Construction and use of a risk stratification instrument for vaccination of elderly against Covid-19 / Construção e utilização de instrumento de estratificação de risco para vacinação de idosos contra a Covid-19 / Construcción y uso de un instrumento de estratificación de riesgo para la vacunación del anciano contra el Covid- 19

Objetivo: Relatar a experiência da construção e utilização de um instrumento de estratificação de risco para vacinação de idosos contra a COVID-19. Métodos: Relato da experiência desenvolvida no município de Massapê ­ Ceará, durante o ano de 2021, a partir do início da campanha de vacinação de idosos contra a COVID-19. Descrição da Experiência: Por conta da escassez de imunobiológicos, na fase inicial da vacinação contra a COVID-19, a Secretaria da Saúde do município de Massapê, estado do Ceará, criou um instrumento para estratificação de riscos sanitários, epidemiológicos e sociais dos idosos, contendo seus dados sociodemográficos e as comorbidades. Após o estabelecimento das variáveis, foram estabelecidos escores para os estratos de risco, que foram classificados em baixo (um a três pontos), médio (quatro a seis pontos), alto (sete a nove pontos) e muito alto (dez pontos e mais). Considerações Finais: O estudo mostra que, apesar da pandemia de COVID-19, uma crise sanitária global sem precedentes como já dito, ações pontuais, mesmo que localizadas, podem ter efeito em cadeia e ser replicadas em outros cenários e momentos.

Objective: To report the experience of building and using a risk stratification instrument for vaccinating the elderly against COVID-19. Methods: Report of the experience developed in the municipality of Massapê - Ceará, during the year 2021, from the beginning of the vaccination campaign for the elderly against COVID-19. Experience Description: Due to the scarcity of immunobiologicals, in the initial phase of vaccination against COVID-19, the Department of Health of the municipality of Massapê, state of Ceará, created an instrument to stratify the health, epidemiological and social risks of the elderly, containing sociodemographic data and comorbidities of the elderly. After establishing the variables, scores were established for the risk strata, which were classified as low (one to three points), medium (four to six points), high (seven to nine points) and very high (ten points and more). Final Considerations: The study shows that, despite the COVID-19 pandemic, an unprecedented global health crisis as already mentioned, specific actions, even if localized, can have a chain effect and be replicated in other scenarios and times.

Objetivo: Relatar la experiencia de construcción y uso de un instrumento de estratificación de riesgo para la vacunación de ancianos contra la COVID-19. Métodos: Informe de la experiencia desarrollada en el municipio de Massapê - Ceará, durante el año 2021, desde el inicio de la campaña de vacunación de ancianos contra la COVID-19. Descripción de la Experiencia: Debido a la escasez de inmunobiológicos, en la fase inicial de la vacunación contra la COVID-19, la Secretaría de Salud del municipio de Massapê, estado de Ceará, creó un instrumento para estratificar los riesgos sanitarios, epidemiológicos y sociales de los ancianos, que contiene datos sociodemográficos y comorbilidades de los ancianos. Luego de establecer las variables, se establecieron puntajes para los estratos de riesgo, los cuales se clasificaron en bajo (uno a tres puntos), medio (cuatro a seis puntos), alto (siete a nueve puntos) y muy alto (diez puntos y más). Consideraciones finales: El estudio muestra que, a pesar de la pandemia de COVID-19, una crisis sanitaria mundial sin precedentes como ya se mencionó, las acciones específicas, aunque sean localizadas, pueden tener un efecto en cadena y replicarse en otros escenarios y tiempos.

Analysis of 65 Years Old and Over Patients with Full Dose Vaccination by Inactive Vaccine and without Vaccination Admitted to Hospital with SARS-Cov-2 PCR Positivity

Objective: In this study, we aimed to analyze real-time reverse transcription-polymerase chain reaction (RT-PCR) positive elderly patients (>= 65 years old) admitted to the hospital with symptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection regarding their vaccination status.Methods: The study included 151 COVID-19 patients aged >= 65 years old, admitted to the hospital between March 10 and June 30, 2021. The study group was divided into two groups: Group 1 consisted of patients who had two doses of inactive vaccine, administered at four weeks interval, and Group 2 consisted of unvaccinated patients who had no vac-cination at all or got one dose of vaccine or had an infection within 15 days of completion of the vaccination schedule. We compared the two groups based on demographic, clinical, laboratory, and mortality data.Results: Groups 1 and 2 included 78 and 73 patients, respectively. There was no significant difference between groups regarding gender distribution, age, intensive care admission, number of underlying diseases, and laboratory and radio-logical findings. However, the number of comorbidities and mortality showed a significant positive correlation. Also, the presence of desaturation was significantly associated with mortality.Conclusion: In this study, we established that an inactive virus vaccine had no significant protectivity for the severity of disease and mortality in the elderly population.

Depression and Associated Factors Among Older Adults in a North Indian State: A Cross-Sectional Study.

INTRODUCTION: India is currently experiencing a significant increase in its elderly population, and it is predicted to rise. Depression is prevalent among the elderly population. This study aimed at measuring the prevalence of depression among the elderly population in India. METHODOLOGY: This cross-sectional study was conducted in both urban and rural regions of Delhi, with a total of 230 participants recruited through systematic random sampling. This sampling method involved selecting households from a comprehensive list. The Patient Health Questionnaire 9 (PHQ-9) was used as a screening tool for depression. Participants with a PHQ-9 score above 9 were considered to potentially experience depression. RESULTS: The study findings revealed that 68.2% (95%CI: 61.8%-74.2%) of the total sample of 230 participants screened positive for depression. Gender (p = 0.02), age category (p < 0.01), place of residence (p < 0.01), and diabetes (p < 0.01) were significantly associated with depression. CONCLUSION: The study found a high prevalence of depression among the elderly population, with females, urban dwellers, and those with a history of diabetes being significantly associated with depression. Early detection through screening programs and community-based interventions could help manage depression in this vulnerable group.

Waning of Antibody Response Among Vaccinees who Received Two Doses of Covishield Vaccine.

Introduction: There are limited data available on the long-term presence of SARS-CoV-2-specific binding antibodies and neutralizing antibodies in circulation among the elderly population. This study aims to examine levels of anti-SARS-CoV-2 antibodies in vaccines who have completed at least 6 months since the second vaccine dose. A cross-sectional study was conducted from November 2021 to January 2022 among 199 vaccines aged 60 years and above residing in Belagavi city, who received two doses of the Covishield vaccine. Methods: Antibody response to SARS-COV-2 virus whole cell antigen was measured by a kit COVID KAWACH IgG Micro LISA (J Mitra and Company, India) in 199 participants who had completed at least 6 months after receiving the second dose of Covishield vaccine. The antibody response was measured as a ratio of optical density (OD) in the participant's sample to the mean OD in negative control test by normal (T/N). Independent Kruskal-Wallis test was applied to test the difference between the T/N ratio by months of vaccination since the second dose and by the age group strata. Results: The median T/N values among participants who completed 6, 7, 8, and 9 months since the second vaccine dose were 14.17, 10.46, 7.93, and 5.11, respectively, and this decline in T/N values was statistically significant. Antibody response values showed a decline with increasing age for participants in the age strata 60-69, 70-79, and 80 and above, respectively. Conclusions: A significant decline was observed in antibody response over 9 months supporting the administration of booster dose of vaccine.

Protecting Older Adult Residents in Care Facilities Against Influenza and COVID-19 Using the Influenza Communication, Advice and Reporting (FluCARE) App: Prospective Cohort Mixed Methods Study.

BACKGROUND: Early detection and response to influenza and COVID-19 outbreaks in aged care facilities (ACFs) are critical to minimizing health impacts. The Sydney Local Health District (SLHD) Public Health Unit (PHU) has developed and implemented a novel web-based app with integrated functions for online line listings, detection algorithms, and automatic notifications to responders, to assist ACFs in outbreak response. The goal of the Influenza Outbreak Communication, Advice and Reporting (FluCARE) app is to reduce time delays to notifications, which we hope will reduce the spread, duration, and health impacts of an influenza or COVID-19 outbreak, as well as ease workload burdens on ACF staff. OBJECTIVE: The specific aims of the study were to (1) evaluate the acceptability and user satisfaction of the implementation and use of FluCARE in helping ACFs recognize, notify, and manage influenza and COVID-19 outbreaks in their facility; (2) identify the safety of FluCARE and any potential adverse outcomes of using the app; and (3) identify any perceived barriers or facilitators to the implementation and use of FluCARE from the ACF user perspective. METHODS: The FluCARE app was piloted from September 2019 to December 2020 in the SLHD. Associated implementation included promotion and engagement, user training, and operational policies. Participating ACF staff were invited to complete a posttraining survey. Staff were also invited to complete a postpilot evaluation survey that included the user Mobile Application Rating Scale (uMARS) measuring app acceptance, utility, and barriers and facilitators to use. An issues log was also prospectively maintained to assess safety. Survey data were analyzed descriptively or via content analysis where appropriate. RESULTS: Surveys were completed by 31 consenting users from 27 ACFs. FluCARE was rated 3.91 of 5 overall on the uMARS. Of the 31 users, 25 (80%) would definitely use FluCARE for future outbreaks, and all users agreed that the app was useful for identifying influenza and COVID-19 outbreaks at their facilities. There were no reported critical issues with incorrect or missed outbreak detection. User training, particularly online training modules, and technical support were identified as key facilitators to FluCARE use. CONCLUSIONS: FluCARE is an acceptable, useful, and safe app to assist ACF staff with early detection and response to influenza and COVID-19 outbreaks. This study supports feasibility for ongoing implementation and efficacy evaluation, followed by scale-up into other health districts in New South Wales.

Protection against severe COVID-19 after second booster dose of adapted bivalent (original/Omicron BA.4-5) mRNA vaccine in persons ≥ 60 years, by time since infection, Italy, 12 September to 11 December 2022.

Effectiveness against severe COVID-19 of a second booster dose of the bivalent (original/BA.4-5) mRNA vaccine 7-90 days post-administration, relative to a first booster dose of an mRNA vaccine received ≥ 120 days earlier, was ca 60% both in persons ≥ 60 years never infected and in those infected > 6 months before. Relative effectiveness in those infected 4-6 months earlier indicated no significant additional protection (10%; 95% CI: -44 to 44). A second booster vaccination 6 months after the latest infection may be warranted.

Pandemic-Related Changes in Technology Use Among a Sample of Previously Hospitalized Older Adult New Yorkers: Observational Study.

BACKGROUND: The COVID-19 pandemic increased the importance of technology for all Americans, including older adults. Although a few studies have indicated that older adults might have increased their technology use during the COVID-19 pandemic, further research is needed to confirm these findings, especially among different populations, and using validated surveys. In particular, research on changes in technology use among previously hospitalized community-dwelling older adults, especially those with physical disability, is needed because older adults with multimorbidity and hospital associated deconditioning were a population greatly impacted by COVID-19 and related distancing measures. Obtaining knowledge regarding previously hospitalized older adults' technology use, before and during the pandemic, could inform the appropriateness of technology-based interventions for vulnerable older adults. OBJECTIVE: In this paper, we 1) described changes in older adult technology-based communication, technology-based phone use, and technology-based gaming during the COVID-19 pandemic, compared to before the COVID-19 pandemic and 2) tested whether technology use moderated the association between changes in in-person visits and well-being, controlling for covariates. METHODS: Between December 2020 and January 2021 we conducted a telephone-based objective survey with 60 previously hospitalized older New Yorkers with physical disability. We measured technology-based communication through three questions pulled from the National Health and Aging Trends Study COVID-19 Questionnaire. We measured technology-based smart phone use and technology-based video gaming through the Media Technology Usage and Attitudes Scale. We used paired t tests and interaction models to analyze survey data. RESULTS: This sample of previously hospitalized older adults with physical disability consisted of 60 participants, 63.3% of whom identified as female, 50.0% of whom identified as White, and 63.8% of whom reported an annual income of $25,000 or less. This sample had not had physical contact (such as friendly hug or kiss) for a median of 60 days and had not left their home for a median of 2 days. The majority of older adults from this study reported using the internet, owning smart phones, and nearly half learned a new technology during the pandemic. During the pandemic, this sample of older adults significantly increased their technology-based communication (mean difference=.74, P=.003), smart phone use (mean difference=2.9, P=.016), and technology-based gaming (mean difference=.52, P=.030). However, this technology use during the pandemic did not moderate the association between changes in in-person visits and well-being, controlling for covariates. CONCLUSIONS: These study findings suggest that previously hospitalized older adults with physical disability are open to using or learning technology, but that technology use might not be able to replace in-person social interactions. Future research might explore the specific components of in-person visits that are missing in virtual interactions, and if they could be replicated in the virtual environment, or through other means.

Relative effectiveness of a 2nd booster dose of COVID-19 mRNA vaccine up to four months post administration in individuals aged 80 years or more in Italy: A retrospective matched cohort study.

Several countries started a 2nd booster COVID-19 vaccination campaign targeting the elderly population, but evidence around its effectiveness is still scarce. This study aims to estimate the relative effectiveness of a 2nd booster dose of COVID-19 mRNA vaccine in the population aged ≥ 80 years in Italy, during predominant circulation of the Omicron BA.2 and BA.5 subvariants. We linked routine data from the national vaccination registry and the COVID-19 surveillance system. On each day between 11 April and 6 August 2022, we matched 1:1, according to several demographic and clinical characteristics, individuals who received the 2nd booster vaccine dose with individuals who received the 1st booster vaccine dose at least 120 days earlier. We used the Kaplan-Meier method to compare the risks of SARS-CoV-2 infection and severe COVID-19 (hospitalisation or death) between the two groups, calculating the relative vaccine effectiveness (RVE) as (1 - risk ratio)X100. Based on the analysis of 831,555 matched pairs, we found that a 2nd booster dose of mRNA vaccine, 14-118 days post administration, was moderately effective in preventing SARS-CoV-2 infection compared to a 1st booster dose administered at least 120 days earlier [14.3 %, 95 % confidence interval (CI): 2.2-20.2]. RVE decreased from 28.5 % (95 % CI: 24.7-32.1) in the time-interval 14-28 days to 7.6 % (95 % CI: -14.1 to 18.3) in the time-interval 56-118 days. However, RVE against severe COVID-19 was higher (34.0 %, 95 % CI: 23.4-42.7), decreasing from 43.2 % (95 % CI: 30.6-54.9) to 27.2 % (95 % CI: 8.3-42.9) over the same time span. Although RVE against SARS-CoV-2 infection was much reduced 2-4 months after a 2nd booster dose, RVE against severe COVID-19 was about 30 %, even during prevalent circulation of the Omicron BA.5 subvariant. The cost-benefit of a 3rd booster dose for the elderly people who received the 2nd booster dose at least four months earlier should be carefully evaluated.

Perception and Attitude Towards COVID-19 Vaccination Among the Elderly: A Community-Based Cross-Sectional Study.

Introduction COVID-19 is one of the most formidable obstacles that humanity has encountered in this century. The death rate was high among the elderly in India; therefore, getting the elderly vaccinated was one of the most important things to do. Objective We conducted this study to assess the perception and attitude about the COVID-19 vaccines among the elderly population. Methods This cross-sectional study was conducted at Fatehpur Beri, New Delhi. We selected 108 participants using systematic random sampling. We used a semi-structured questionnaire to collect the data. Results Out of 108 participants, 52.8% were men. Among them, 9.3% of participants had tested positive before. The average number of days of illness among the participants was 5.3 (SD + 3.5). Males had a higher average day of illness (5.5, SD +3.7) than females (4.9, SD +3.3). Among those who had not been vaccinated, 73.3% of participants said they would receive the vaccine, 6.7% were unsure, and 20% were not willing to receive the vaccine. Conclusion COVID vaccination in an elderly population showed a relatively high vaccine acceptance rate, and the willingness to get the vaccine was also high among the unvaccinated.

Mental Health Issues Associated With COVID-19 Among the Elderly Population: A Narrative Review.

Since its discovery in December 2019, coronavirus disease 2019 (COVID-19) has been affecting humanity in economic, social, physical, and psychological manner. During COVID-19, the older population needs special consideration since they have a greater risk of developing serious illnesses. We used a narrative review approach to identify the relevant articles. PubMed, Scopus, and Google Scholar databases were searched for the following keywords: (mental health OR mental illness(es) OR anxiety OR depression OR irritability) AND (elderly OR older people OR aged 60 years or more) AND (Covid-19 OR pandemic OR chronic diseases) AND (mitigate OR manage). In the initial search, we found 948 articles related to our search string, and only 33 studies were included in this narrative review. The results demonstrated that the elderly population is more prone to mental health issues associated with COVID-19. This narrative review also reported that loneliness, stress, depression, anxiety, sleep disturbance, and suicidal ideation symptoms are experienced by the elderly during the pandemic. Our results also demonstrate that interventions, such as community activities through social interactions, and the use of digital technologies could improve the quality of life of older people and help in the mitigation and management of the adverse effects of COVID-19.

Epidemiological and clinical features of COVID-19 in elderly patients: A cross-sectional study

Background: Elderly population represents the most vulnerable group with increased risk of developing severe COVID-19 infection and high mortality. More research is needed in understanding the complexity of disease due to limited data as only few studies have been conducted till date in India. Objectives: This study aimed to identify the epidemiological and clinical features among elderly population with COVID-19 infection at a tertiary care center, south India. Materials and Methods: A prospective, cross-sectional study was conducted among reverse transcription-polymerase chain reaction (RT-PCR)-confirmed COVID-19 elderly patients >= 60 years admitted at a tertiary care center in south India from June 2021 to August 2021 after the institutional ethical committee clearance. Their demographic and clinical data were collected and analyzed. Results: A total of 32 RT-PCR-confirmed patients of age >= 60years were included. Majority (62.5%) of them were in the age group of 60-70 years, and the mean age was 70.25 +/- 5.68 years. Females were predominant. Severe infection was found in 31.25% of the patients, and 56.25% had moderate infection. Hypertension (43.75%) was the predominant comorbidity followed by diabetes mellitus (34.37%). Cough (82%), dyspnea (70%), and fever (63%) were the most common presenting symptoms. The mean duration of symptoms to hospitalization was 4.7 +/-;2.09 days, with majority of patients presenting bilateral lung involvement. Conclusion: There is high prevalence of COVID-19 in the age group of 60-70 years, predominantly female patients. Cough and dyspnea are common presenting symptoms. Hypertension and diabetes are major comorbidities. Most patients presented with bilateral lung involvement and longer duration of symptom onset to hospitalization. High index of suspicion with preventive strategies is required for better healthcare in elderly patients.

Impact of Covid-19 Pandemic on Old People in India: An Empirical Research

Background - There has been a significant impact of COVID-19 on the global economy and public health. Various countries have made unmatched efforts and awareness to ensure containment of this deadly virus. In order to make it possible, several routine activities have been affected which changed behavioural patterns of the common public. A lot of countries have imposed lockdown, social distancing, use of masks and sanitizers, frequent hand washing, vaccination, and other preventive measures. Elderly citizens have been the most vulnerable group which has been affected by the pandemic. Objective - Considering the above arguments, this study is aimed to study the impact of COVID-19 pandemic on elderly people in India, especially their daily life, physical and mental health, social life, and preventive measures taken by them. Methodology - An empirical survey was conducted as part of descriptive research. A self-structured questionnaire was sent through Google Form to collect survey data online. Total 126 responses were collected to analyse the impact of COVID-19 on elderly. All the survey participants are elderly to meet the inclusion criteria. SPSS version 22 was used to analyse the survey data. Result - The finding of the study suggests that there was a significant impact of COVID-19 on daily life and overall health of elderly in India (p<0.05). However, the best part is that all of the survey respondents have followed all security measures suggested by the government, such as double dose of vaccination, social distancing, masks and sanitizers, and avoiding social gatherings. Copyright © 2022 Authors. All rights reserved.

Bronchopulmonary Fistula Development in an Elderly Male With COVID-19 Infection.

COVID-19 pneumonia can cause a wide range of complications including pneumothorax and empyema. However, in severe cases, it can lead to bronchopulmonary fistula (BPF) formation and a persistent air leak due to a connection between the pleural space and the bronchial tree. We report the case of a 77-year-old man with a history of hypertension, who presented to the emergency department for evaluation of dyspnea. Admission labs were significant for a positive rapid antigen SARS-Cov-2 test and elevated troponin I. A chest x-ray demonstrated patchy interstitial opacification and ground glass appearance bilaterally. Within the first 24 hours of presentation, the patient developed a right-sided spontaneous pneumothorax and had a 14 French pigtail catheter placed. The patient subsequently developed a persistent air leak after chest tube placement and required video-assisted thoracoscopic surgery (VATS) with talc pleurodesis and a 32 French chest tube placement. In this unique case, we describe an elderly patient's experience of bronchopulmonary fistula formation as a complication of COVID-19 pneumonia and the successful management of this complication with VATS.

The Changes in Levels and Barriers of Physical Activity Among Community-Dwelling Older Adults During and After the Fifth Wave of COVID-19 Outbreak in Hong Kong: Repeated Random Telephone Surveys.

BACKGROUND: COVID-19 has had an impact on physical activity (PA) among older adults; however, it is unclear whether this effect would be long-lasting, and there is a dearth of studies assessing the changes in barriers to performing PA among older adults before and after entering the "postpandemic era." OBJECTIVE: The aim of this study was to compare the levels and barriers of PA among a random sample of community-dwelling older adults recruited during (February to April 2022) and after the fifth wave of the COVID-19 outbreak (May to July 2022) in Hong Kong. In addition, we investigated factors associated with a low PA level among participants recruited at different time points. METHODS: This study involved two rounds of random telephone surveys. Participants were community-dwelling Chinese-speaking individuals aged 65 years or above and having a Hong Kong ID card. Household telephone numbers were randomly selected from the most updated telephone directories. Experienced interviewers carried out telephone interviews between 6 PM and 10 PM on weekdays and between 2 PM and 9 PM on Saturdays to avoid undersampling of working individuals. We called 3900 and 3840 households in the first and second round, respectively; for each round, 640 and 625 households had an eligible older adult and 395 and 370 completed the telephone survey, respectively. RESULTS: As compared to participants in the first round, fewer participants indicated a low level of PA in the second round (28.6% vs 45.9%, P<.001). Participants in the second round had higher metabolic equivalent of tasks-minutes/week (median 1707.5 vs 840, P<.001) and minutes of moderate-to-vigorous PA per week (median 240 vs 105, P<.001) than those in the first round. After adjustment for significant background characteristics, participants who perceived a lack of physical capacity to perform PA (first round: adjusted odds ratio [AOR] 3.34, P=.001; second round: 2.92, P=.002) and believed that PA would cause pain and discomfort (first round: AOR 2.04, P=.02; second round: 2.82, P=.001) were more likely to have a low level of PA in both rounds. Lack of time (AOR 4.19, P=.01) and concern about COVID-19 infection during PA (AOR 1.73, P=.02) were associated with a low level of PA among participants in the first round, but not in the second round. A perceived lack of space and facility to perform PA at home (AOR 2.03, P=.02) and unable to find people to do PA with (AOR 1.80, P=.04) were associated with a low PA level in the second round, but not in the first round. CONCLUSIONS: The level of PA increased significantly among older adults after Hong Kong entered the "postpandemic era." Different factors influenced older adults' PA level during and after the fifth wave of the COVID-19 outbreak. Regular monitoring of the PA level and its associated factors should be conducted to guide health promotion and policy-making.

Analysis of Prior Aspirin Treatment on in-Hospital Outcome of Geriatric COVID-19 Infected Patients.

Background and Objectives: Aspirin (ASA) is a commonly used antithrombotic drug that has been demonstrated to reduce venous thromboembolism. The aim was to analyze if geriatric COVID-19 patients undergoing a 100 mg/day Aspirin (ASA) treatment prior to hospitalization differ in hospital outcome compared to patients without previous ASA therapy. Materials and Methods: An observational retrospective study was carried out using an anonymized database including geriatric COVID-19 patients (March to April 2020) admitted to Madrid Hospitals Group. A group of COVID-19 patients were treated with low ASA (100 mg/day) prior to COVID-19 infection. Results: Geriatric ASA-treated patients were older (mean age over 70 years; n = 41), had higher frequency of hypertension and hyperlipidemia, and upon admission had higher D-dimer levels than non-ASA-treated patients (mean age over 73 years; n = 160). However, patients under ASA treatment did not show more frequent pulmonary thromboembolism (PE) than non-ASA-treated patients. ASA-treated geriatric COVID-19-infected patients in-hospital < 30 days all-cause mortality was more frequent than in non-ASA-treated COVID-19 patients. In ASA-treated COVID-19-infected geriatric patients, anticoagulant therapy with low molecular weight heparin (LMWH) significantly reduced need of ICU care, but tended to increase in-hospital < 30 days all-cause mortality. Conclusions: Prior treatment with a low dose of ASA in COVID-19-infected geriatric patients increased frequency of in-hospital < 30 days all-cause mortality, although it seemed to not increase PE frequency despite D-dimer levels upon admission being higher than in non-ASA users. In ASA-treated geriatric COVID-19-infected patients, addition of LMWH therapy reduced frequency of ICU care, but tended to increase in-hospital < 30 days all-cause mortality.

The Impact of COVID-19 on Older Adults' Perceptions of Virtual Care: Qualitative Study.

BACKGROUND: In response to the COVID-19 pandemic, older adults worldwide have increasingly received health care virtually, and health care organizations and professional bodies have indicated that virtual care is "here to stay." As older adults are the highest users of the health care system, virtual care implementation can have a significant impact on them and may pose a need for additional support. OBJECTIVE: This research aims to understand older adults' perspectives and experiences of virtual care during the pandemic. METHODS: As part of a larger study on older adults' technology use during the pandemic, we conducted semistructured interviews with 20 diverse older Canadians (mean age 76.9 years, SD 6.5) at 2 points: summer of 2020 and winter/early spring of 2021. Participants were asked about their technology skills, experiences with virtual appointments, and perspectives on this type of care delivery. Interviews were digitally recorded and transcribed. A combination of team-based and framework analyses was used to interpret the data. RESULTS: Participants described their experiences with both in-person and virtual care during the pandemic, including issues with accessing care and long gaps between appointments. Overall, participants were generally satisfied with the virtual care they received during the pandemic. Participants described the benefits of virtual care (eg, increased convenience, efficiency, and safety), the limitations of virtual care (eg, need for physical examination and touch, lack of nonverbal communication, difficulties using technology, and systemic barriers in access), and their perspectives on the future of virtual care. Half of our participants preferred a return to in-person care after the COVID-19 pandemic, while the other half preferred a combination of in-person and virtual services. Many participants who preferred to access in-person services were not opposed to virtual care options, as needed; however, they wanted virtual care as an option alongside in-person care. Participants emphasized a need for training and support to be meaningfully implemented to support both older adults and providers in using virtual care. CONCLUSIONS: Overall, our research identified both perceived benefits and perceived limitations of virtual care, and older adult participants emphasized their wish for a hybrid model of virtual care, in which virtual care is viewed as an addendum, not a replacement for in-person care. We recognize the limitations of our sample (small, not representative of all older Canadians, and more likely to use technology); this body of literature would greatly benefit from more research with older adults who do not/cannot use technology to receive care. Findings from this study can be mobilized as part of broader efforts to support older patients and providers engaged in virtual and in-person care, particularly post-COVID-19.

The Usability of a Smartphone-Based Fall Risk Assessment App for Adult Wheelchair Users: Observational Study.

BACKGROUND: Individuals who use wheelchairs and scooters rarely undergo fall risk screening. Mobile health technology is a possible avenue to provide fall risk assessment. The promise of this approach is dependent upon its usability. OBJECTIVE: We aimed to determine the usability of a fall risk mobile health app and identify key technology development insights for aging adults who use wheeled devices. METHODS: Two rounds (with 5 participants in each round) of usability testing utilizing an iterative design-evaluation process were performed. Participants completed use of the custom-designed fall risk app, Steady-Wheels. To quantify fall risk, the app led participants through 12 demographic questions and 3 progressively more challenging seated balance tasks. Once completed, participants shared insights on the app's usability through semistructured interviews and completion of the Systematic Usability Scale. Testing sessions were recorded and transcribed. Codes were identified within the transcriptions to create themes. Average Systematic Usability Scale scores were calculated for each round. RESULTS: The first round of testing yielded 2 main themes: ease of use and flexibility of design. Systematic Usability Scale scores ranged from 72.5 to 97.5 with a mean score of 84.5 (SD 11.4). After modifications were made, the second round of testing yielded 2 new themes: app layout and clarity of instruction. Systematic Usability Scale scores improved in the second iteration and ranged from 87.5 to 97.5 with a mean score of 91.9 (SD 4.3). CONCLUSIONS: The mobile health app, Steady-Wheels, has excellent usability and the potential to provide adult wheeled device users with an easy-to-use, remote fall risk assessment tool. Characteristics that promoted usability were guided navigation, large text and radio buttons, clear and brief instructions accompanied by representative illustrations, and simple error recovery. Intuitive fall risk reporting was achieved through the presentation of a single number located on a color-coordinated continuum that delineated low, medium, and high risk.

Pneumococcal Vaccine Recommendations for Old-Age Home Indian Residents: A Literature Review.

Advancing age is accompanied by decreased immunity, poor health, and physiological changes, which render the elderly population highly susceptible to infectious diseases. We aim to identify the guidelines for pneumococcal vaccines in old-age facilities in India. We performed an extensive review of Indian literature (indexed and non-indexed publications) from 2010 to 2020 using search strings "Pneumococcal vaccine AND Recommendations AND India," "Pneumococcal vaccine AND Guidelines AND India," followed by a hand search to identify the most updated versions of recommendations. We reviewed immunization guidelines recommended by nine medical associations and societies in India-Association of Physicians of India (API), Geriatric Society of India (GSI), Indian Society of Nephrology (ISN), Mass Gathering Advisory Board Consensus Recommendation, Indian Medical Association (IMA), Indian Chest Society and National College of Chest Physicians (ICS-NCCP), Research Society for Study of Diabetes in India (RSSDI), Indian Association of Occupational Health Guidelines for Working Adults (IAOH), and API guidelines for immunization during COVID19 pandemic. All bodies recommend pneumococcal vaccines, sequence and preference of which depend on factors such as age, underlying conditions, and immune status. Integration of society recommendations and their implementation into public and private vaccination programs are required to promote adult immunization.

Fear of COVID-19 infection and its relation to depressive and anxiety symptoms among elderly population: online survey

Background The pandemic of COVID-19 is considered as one of the major threats that affected all age groups all over the world. Old age group has been highly affected with increased risk of severe health complications that may result in several mental health problems such as anxiety symptoms, depressive symptoms, sleep problems, or any other mental health disorder. Thus the aim of this study is to investigate the fear of COVID-19 infection and its relation to depressive and anxiety symptoms among elderly population during COVID-19 outbreak. A survey was distributed online through social media via a link to people who are 60 years old or above (N = 161). Results The average score of fear of COVID-19 scale was 17.7 +/- 5.4. There was a highly statistically significant correlation between anxiety subscale, depression subscale, and total score of hospital anxiety and depression scale with fear of COVID-19 score. Conclusions Participants who were more worried about having the disease developed more symptoms of anxiety and depression during the COVID-19 pandemic. It is necessary to screen the older people for the COVID-19-related fear and accompanying psychological disorders.