 5/3/2020 and 12/01/2022 were included. Patients were classified into two groups: eRHB or not eRHB. Demographic and clinical data were collected, and a telephone survey was conducted one year after D/C. Clinical Frailty Scale at ICU admission (T1) and one year after D/C (T5);Medical Research Council (MRC) at the start of rehabilitation (T2) and hospital D/C (T4);Barthel Index at ICU D/C (T3), T4 and T5;and the SF-36 health questionnaire at T5 were also collected. Statistical analysis was performed between subgroups: Pearson's Chi-square test or Mann-Whitney U test to find significant differences. ART-ANOVA was used to analyse the survey results. Result(s): Of 99 patients, 64.6% belonged to the eRHB group. There were no statistically significant differences in the analysis of clinicdemographic variables. We observed a significant improvement of the MRC, a better Barthel Index in the eRHB group, and a statistically significant positive impact on several components of the SF-36 in the eRHB group (physical functioning, vitality, social functioning, bodily pain, general health, and self-reported health transition). Conclusion(s): Patients who received eRHB had better physical functioning and higher vitality recovery. In addition, they suffered less impact on their social life, had better pain control, and reported improved general health. All this emphasises the need for eRHB protocols in the ICU, promoting multidisciplinary care of our patients.

Analysis of mortality and long-term prognosis in ventilated patients with COVID-19: a multicenter prospective observational study

Introduction: Long-term prognosis, especially for post-intensive care syndrome (PICS) is an emerging problem in critically ill patients. Prevalence and risk factors are unclear in patients with severe coronavirus disease 2019 (COVID-19). We aimed to investigate the prevalence and risks of mortality and PICS in ventilated patients with COVID-19. Method(s): A multicenter prospective study was conducted on ventilated patients with COVID-19 infection. The questionnaire for PICS evaluation was mailed within a median of 6 mo after hospital discharge, concerning Barthel Index, Short-Memory Questionnaire, and Hospital Anxiety and Depression Scale scores. Result(s): 251 patients completed the PICS questionnaires with a prevalence of PICS of 58.6%, along with the highest percentages of cognitive impairment. Delirium (OR 2.34, p = 0.03) and the duration of mechanical ventilation (OR 1.29, p = 0.02) were identified as independent risks for PICS. In 297 patients who received mechanicalventilation for 7 day or longer, protein and energy delivery in day 4-7, especially for protein delivery, were independently and monotonically associated with in-hospital mortality, but not with PICS occurence. Conclusion(s): 60% of the ventilated patients with COVID-19 suffered from PICS. Delirium and longer mechanical ventilation were identified as risks for PICS. In the patents requiring longer mechanical ventilation, nutrition delivery in the late period of the acute phase might be imprtant to survive COVID-19.

Prevalence of adverse drug reactions associated with emergency department visits and risk factors for hospitalization

Objective: Adverse drug reactions increase morbidity and mortality, prolong hospital stay and increase healthcare costs. The primary objective of this study was to determine the prevalence of emergency department visits for adverse drug reactions and to describe their characteristics. The secondary objective was to determine the predictor variables of hospitalization for adverse drug reactions associated with emergency department visits. Method(s): Observational and retrospective study of adverse drug reactions registered in an emergency department, carried out from November 15th to December 15th, 2021. The demographic and clinical characteristics of the patients, the drugs involved and the adverse drug reactions were described. Logistic regression was performed to identify factors related to hospitalization for adverse drug reactions. Result(s): 10,799 patients visited the emergency department and 216 (2%) patients with adverse drug reactions were included. The mean age was 70 +/- 17.5 (18-98) years and 47.7% of the patients were male. A total of 54.6% of patients required hospitalization and 1.6% died from adverse drug reactions. The total number of drugs involved was 315 with 149 different drugs. The pharmacological group corresponding to the nervous system constituted the most representative group (n = 81). High-risk medications, such as antithrombotic agents (n = 53), were the subgroup of medications that caused the most emergency department visits and hospitalization. Acenocumarol (n = 20) was the main drug involved. Gastrointestinal (n = 62) disorders were the most common. Diarrhea (n = 16) was the most frequent adverse drug reaction, while gastrointestinal bleeding (n = 13) caused the highest number of hospitalizations. Charlson comorbidity index behaved as an independent risk factor for hospitalization (aOR 3.24, 95% CI: 1.47-7.13, p = 0.003, in Charlson comorbidity index 4-6;and aOR 20.07, 95% CI: 6.87-58.64, p = 0.000, in Charlson comorbidity index >= 10). Conclusion(s): The prevalence of emergency department visits for adverse drug reactions continues to be a non-negligible health problem. High-risk drugs such as antithrombotic agents were the main therapeutic subgroup involved. Charlson comorbidity index was an independent factor in hospitalization, while gastrointestinal bleeding was the adverse drug reaction with the highest number of hospital admissions.Copyright © 2022 Sociedad Espanola de Farmacia Hospitalaria (S.E.F.H)

Challenges of Singapore's First Acute Geriatric Isolation Facility During the COVID-19 Pandemic

Aim: The COVID-19 pandemic has seen hospitals isolating suspect cases. Geriatric populations are at a risk of severe COVID-19 disease and often present with concomitant geriatric syndromes requiring holistic interdisciplinary care. However, isolation of older people poses challenges to care delivery. This study shares the experience of Singapore's first acute geriatric isolation facility geriatric PARI (Pneumonia-Acute Respiratory Infection) ward and describes the geriatric-related outcomes and pitfalls in care delivery. Method(s): This is a retrospective cross-sectional study performed in 7 negative pressure isolation rooms in an acute care public hospital in Singapore. 100 patients admitted consecutively to the geriatric PARI ward were included. Patient demographics, presenting symptoms and geriatric-related adverse outcomes associated with hospitalisation were collected and analysed. Result(s): Patients' mean age was 86.4 years (standard deviation [SD]: 6.8) with significant comorbidities being hypertension (81%), hyperlipidaemia (74%) and renal disease (70%). 51% of patients had dementia and 24% had behaviour and psychological symptoms of dementia (BPSD). 27% of patients presented atypically with delirium and 15% presented with a fall. Delirium was associated with restraint use (OR: 3.88;p-value 0.01). Falls rate was 1.64 per 1000 occupied bed. 1 patient screened positive for COVID-19. Conclusion(s): The geriatric PARI ward is essential for curbing nosocomial transmission of COVID-19. This is important in the older people with comorbidities who are more likely to develop morbidity and mortality. Our study reveals challenges in delivering person-centred care to the older patients in isolation rooms, especially in the management of delirium and falls prevention. Innovative strategies should be developed to minimise isolation-related adverse outcome.Copyright © The Author(s) 2022.

Clinical and functional characteristics of patients recovering from severe COVID-19 attending an inpatient pulmonary rehabilitation program

Background and Aims: A proportion of patients with coronavirus disease 2019 (COVID-19) need hospitalization due to severe respiratory symptoms. This study describes the characteristics of survivors of severe COVID-19 subsequently admitted to inpatient pulmonary rehabilitation (PR) and identifies their rehabilitation needs. Subjects and methods: From the COVID-19 Registry of the Fondazione Don Gnocchi we extracted 203 patients admitted for inpatient PR after severe COVID-19 from April 2020 till September 2021. Specific information on the acute-hospital stay, clinical and functional characteristics on admission to the rehabilitation units were collected. Result(s): During the acute phase of the disease 80% of patients needed ICU admission, receiving mechanical ventilation (MV) for 26 days. On admission to the rehabilitation units, 10% of patients were still on MV, 28% had tracheostomy, 70% were on O2 therapy, 24% were diagnosed critical illness neuropathy. Eighty % showed a modified Barthel Index <75 and only 25% were able to perform a six-minute walk test. Montreal Cognitive Assessment and Hospital Anxiety and Depression Scale were also performed, indicating a variable presence of neurocognitive impairment and symptoms of anxiety and/or depression. Moreover, 32% scored >=2 at the Malnutrition Universal Screening Tool and 47% showed dysphagia needing logopedic treatment Conclusion(s): Our analysis shows that patients admitted for inpatient PR after severe COVID-19 represent a multifaceted and clinically complex patient population who need customized, comprehensive rehabilitation programs, carried out by teams with different professional skills.

Effects Of An Early Rehabilitation Program In COVID-19 Patients Weaned From Non-Invasive Mechanical Ventilation: The Experience Of A Respiratory Subintensive Unit

Background: The purpose of the study was to verify the variation of some physiopathological-respiratory parameters, physical performance indicators and the ability to carry out activities of daily living in a group of patients suffering from respiratory failure secondary to SARS-CoV2 pneumonia newly weaned from non-invasive ventilation. Method(s): This study was conducted on 20 patients with SARS-CoV2 pneumonia admitted in a COVID-19 subintensive respiratory unit of Cotugno Hospital in Naples, who have just been weaned from non-invasive mechanical ventilation. The experimental group underwent an early rehabilitation lasting 7 days in addition to a specific medical therapy. Result(s): The intragroup comparison showed in the rehabilitation group an improvement in PaO2/FiO2 ratio, respiratory function physical performance measured by "handgrip test" and by "sit to stand test" (number of repetitions, dyspnoea measured by Borg modified scale, muscular fatigue measured by Borg) and in Barthel Index score. The control group showed an improvement only in PaO2/FiO2 ratio and Bathel Index Score. Conclusion(s): An early rehabilitation program initiated immediately after weaning from NIV is effective in improving gas exchanges, physical performance and daily life activities in a group of patients with respiratory failure secondary to SARS-CoV2 pneumonia.

Characteristics and risk factors for in-hospital mortality in 243 elderly patients with COVID-19 in Santorso, Italy: a retrospective study.

Large proportion of deaths from SARS-CoV-2 infections occurred worldwide, especially in elderly patients. The aim of this research is to investigate the potential risk factors for mortality in the elderly patients with COVID-19. 65 years old or older patients with COVID-19 admitted to the Hospital «Alto Vicentino¼ of Santorso, Vicenza, from 23th February to 25th May 2020, were enrolled in this retrospective cohort study. Data of demographics, clinical features, comorbidities and blood tests were collected and compared for different outcomes. Charlson Comorbidity Index (CCI), Barthel Index (BI) and Modified Early Warning Score (MEWS) were evaluated. Univariate and multivariate logistic regression analyses were performed to explore risk factors for death. 243 patients with mean age 81,3±8,4 years were enrolled, of which 121 (49,8%) were females. This cohort included 11 (4,5%) mild, 131 (53,9%) moderate, 94 (38,7%) severe, 7 (2,9%) critical cases. CCI and BI were 2,8±2,1 points and 31,3±34,9 points respectively. Lethality rate was 28,4% (69 cases). Univariate logistic regression showed a significant increase in mortality risk with increasing age, CCI, polypharmacy, MEWS, Severity Index and reduced BI. Among blood tests thrombocytopenia, high CRP and elevated LDH showed a significant correlation with mortality. In the multivariate logistic regression high CCI, low BI and thrombocytopenia remained to be predictors of death. Tools, which evaluate functional dependence like BI and multiple morbidity like CCI, can be useful in identifying the elderly patients with COVID-19 at greater risk.

Negative impact of behavior restriction amidst a clustered COVID-19 infection on immobility syndrome in older patients negative for COVID-19: report from a chronic care hospital in Japan.

Previous studies have reported on associations between immobility syndrome and the COVID-19 pandemic. However, little is known about the aggravation of this syndrome in older patients negative for COVID-19 infection amidst behavior restriction due to a clustered COVID-19 infection. Patients hospitalized one month before a clustered COVID-19 infection occurred in our hospital were recruited. Rehabilitation therapy was suspended for 25 days during behavior restriction. The ability of daily living of the patients was evaluated with the functional independence measure and Barthel index. Chronological changes in the functional independence measure and Barthel index scores were evaluated monthly, beginning one month before the clustered COVID-19 infection to one month after re-initiation of rehabilitation therapy. Patients with minimum scores in the functional independence measure (18) and Barthel index (0) prior to the clustered COVID-19 infection were excluded. Functional independence measure scores of 73 older patients and the Barthel index scores of 48 patients were analyzed. The mean total functional independence measure score amidst the behavior restriction significantly changed from 36.3 to 35.1 (p = 0.019), while statistical significance was not detected in the mean motor subtotal (from 21.6 to 20.9 with p = 0.247) or cognitive subtotal functional independence measure scores (from 14.6 to 14.2 with p = 0.478). During the behavior restriction, the mean Barthel index scores declined from 25.8 to 23.2 without statistical significance (p = 0.059). Behavior restriction due to a clustered COVID-19 infection may aggravate immobility syndrome in older patients who are negative for COVID-19.

The prognostic value of the Barthel Index for mortality in patients with COVID-19: A cross-sectional study.

Objective: This study aimed to analyze the association between the activity of daily living (ADL), coronavirus disease (COVID-19), and the value of the Barthel Index in predicting the prognosis of patients. Methods: This study included 398 patients with COVID-19, whose ADL at admission to hospital were assessed with the Barthel Index. The relationship between the index and the mortality risk of the patients was analyzed. Several regression models and a decision tree were established to evaluate the prognostic value of the index in COVID-19 patients. Results: The Barthel Index scores of deceased patients were significantly lower than that of discharged patients (median: 65 vs. 90, P < 0.001), and its decrease indicated an increased risk of mortality in patients (P < 0.001). After adjusting models for age, gender, temperature, pulse, respiratory rate, mean arterial pressure, oxygen saturation, etc., the Barthel Index could still independently predict prognosis (OR = 0.809; 95% CI: 0.750-0.872). The decision tree showed that patients with a Barthel Index of below 70 had a higher mortality rate (33.3-40.0%), while those above 90 were usually discharged (mortality: 2.7-7.2%). Conclusion: The Barthel Index is of prognostic value for mortality in COVID-19 patients. According to their Barthel Index, COVID-19 patients can be divided into emergency, observation, and normal groups (0-70; 70-90; 90-100), with different treatment strategies.

Long-Term Evolution of Activities of Daily Life (ADLs) in Critically Ill COVID-19 Patients, a Case Series.

BACKGROUND: The most common long-term symptoms of critically ill COVID-19 patients are fatigue, dyspnea and mental confusion. Adequate monitoring of long-term morbidity, mainly analyzing the activities of daily life (ADLs), allows better patient management after hospital discharge. The aim was to report long-term ADL evolution in critically ill COVID-19 patients admitted to a COVID-19 center in Lugano (Switzerland). METHODS: A retrospective analysis on consecutive patients discharged alive from ICU with COVID-19 ARDS was performed based on a follow-up one year after hospital discharge; ADLs were assessed through the Barthel index (BI) and the Karnofsky Performance Status (KPS) scale. The primary objective was to assess differences in ADLs at hospital discharge (acute ADLs) and one-year follow-up (chronic ADLs). The secondary objective was to explore any correlations between ADLs and multiple measures at admission and during the ICU stay. RESULTS: A total of 38 consecutive patients were admitted to the ICU; a t-test analysis between acute and chronic ADLs through BI showed a significant improvement at one year post discharge (t = -5.211, p < 0.0001); similarly, every single task of BI showed the same results (p < 0.0001 for each task of BI). The mean KPS was 86.47 (SD 20.9) at hospital discharge and 99.6 at 1 year post discharge (p = 0.02). Thirteen (34%) patients deceased during the first 28 days in the ICU; no patient died after hospital discharge. CONCLUSIONS: Based on BI and KPS, patients reached complete functional recovery of ADLs one year after critical COVID-19.

COVID-19 does not influence functional status after ARDS therapy.

RATIONALE: Health-related quality of life after surviving acute respiratory distress syndrome has come into focus in recent years, especially during the coronavirus disease 2019 pandemic. OBJECTIVES: A total of 144 patients with acute respiratory distress syndrome caused by COVID-19 or of other origin were recruited in a randomized multicenter trial. METHODS: Clinical data during intensive care treatment and data up to 180 days after study inclusion were collected. Changes in the Sequential Organ Failure Assessment score were used to quantify disease severity. Disability was assessed using the Barthel index on days 1, 28, 90, and 180. MEASUREMENTS: Mortality rate and morbidity after 180 days were compared between patients with and without COVID-19. Independent risk factors associated with high disability were identified using a binary logistic regression. MAIN RESULTS: The SOFA score at day 5 was an independent risk factor for high disability in both groups, and score dynamic within the first 5 days significantly impacted disability in the non-COVID group. Mortality after 180 days and impairment measured by the Barthel index did not differ between patients with and without COVID-19. CONCLUSIONS: Resolution of organ dysfunction within the first 5 days significantly impacts long-term morbidity. Acute respiratory distress syndrome caused by COVID-19 was not associated with increased mortality or morbidity.

Physical Function Assessment Tools in the Intensive Care Unit: A Narrative Review

Prolonged immobilization and bed rest in critically ill patients leads to loss of physical functional ability. Therefore, assessment of physical functional ability during intensive care unit (ICU) stay and at discharge plays a central role in planning early intervention and insti-tuting rehabilitation measures to improve physical function outcomes. Various scales have been developed, modified, and applied to assess functional ability, impairments, and disabilities in ICU patients. The selection of the most appropriate assessment scale depends on the specific patient population, the diagnosis, the phase of rehabilitation and the psychometric properties of the measurement tool. This narrative review aims to describe the various physical function assessment tools applicable to patients in the ICU, to determine the psychometric evidence for reliability and validity, and to summarize the strengths and weaknesses of each of these scales in order to enable clinicians to make an informed choice while selecting outcome variables during rehabilitation of patients in the critical care unit. Copyright © 2022 by Begell House, Inc.

Effect of SARS-CoV-2 Vaccination in a Frailty COVID-19 Cohort: a Real Life Experience in a Northern Italy Hospital

Background. Clinical trial demonstrated that SARS-CoV-2 vaccines have the ability of reduce mortality and morbidity due to COVID-19. The aim of this study is to describe the effect of vaccination in term of mortality, type of ventilation and ICU admission among patients hospitalized for COVID-19 from May to December 2021 in a Ligurian Hospital. Methods. This is a retrospective, single-center study conducted in San Martino Hospital (Genoa, Italy), including patients >= 18 years hospitalized for COVID-19 in Infectious Disease and Emergency Units from 1st May to 31st December 2021. We collected demographical data, multimorbidity and disability score, vaccination time ("vaccinated" all patients hospitalized >= 14 days after first dose or >= 7 days after second/ third dose), therapy for COVID-19, mortality at 7 and 30 days, ICU admission, ventilation type. Characteristics of vaccinated (group A) versus non vaccinated (group B) patients were compared using Chi-squared/Fisher's exact test for categorical variables and t-test /Kruskal-Wallis test for the continuous ones. Cox proportional hazards models for death at 30 days were performed as univariate analysis as well as adjusting for age, Cumulative Illness Rating Scale [CIRS], gender, Remdesivir, Monoclonal antibodies, Tocilizumab use. Results. Overall, 405 patients SARS-CoV-2 infected were enrolled. Data about timing of vaccination were available for 360 patients (89%). We compared clinical characteristics and outcomes of group A (32%) versus group B (68%). In group A patients were older (p< 0.001) and frailer (higher CIRS score and lower Barthel index, p< 0.001) than in group B. Among patients requiring oxygen, 76 (31.5%) in group B vs 26 (22.41%) in group A needed high flow ventilation (p=0.036);33 (13.52%) vs 3 (2.59%) respectively were admitted to ICU (Figure 1). Mortality at 30 days after hospitalization was higher in group A at univariate analysis [HR(95%CI) 1.44(0.82;2.53), p=0.208], lower at multivariate analysis [0.57(0.31;1.02), p=0.059]. Conclusion. The results of this study confirm that SARS-CoV-2 vaccination reduces rate of admission to ICU and 30 days mortality among patients hospitalized for COVID-19. In our cohort mortality among vaccinated patients remains high and we hypothesized this is due to high frailty of evaluated population.

Mortality risk model validation in a prospective cohort of patients from the sixth wave of the COVID-19 pandemic in a hospital emergency department

Objective. To validate risk factors for mortality in patients treated for COVID-19 in a hospital emergency department during the sixth wave of the pandemic. Method. Prospective observational noninterventional study. We included patients over the age of 18 years with a confirmed diagnosis of COVID-19 between December 1, 2021, and February 28, 2022. For each patient we calculated a risk score based on age 50 years or older (2 points) plus 1 point each for the presence of the following predictors: Barthel index less than 90 points, altered level of consciousness, ratio of arterial oxygen saturation to fraction of inspired oxygen less than 400, abnormal breath sounds, platelet concentration less than 100 x 109/L, C-reactive protein level of 5 mg/dL or more, and glomerular filtration rate less than 45 mL/min. The model was assessed with the area under the receiver operating characteristic curve (AUC). Results. Of the 1156 patients included, 790 (68%) had received at least 2 vaccine doses. The probability of 30-day survival was 96%. A risk score was calculated for 609 patients. Four hundred seventeen patients were at low risk of death, 180 were at intermediate risk, and 10 were at high risk. The probability of death within 30 days was 1%, 13%, and 50% for patients in the 3 risk groups, respectively. The sensitivity, specificity, and positive and negative predictive values of a risk score of 3 points or less were 88%, 72%, 19%, 99%, respectively.The AUC for the model was 0.87. Conclusion. The risk model identified low risk of mortality and allowed us to safely discharge patients treated for COVID-19 in our tertiary-care hospital emergency department. Copyright © 2023, Saned. All rights reserved.

Systematic Review Examining the Effect of Vitamin D Supplementation on Outcomes Post Stroke

Objective(s): The objective of this systematic review was to explore the effect of vitamin D supplementation on functional outcomes among individuals post stroke(PROSPERO CRD42022296462). Data Sources: MEDLINE, PsycInfo, EMBASE, and CINAHL were searched for articles published in any language from database inception to January 5, 2022. Study Selection: Only interventional studies assessing vitamin D supplementation compared to placebo or usual care in adult stroke patients were selected. After duplicate removal, 2,825 studies were screened by two independent reviewers. A total of 41 studies underwent full text review;8 studies met inclusion criteria (6 randomized controlled trials [RCTs] and 2 observational studies). Data Extraction: Data were extracted by two independent reviewers using Covidence software. Motor function (Brunnstrom Recovery Stage, Berg Balance Score), mobility (Functional Ambulation Category), activities of daily living (Barthel Index, Functional Independence Measure) and stroke impairment (Modified Rankin Scale, National Institutes for Health Stroke Severity, Scandinavian Stroke Severity) were the outcome measures of interest included in the studies. Data Synthesis: In total, 562 patients were studied for which 9 of 13 outcome measures showed improvement with vitamin D supplementation. Conclusion(s): The majority of studies showed an improvement in motor function, mobility, and stroke impairment with vitamin D supplementation;however, the evidence did not support an improvement in activities of daily living with treatment. Strong, methodologically sound RCTs are required to verify these findings. Author(s) Disclosures: None. Copyright © 2022

EFFECT OF TELEREHABILITATION IN FACILITATING UPPER EXTREMITY HOME PROGRAMS AND ASSOCIATED FUNCTIONAL REGAIN AMONG CHRONIC STROKE SURVIVORS: A PILOT STUDY

Background: Stroke is a leading cause of disability in adults, requiring regular patient-therapist contacts to achieve greater functional regain of the affected extremities. Factors such as the recent Covid-19 pandemic have limited access to Rehabilitation services across several communities globally. A proliferation of telerehabilitation to ameliorate these healthcare challenges has been palpable in the recent years across the globe. Purpose: To assess the effect of telerehabilitation in facilitating upper extremity home program and associated functional regain among chronic stroke survivors. Methods: Two groups pretest-posttest study design was employed. Participants were instructed to perform upper extremity home programs three times a week for four weeks. A task-oriented, individually tailored, and intensive home-based telerehabilitation program was administered to the participants using audio calls. Upper extremity functional status was assessed using Fugl-Meyer Motor Assessment, and Wolf Motor Function Test. The Barthel Index was used to assess the extent of activities of daily living. Results: A total number of 14 people were recruited (experimental n=7 age, 58 ± 5.83;control n=7, age 50.71 ± 8.62). Participants showed significant improvement for Fugl-Meyer Motor Assessment changed from 17.57 to 25.86 (p=0.02), whereas Wolf Motor Function Test changed from 28.14 to 43.71 (p=0.03). Conclusions: Amidst situations restricting regular hospital visit among stroke survivors;telerehabilitation could serve as an adjunct therapeutic option for upper extremity rehabilitation. Future studies should employ a randomized controlled trial design with a larger sample size to confirm the utility of telerehabilitation.

Recovery from Disorders of Consciousness after Severe COVID-19

Objective: To examine long-term outcomes of disorders of consciousness (DoC) after severe COVID-19. Background: Some patients with severe COVID-19 experience persistently impaired arousal and/or awareness after discontinuation of sedation, consistent with DoC. In our recently published analysis of 21 such patients, 12 (57%) recovered to minimally conscious state (MCS) or better before hospital discharge. Recovery to MCS-especially within 8 weeks of injury-is an important prognostic indicator in DoC of other etiologies, but its significance in COVID-19 remains unknown. Design/Methods: All 21 patients were included in a prospectively followed cohort involving telephonic assessment 6 and 12 months after discharge. We examined relationships between recovery to MCS and survival. For patients completing telephone assessments, we report functional outcomes including Barthel Index, extended Glasgow Outcome Scale (E-GOS), and modified Rankin Scale (mRS);and psychological outcomes using Quality of Life in Neurological Disorders (Neuro-QOL) anxiety, depression, fatigue, and sleep disturbance inventories. Results: Recovery to MCS within 8 weeks of illness onset-but not later-was associated with 12-month survival (6/8 versus 2/9, p=0.024). Six patients completed both assessments. Of these, 2 were in DoC at 6 months and died by 12 months;1 recovered consciousness after 6 months but remained severely disabled;1 was moderately disabled;and 2 achieved functional independence (Barthel Index 100;E-GOS 5-7;mRS 1-2). Neuro-QOL scores were elevated at 6 but not 12 months. Conclusions: Ten percent (2/21) of our original cohort achieved functional independence by 12 months, demonstrating that recovery is possible after COVID-19-associated DoC. Consistent with the literature on non-COVID DoC, recovery to MCS within 8 weeks of illness onset may be prognostically favorable. Psychological symptoms in this severely ill group were less common than in patients with neurologic sequelae of COVID-19 generally. More work is needed to understand the natural history of long-term recovery from severe COVID-19.

The Effect of Coffee Aromatherapy on Reducing Fatigue and Stress Levels of Female Caregivers Caring for the Elderly in Hospitals

BACKGROUND: The exploration of coffee as an aromatherapy in the health service has not been widely carried out. In many cases, aromatherapy has been shown to reduce stress and fatigue. PURPOSE: The purpose of the study was to analyzes the effect of coffee aromatherapy on the fatigue and stress levels of female caregivers caring for the elderly at the University of Sumatera Utara Hospital (USU Hospital), in Medan. METHODS: This is a quasi-experiment one group pre-test post-test design. The research involved 16 caregivers were given a treatment of coffee oil by inhalation for 15 min for 3 consecutive days, without coffee oil inhalation and 10% of coffee oil concentration on the 1st day, 20% on the 2nd day, and 30% on the 3rd day. Each sample received a pre-test and post-test in the form of stress and fatigue instruments. The data analysis performed was univariate in order to describe the properties of each variable examined and analyze the mean score. Similarly, bivariate analysis with the analysis of variance (ANOVA) statistical test was used to determine the effect of coffee aromatherapy on reducing the fatigue and stress level. RESULTS: The result showed that most caregivers were elderly children with an average age of 38 years, 81.3% assisted in caring for the elderly, and actively working outside the home. Based on the ANOVA test, the data showed that the administration of coffee aromatherapy for 3 consecutive days has no effect on female caregivers’ fatigue and stress level. However, the mean score showed a decrease in fatigue and stress level before and after coffee oil inhalation in 3 days. CONCLUSION: It is necessary to provide coffee oil aromatherapy intervention with a longer duration to have an effect on reducing caregiver fatigue and stress in the future, so the results are expected to form the basic data for the design of nursing interventions based on complementary therapies in order to reduce the fatigue and stress of caregivers while providing care to the hospitalized elderly.

COVID-19 Morbidity in Irish Nursing Home Residents

Background COVID-19 has had a disproportionate impact on nursing home residents with significantly higher mortality rates compared to the general population. Less attention however has been paid to COVID- 19 induced morbidity in this cohort. Our study aims to examine how nursing home (NH) residents who survived a COVID-19 infection, have been affected in terms of their cognitive, mood and functional outcomes as compared to residents that did not contract the virus. Method We performed an observational retrospective cohort study of the records of 452 residents in NHs affected by COVID-19 in Ireland from February 2020 to February 2021. We extracted data from the scheduled monthly assessments of the Barthel Index (BI), the Mini Mental State Examination (MMSE) and the Geriatric Depression Scale (GDS) performed on residents of these NHs. We compared data from residents who had contracted COVID-19 (cases) to those that had not (controls);at 6, 3 and 1 month prior to a positive COVID-19 PCR test, to ensure comparability of control group, and again at 1, 3 and 6 months after the infection using a Students-T test for normally distributed data. Results We noted a significant deterioration in MMSE, BI and GDS scores in residents who had contracted COVID-19 as outlined in the table. While there was recovery in BI and GDS in the months following the index infection, the MMSE score in COVID-19 affected residents remained significantly adversely affected at 6 months. Conclusion Our study demonstrates the significant impact of COVID-19 infection on the physical, functional, cognitive and mental health of nursing home residents. The patient cohort displayed significant resilience in recovering from the physical and psychological consequences of the disease. The failure of cognitive function to improve over the period of observation may represent the development of 'Long COVID' in these patients. The development of this condition in nursing home residents has been poorly studied, is likely under reported and requires further exploration.

DIFFERENTIAL DETERMINANTS OF SOCIAL ISOLATION AND LONELINESS

Background During COVID-19, social distancing was prevalent to curb disease transmission, particularly for vulnerable older adults. However, this isolation leads to low mood, functional decline and frailty. Hence, such preventative measures have brought to the fore the heavy implications of social isolation, the lack of social contact and interaction. Associated but separate is loneliness, the feeling of being alone or separated from others. While it is evident that either or both impact health negatively, attributable risk factors and relationship with geriatric syndromes such as frailty and sarcopenia are still unclear. Understanding these aspects would be important in developing healthcare policies to reduce social isolation and loneliness in our older adults. Hence, we aim to investigate the differential determinants of social isolation and loneliness in community dwelling older adults. Methods We surveyed 299 community dwelling older adults ≥60years. Parameters documented include demographics, 6-item Lubben Social Network Scale, UCLA loneliness scale, EQ5D, Montreal Cognitive Assessment, Geriatric Depression Scale, functional screening with Barthel index, Lawton instrumental activities of daily living scale, FRAIL scale and SARC-F. Linear regression analysis was performed. Results 234(78.26%) were female, mostly of Chinese ethnicity(90.30%), mean age 74.31±7.81years. 62(20.74%) were living alone. 220(73.58%) had primary school education or less. Mean number of chronic diseases 1.57±0.07 and 81(27.09%) classified as frail, ie FRAIL score 3 and above. Social isolation was significantly correlated with perceived health status (β=0.08;95%CI 0.04 to 0.13;p<0.01), self-care (β= -2.18;95%CI -4.19 to -0.17;p=0.03), sarcopenia (β= -0.57;95%CI -1.12 to -0.02;p=0.04) and cognition (β=0.26;95% CI 0.12 to 0.39;p<0.01). Loneliness was significantly correlated with pain (β= -0.23;95%CI -0.45 to -0.01;p=0.04). Conclusion Social isolation was linked to lower perceived health and cognition, but better physical function as seen from lower levels of sarcopenia and issues with self-care. This finding highlights that isolated older adults may not only be limited by physical disabilities. Mood and cognition have to be considered. Loneliness on the other hand was linked to pain, emphasising that this common symptom has far-reaching implications. Our study is important in identifying key risk factors to be investigated. More work is needed to delineate mechanisms.