Risk of 12-month mortality following a severe inpatient hypoglycaemic event: A single centre retrospective study from the North-West of England

Aims: At our Trust, all severe inpatient hypoglycaemic episodes in individuals with diabetes (defined as a hypoglycaemic episode requiring injectable treatment) are reported to NaDIA-Harms (National Diabetes Inpatient Audit). We conducted a detailed review of the care of all these events to improve patient safety. In this study, we assessed the risk of 12-month mortality following an episode of severe inpatient hypoglycaemia. Method(s): Reportable NaDIA harms of patients admitted during the period 2018-2022 were recorded into a dataset. Applicable patient records were reviewed at 12 months following the event to see how many patients were deceased and details of comorbidities at the time of the severe hypoglycaemic episode were collected. Result(s): To date, of 107 inpatients who experienced a severe hypoglycaemic episode 55% were deceased within 12 months. In patients admitted during the peak of the Covid-19 pandemic recorded as year April 2020/March 2021, 80% of patients who had a NaDIA hypoglycaemic event died within 12 months. Conclusion(s): Mortality rate following an episode of inpatient hypoglycaemia appears to be several-fold higher than previous reported rates of 4.45%-22.1% for community-dwelling individuals who experience a severe hypoglycaemic event. This maybe partially explained by the increased frailty, polypharmacy and multimorbidity among this cohort, but there is evidence linking hypoglycaemia with cardiovascular mortality. Although no causality between severe inpatient hypoglycaemia and death can be inferred from this study because of the observational nature, it does highlight the importance preventing inpatient episodes of hypoglycaemia through effective monitoring and proactive treatment modification.

Basic Investigation of the Effect of Insole Shape on Leg Skeletal Muscle Mass and Pressure Changes during Walking

The COVID-19 pandemic has an impact on people's ability to exercise and walk. Decreased ex-ercise habit leads to decreased muscle mass, which may hamper social activities. The decline in exercise habit is a particular challenge among older people, as it may lead to frailty. In this paper, we report that creating arches at the cuboid boneand adductor muscles activates toe movement. We examined whether the arches could be built into shoe insole to correct left-right differences in leg skeletal muscle mass. A prototype insole with arches created at the cuboid boneand transverse head of adductor hallucis musclewas designed, and a prospec-tive cohort study was conducted to examine its effects. Plantar pressure during walking was recorded in 10 sub-jects, and a 3-month intervention study was conducted in 40 subjects. The results showed an increase in toe pressure from before to after wearing the prototype insoles. In addition, leg skeletal muscle mass increased in the group wearing the prototype insole, and a significant difference compared to the control group was detect-ed by Wilcoxon signed-rank test. The results from this study demonstrate that the prototype insole promotes toe movement and increases leg skeletal muscle mass.

ICU without walls = ICU without Data? the Covid-19 deficit

Introduction: Northern Ireland (NI) has 5.5 ICU beds/100 000 population,1 amongst the lowest in Western Europe.2 Alongside ICU bed expansion the Covid-19 response required delivery of advanced Respiratory support (Continuous Positive Airway Pressure (CPAP) and High Flow Nasal Oxygen (HFNO)) outside ICU. ICNARC provides robust data for patients within ICU but this is unavailable for those receiving 'critical care' elsewhere. Objective(s): To evaluate delivery of CPAP/HFNO outside of ICU to Covid-19 patients - focusing on demographics and outcomes including ICU admission and mortality. Method(s): Ward-CPAP for acute hypoxaemic respiratory failure (AHRF) was not previously utilised.3 It was introduced for Covid-19 to Medical wards. Data was analysed using the NI Electronic Care Record, ward electronic note system (EDAMS) and ICU system (ICCA, Koninklijke Philips N.V.). Data was compared between Wave 1 (01/03/2020 - 12/12/2020) and Wave 2 (13/12/2020 - 01/04/2021). Result(s): 215 patients received CPAP/HFNO/Invasive Mechanical Ventilation (IMV) for Covid-19: 103 in Wave 1 and 112 in Wave 2. 75 Covid-19 patients were admitted to the ICU itself (comprising 44 of the study cohort, 11 direct from ED and 20 transferred from other Trusts). Table 1 shows demographics. Fewer patients were female as seen elsewhere,4 there were more young patients in Wave 2. The majority of patients would likely have been ICU candidates pre-pandemic,3 but a subset of 25% were deemed for a ward ceiling-of-care on admission by a Consultant and the proportion of elderly patients was higher than described by ICNARC.4 Comorbidities and obesity were common. Outcomes are shown in Table 2 and Figures 1-3. Close co-operation with ICU saw 61% of patients with a documented ICU review. Overall 20% of patients were admitted to ICU, and 15% received IMV. Mortality was 37%, but 22% if patients with an admission ward ceiling-of-care decision were excluded. Mortality correlated with frailty and age (fig 2&3). Outcomes were generally better in Wave 2. Conclusion(s): This Evaluation documents the huge contribution to the critical care Covid-19 response made by our Medical teams, not captured by ICNARC. Most patients avoided ICU admission and IMV and outcomes were likely at least comparable which undoubtedly freed up vital ICU beds. We thank the teams involved and believe it is vital to evaluate the outcome of all critically ill Covid-19 patients irrespective of their location.

Loneliness Decreased for Older Adults Using Telephone and Video Communications

AimsTo study feasibility and impact of telephone and video communication on perceptions of loneliness and social isolation in community-dwelling older adults.MethodsPurposive flyer distribution to communities, area agencies on aging, meals on wheels, and snowball sampling. Sixteen people met inclusion criteria. Pre- and post-intervention data were collected: UCLA-3, UCLA20, FRAIL Scale, and Social Frailty Scale. Participants were allocated to either telephone or video communication groups, completing 8 weeks of one time per week 45-60-minute conversations.ResultsUCLA-20 demonstrated statistical significance (p = .017) for the full cohort with large effect size (Hedges' g = 1.273). UCLA-3, SFS-8, and FRAIL Scale did not demonstrate statistically significant pre-post differences. No statistically significant differences (p > .05) were identified between the telephone and video communication groups.ConclusionRemote communication may have a positive impact on perceptions of loneliness that appear to be independent of the communication modality utilized. Randomized controlled trials are required to determine if either modality is more effective.

[COVID-19, neuroCOVID-19 and cognitive impairment in elderly and old patients (literature review).]

The new coronavirus infection COVID-19 causes damage to many organs and systems, is a multi-organ disease. Many researchers are studying the relationship of the new coronavirus infection with polymorbid pathology, frailty, sarcopenia. The SARS-CoV-2 virus has the property of neurotropism, therefore, olfactory, taste disorders, as well as cognitive impairments can join the spectrum of clinical manifestations and consequences of the disease. Alzheimer's disease is the most common cause of dementia in the world. It is of interest that there is a link between the coronavirus infection and the development of cognitive impairment, including Alzheimer's disease.

Impact and risk factors related to the spread of SARS-CoV-2 (Covid-19) in older adults

Objective: To identify and describe the risk factors that increase susceptibility in older adults to infection by SARS-CoV-2 (Covid-19). Material(s) and Method(s): Descriptive, cross-sectional study in adults over 60 years, patients with a positive result (RT-PCR) were analysed to detect SARS-CoV-2. The study was carried out from May 17 to July 21, 2020. A multiple logistic regression model was used to analyse the risk factors of the study population. Result(s): 102 older adults were included with a mean age of 82.5 +/- 8.8 years, 55 (54%) were positive and 47 (46%) were negative. When analysing the risk factors related to higher mortality coupled with Covid-19 infection, the statistically significant variable was frailty, with an OR of 11.6 in frail adults compared to robust individuals (p-value = 0.024.) Conclusion(s): In the vulnerable population, risk factors must be identified and treated, but above all, such factors must be prevented in advance;early detection, isolation, effective treatment must be carried out as well as follow-up of contacts and prevention of the spread of the new virus to reduce mortality in vulnerable groups.Copyright © 2022 Sociedad Medica del Hospital General de Mexico. Published by Permanyer.

Physical effects of Covid-19 in patients with diabetes 1 year after hospitalisation in the UK: PHOSP-Covid study

Aim: To investigate the impact of Covid-19 on daily activity, maximal physical performance, and clinical frailty of people living with diabetes (any type) 1-year post-hospitalisation for Covid-19 in the UK. Method(s): This study is part of PHOSP-Covid, a multicentre long-term cohort study that recruited adults (>=18 years) who were discharged from one of the 83 NHS hospitals across the four UK nations following a clinical diagnosis of Covid-19 before March 31, 2021. We compared The Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue, Incremental shuttle walk test (ISWT) distance (m), and clinical frailty (Rockwood frailty level), 5-month and 1-year after discharge in patients with and without diabetes. Result(s): Out of 2545 individuals (538 (21%) with diabetes), the proportion of individuals who classified as either 'mildly frail' or 'moderately or higher frail severity' was higher in individuals with diabetes (month 5: diabetes 9.9%, no diabetes 4.7%;month 12: diabetes 8%, no diabetes 4.9%). ISWT distance in patients with diabetes were significantly lower at both follow-ups but this measure improved from 5-months to 1-year (290 [95% CI: 190-440] vs 370 [250-560] for diabetes and 340 [210-450] vs 420 [270-590] for those without, both p < 0.01). At both time points, people with diabetes reported higher levels of fatigue (36 [24-44] vs 39 [25-46] at 5-month (p = 0.03);37 [26-45] vs 40 [28-47] at 1-year visit (p < 0.01)). Conclusion(s): One year after hospitalisation long Covid is more observed in people with diabetes.

Should COVID-19 pandemic mitigations in the myeloma clinic continue? A summary of patient opinions

Introduction: The COVID-19 pandemic necessitated multiple changes to the format of myeloma clinics to minimise the risk of infection among patients and staff. These included changing in-person clinic appointments to telephone appointments when there was no medical need for face-to- face review and instituting a courier service for delivery of oral or self-administered medications. As COVID-19 restrictions relaxed, we sought to investigate the acceptability of these changes to our patients and to determine which, if any, of the new arrangements should continue. Method(s): Patients who attended the Myeloma Clinic at The Royal Marsden Hospital, both in-person and by telephone, on four separate dates in August and September 2022 were asked to complete a questionnaire to provide their opinions using a combination of multiple-choice, Likert scale and free-text questions. These covered the main domains of change outlined above along with questions about blood test location and attendance with family and friends. Result(s): Questionnaires were returned by 59 patients, 11 relating to in-person appointments and 48 to telephone appointments. 86.0% of patients were in favour of continuing the option of telephone appointments, with many highlighting their convenience and the avoidance of long travel and waiting times, with some also mentioning their COVID-19 security. However, a number of patients expressed concerns including communication difficulties, the inability to effectively assess physical health with an examination and a lack of reassurance. Furthermore, those who attended in-person appointments felt they were very COVID-secure, assigning them a mean of score of 4.5, where 1 was very insecure and 5 very secure. Several suggested that the optimum schedule would include regular telephone appointments with occasional in-person meetings. Interestingly, only 25.5% of patients wanted a video calling option. Patients were also very positive about receiving medications by courier, with 94.1% of patients receiving their medications within two working days of their clinic appointment. 81.8% of patients expressed a wish for this option to continue, highlighting the increased convenience and reduction in waiting times. Conclusion(s): These results suggest that changes made to the Myeloma Clinic in response to the COVID-19 pandemic have improved the patient experience. A mixture of telephone and in-person appointments may be preferable for this cohort of patients, many of whom require regular appointments for chemotherapy approval but are medically stable, and whose frailty makes long travel and waiting times challenging. These findings have implications for the planning of myeloma clinics across the UK.

Different reversibility of skeletal muscle mass and strength in elderly Japanese women after the first wave of COVID-19

BackgroundRestrictions on outdoor movements due to the coronavirus disease (COVID-19) pandemic have led to a decreased physical activity;this can lead to sarcopenia and frailty in older adults. Our recent study has demonstrated a significant decrease in the trunk muscle mass immediately after the pandemic's first wave (April–May 2020) among Japanese community-dwelling older women. In the present study, we further examined whether muscle mass recovery or deterioration occurs after 1 year of the pandemic's first wave by comparing physical measurements among the following assessment periods: before the first wave, immediately after the first wave, and at 1-year follow-up thereafter.MethodsThis study included 77 women (78.0 ± 5.7 years) who underwent physical measurements for muscle mass, grip strength, one-leg stand-up ability (3 s), and oral motor skills and answered questionnaires on sociality (social network, participation, and support) in the three assessment periods.ResultsThe frequency of going out and the subjective vitality were significantly decreased immediately after the first wave;these recovered at the 1-year follow-up (P < 0.001). When comparing muscular measures, the trunk muscle mass index preferentially decreased immediately after the first wave but recovered significantly at the 1-year follow-up (P < 0.001). Conversely, the appendicular skeletal muscle mass index (ASMI) and grip strength continued to decrease until the 1-year follow-up (P < 0.001 and P = 0.03, respectively). The ability to perform a one-leg stand-up for 3 s and the oral motor skills did not change significantly across the assessment periods. The prevalence of pre-sarcopenia and sarcopenia tended to increase during these periods (P = 0.068). The reduction and subsequent recovery patterns for sociality were similar to those observed for the trunk muscle mass.ConclusionsOur findings demonstrated differences in the reversibility of skeletal muscle mass and strength at 1 year after the first wave of the COVID-19 pandemic: the trunk muscle mass declined acutely and recovered rapidly, whereas the ASMI and grip strength declined continuously. These differences in the skeletal muscle recovery and deterioration might help formulate short-term or long-term strategies for COVID-19-related sarcopenia prevention in community-dwelling older adults.

Associations of anemia and blood transfusions with mortality in old, critically ill COVID-19 patients - Results from the prospective COVIP Study.

AIMS: Anemia is common in the old and often observed in critically ill patients. Increased age is associated with higher mortality following a COVID-19 infection, making old patients prone to poor outcomes. We investigated whether anemia at admission to the ICU or the need for blood transfusion was associated with 90-day mortality in older, critically ill COVID-19 patients. METHODS: In this prospective multicenter study, the 90-day mortality of COVID-19 patients≥70 years treated in 138 intensive care units (ICU) was analyzed. Associations between anemia (WHO definition) at admission and discharge from ICU and the use of red blood cell (RBC) transfusions with mortality were assessed. Hemoglobin thresholds of RBC transfusions in old, critically ill COVID-19 patients were recorded. RESULTS: In 493 patients (350 anemic, 143 non-anemic), anemia (WHO definition) at the time of ICU admission was not associated with impaired overall survival. Transfusion and severe anemia (hemoglobin≤10 g/dL) at ICU discharge were independently associated with a higher risk of 90-day mortality. CONCLUSION: The need for red blood cell transfusions and severe anemia at ICU discharge, but not at the timepoint of admission, were independently associated with 90-day mortality in critically-ill old COVID-19 patients.

Relationship between the spread of COVID-19, social frailty, and depressive symptoms in patients with heart failure.

In community-dwelling older people, coronavirus disease 2019 (COVID-19) has been reported to be associated with the development of frailty and depressive symptoms. We aimed to investigate whether the spread of COVID-19 is associated with the development of frailty in patients with heart failure (HF). The presence of the multi-domain of frailty in 257 patients with HF was assessed at hospital discharge. The spread of COVID-19 was significantly associated with the development of social frailty and depressive symptoms. Evaluation of these symptoms during hospitalization would support disease management and understanding of their social and psychological conditions.

Site of care and factors associated with mortality in unvaccinated Australian aged care residents during COVID-19 outbreaks.

BACKGROUND: Residential InReach presents an alternative to hospital admission for aged care residents swabbed for coronavirus disease 2019 (COVID-19), although relative outcomes remain unknown. AIMS: To compare rates and predictors of 28-day mortality for aged care residents seen by InReach with COVID-19, or 'suspected COVID-19' (sCOVID), including hospital versus InReach-based care. METHODS: Prospective observational study of consecutive patients referred to a Victorian InReach service meeting COVID-19 testing criteria between April and October 2020 (prevaccine availability). COVID-19 was determined by positive polymerase chain reaction testing on nasopharyngeal swab. sCOVID-19 was defined as meeting symptomatic Victorian Government testing criteria but persistently swab negative. RESULTS: There were no significant differences in age, sex, Clinical Frailty Score (CFS) or Charlson Comorbidity Index (CCI) between 152 patients with COVID-19 and 118 patients with sCOVID. Similar results were found for 28-day mortality between patients with COVID-19 (35/152, 23%) and sCOVID (32/118, 27%) (P = 0.4). For the combined cohort, 28-day mortality was associated with initial oxygen saturation (P < 0.001), delirium (P < 0.001), hospital transfer for acuity (P = 0.02; but not public health/facility reasons), CFS (P = 0.04), prior ischaemic heart disease (P = 0.01) and dementia (P = 0.02). For patients with COVID-19, 28-day mortality was associated with initial oxygen saturation (P = 0.02), delirium (P < 0.001) and hospital transfer for acuity (P = 0.01), but not public health/facility reasons. CONCLUSION: Unvaccinated aged care residents meeting COVID-19 testing criteria seen by InReach during a pandemic experience high mortality rates, including with negative swab result. Residents remaining within-facility (with InReach) experienced similar adjusted mortality odds to residents transferred to hospital for public health/facility-based reasons, and lower than those transferred for clinical acuity.

Characteristics of Frailty in Perimenopausal Women with Long COVID-19.

The aim of this study was to compare the prevalence of risk factors for frailty between perimenopausal women with long COVID-19 syndrome, women having successfully recovered from COVID-19, and controls from the community. Women with a diagnosis of long COVID-19 and at least one symptom related to the perimenopausal period, women who had successfully recovered from COVID-19, and healthy women of comparable age were included in this study. Symptom severity and functional disability were assessed with the COVID-19 Yorkshire Rehabilitation Scale, and the presence of frailty was evaluated considering the Fried criteria. A total of 195 women were included in the study, distributed over the three groups. The long COVID-19 group showed a higher prevalence of perimenopausal symptoms and impact of COVID-19. Statistically significant differences were found between the long COVID-19 group and the other two groups for the frailty variables. When studying the associations between frailty variables and COVID-19 symptom impact, significant positive correlations were found. Perimenopausal women with long COVID-19 syndrome present more frailty-related factors and experience a higher range of debilitating ongoing symptoms. A significant relationship is shown to exist between long COVID-19 syndrome-related disability and symptoms and frailty variables, resulting in an increased chance of presenting disability.

[Categorization of the health status and its transition of community-dwelling older adults during the coronavirus disease (COVID-19) epidemic].

AIM: The purpose of this study was to categorize and clarify transitions in the health status of older adults living in the community during the coronavirus disease (coronavirus disease 2019: COVID-19) pandemic. METHODS: The participants were older adults (≥65 years of age) who lived in Takasaki City, Gunma Prefecture. The survey items included basic information and subjective health perception (questionnaire for medical checkup of old-old). Latent class analyses were conducted for the first (baseline) and second surveys (6 months). The scores for each item were compared to identify the characteristics of each class at baseline and at 6 months. In addition, transitions in class affiliation from baseline to 6 months were summarized. RESULTS: A total of 434 of 1,953 participants (mean age: 79.1 years, 98 males and 336 females) completed the survey (22.2%). In both time periods, the responses were categorized into four classes: 1) good, 2) poor physical, oral and cognitive function, 3) poor social status and lifestyle, and 4) poor in all except social status and lifestyle. During 6 months of follow-up, a transition from the generally good class to the poor physical, oral and cognitive functions class was observed in many cases. CONCLUSIONS: The health status of the older adults living in the community was classified into four classes, and changes in health status occurred even within a short period of time during the COVID-19 pandemic.

Improving Multidisciplinary Team Working to Support Integrated Care for People with Frailty Amidst the COVID-19 Pandemic.

Multidisciplinary team (MDT) working is essential to optimise and integrate services for people who are frail. MDTs require collaboration. Many health and social care professionals have not received formal training in collaborative working. This study investigated MDT training designed to help participants deliver integrated care for frail individuals during the Covid-19 pandemic. Researchers utilised a semi-structured analytical framework to support observations of the training sessions and analyse the results of two surveys designed to assess the training process and its impact on participants knowledge and skills. 115 participants from 5 Primary Care Networks in London attended the training. Trainers utilised a video of a patient pathway, encouraged discussion of it, and demonstrated the use of evidence-based tools for patient needs assessment and care planning. Participants were encouraged to critique the patient pathway, reflect on their own experiences of planning and providing patient care. 38% of participants completed a pre-training survey, 47% a post-training survey. Significant improvement in knowledge and skills were reported including understanding roles in contributing to MDT working, confidence to speak in MDT meetings, using a range of evidence-based clinical tools for comprehensive assessment and care planning. Greater levels of autonomy, resilience, and support for MDT working were reported. Training proved effective; it could be scaled up and adopted to other settings.

Tactics in Support of the Strategy to Include Artistic Research as Evidence in Systematic Reviews

Artistic research studies produce a felt and often physically embodied type of knowledge initiated in an artistic experience and consolidated as an art form. The actual art work as the outcome of these studies, complements other types of knowledge and therefore requires attention from systematic review authors who synthesize evidence from primary studies. Working with artistic research evidence in a systematic review context requires a different approach to searching, appraising, analysing and integrating research findings than what is usually promoted by international review organisations. In this paper we outline how the different steps in a systematic review process can be adapted to include art work as as a multimodal type of research evidence in systematic reviews. We discuss useful tactics of identifying artistic research evidence, judging its value, analysing and synthesizing such evidence, hereby building on iconographic, thematic and/or art and design related analytical frameworks. In addition, we feature a gallery approach to present artistic research evidence to end-users and feature a multimodal type of evidence synthesis in which individual art works are comprehensively integrated in an audio visual production.

High Flow Nasal Oxygen in frail COVID-19 patients hospitalized in intermediate care units and non-eligible to invasive mechanical ventilation

Background in COVID-19 patients, older age (sixty or older), comorbidities, and frailty are associated with a higher risk for mortality and invasive mechanical ventilation (IMV) failure. It therefore seems appropriate to suggest limitations of care to older and vulnerable patients with severe COVID-19 pneumonia and a poor expected outcome, who would not benefit from invasive treatment. HFNO (high flow nasal oxygen) is a non-invasive respiratory support device already used in de novo acute respiratory failure. The main objective of this study was to evaluate the survival of patients treated with HFNO outside the ICU (intensive care unit) for a severe COVID-19 pneumonia, otherwise presenting limitations of care making them non-eligible for IMV. Secondary objectives were the description of our cohort and the identification of prognostic factors for HFNO failure. Methods we conducted a retrospective cohort study. We included all patients with limitations of care making them non-eligible for IMV and treated with HFNO for a severe COVID-19 pneumonia, hospitalized in a COVID-19 unit of the pulmonology department of Lyon Sud University Hospital, France, from March 2020 to March 2021. Primary outcome was the description of the vital status at day-30 after HFNO initiation, using the WHO (World Health Organization) 7-points ordinal scale. Results fifty-six patients were included. Median age was 83 years [76.3-87.0], mean duration for HFNO was 7.5 days, 53% had a CFS score (Clinical Frailty Scale) >4. At day-30, 73% of patients were deceased, one patient (2%) was undergoing HFNO, 9% of patients were discharged from hospital. HFNO failure occurred in 66% of patients. Clinical signs of respiratory failure before HFNO initiation (respiratory rate >30/min, retractions, and abdominal paradoxical breathing pattern) were associated with mortality (p=.001). Conclusions we suggest that HFNO is an option in non-ICU skilled units for older and frail patients with a severe COVID-19 pneumonia, otherwise non-suitable for intensive care and mechanical ventilation. Observation of clinical signs of respiratory failure before HFNO initiation was associated with mortality.Background

[COVID-19, neuroCOVID-19 and cognitive impairment in elderly and old patients (literature review).]

The new coronavirus infection COVID-19 causes damage to many organs and systems, is a multi-organ disease. Many researchers are studying the relationship of the new coronavirus infection with polymorbid pathology, frailty, sarcopenia. The SARS-CoV-2 virus has the property of neurotropism, therefore, olfactory, taste disorders, as well as cognitive impairments can join the spectrum of clinical manifestations and consequences of the disease. Alzheimer's disease is the most common cause of dementia in the world. It is of interest that there is a link between the coronavirus infection and the development of cognitive impairment, including Alzheimer's disease.

Resiliency among Older Adults Receiving (Roar) Lung Cancer Treatment: A Feasibility Study

PURPOSE/HYPOTHESIS: Poor physical performance and negative mood are two risk factors for functional decline among older adults with lung cancer. Yet, targeted interventions to maintain independence prevent functional decline are not well studied. Our primary objective was to assess the feasibility of a novel virtual health physical therapy (PT) plus progressive muscle relaxation (PMR) intervention with longitudinal microbiome biospecimen collection delivered to older adults with advanced lung cancer. Secondary objectives were to characterize functional status and clinical factors pre and post-study intervention. NUMBER OF SUBJECTS: We accrued adults aged >=60 years with advanced non-small cell or extensive-stage small cell lung cancer receiving treatment at The Ohio State University James Comprehensive Cancer Center (OSU-JCCC) in the Thoracic Oncology department (N=22). There were no exclusion criteria pertaining to Eastern Cooperative Oncology Group (ECOG) performance status, laboratory values, prior cancer diagnoses, presence of comorbidities, or brain metastases. MATERIALS AND METHODS: Participants were asked about functional status, symptoms, mood through the PHQ-9, GAD-7, POMS, and acceptability questions about the program. PT evaluation and assessment included SPPB and 2- or 6-minute walk test outcomes. The study sought to collect gut microbiome samples for every in-person visit and activity monitoring data (Actigraph) on a subset. Feasibility was defined as successfully collecting specimens, wearing an Actigraph activity monitor, and adhering to the intervention. PT and psychologists evaluated participants in-person at the first and final visit. The rest of the 12-week intervention was conducted via virtual health. Physical therapy intervention consisted of endurance, strength, and flexibility exercises. RESULT(S): In total, 22 patients consented and 18 started the intervention (81.8%). Seven microbiome samples were collected from four participants. Six patients collected activity monitoring data. Among the 18 participants, 11 participants (61.1%) completed 70% or more of all the intervention visits. The SPPB data show a moderate effect size (Cohen's d=0.24) from pre- to post-data. On average patients improved by 1.8 total points on the SPPB. Patients demonstrated improvement on timed walk tests throughout intervention from an average of 108 feet pre-intervention to an average of 138.4 feet post intervention. CONCLUSION(S): Despite the challenges of the COVID-19 pandemic, longitudinal biospecimen and correlative data collection were feasible in the context of PT and PMR intervention among older adults with advanced lung cancer. Virtual physical therapy interventions can be safely delivered to improve physical performance as demonstrated by a moderate effect size for the SPPB in this patient population. CLINICAL RELEVANCE: Based on the feasibility study results, delivering a virtual PT intervention to older patients with lung cancer can improve SPPB score leading to decreased frailty and improve quality of life among patients.