Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 572
Filter
1.
BMC Geriatr ; 23(1):18, 2023.
Article in English | PubMed | ID: covidwho-2196067

ABSTRACT

BACKGROUND: Frailty is an age-associated state of increased vulnerability to stressors that strongly predicts poor health outcomes. Epidemiological evidence on frailty is limited during the COVID-19 pandemic, and whether frailty is associated with the risk of infection is unknown. OBJECTIVES: We derived a robust Frailty Index (FI) to measure the prevalence of frailty and its risk factors in community-dwelling older adults in Southern Switzerland (Ticino), and we explored the association between frailty and serologically confirmed SARS-CoV-2 infection. METHODS: In September 2020, we recruited a random sample of community-dwelling older adults (65 +) in the Corona Immunitas Ticino prospective cohort study (CIT) and assessed a variety of lifestyle and health characteristics. We selected 30 health-related variables, computed the Rockwood FI, and applied standard thresholds for robust (FI < 0.1), pre-frail (0.1 ≤ FI < 0.21), and frail (FI ≥ 0.21). RESULTS: Complete data for the FI was available for 660 older adults. The FI score ranged between zero (no frailty) and 0.59. The prevalence of frailty and pre-frailty were 10.3% and 48.2% respectively. The log-transformed FI score increased by age similarly in males and females, on average by 2.8% (p < 0.001) per one-year increase in age. Out of 481 participants with a valid serological test, 11.2% were seropositive to either anti-SARS-CoV-2 IgA or IgG. The frailty status and seropositivity were not statistically associated (p = 0.236). CONCLUSION: Advanced age increases the risk of frailty. The risk of COVID-19 infection in older adults may not differ by frailty status.

2.
BMC geriatrics ; 23(1):1, 2023.
Article in English | EMBASE | ID: covidwho-2196062

ABSTRACT

BACKGROUND: Frailty is a physiological condition characterized by a decreased reserve to stressors. In patients with COVID-19, frailty is a risk factor for in-hospital mortality. The aim of this study was to assess the relationship between clinical presentation, analytical and radiological parameters at admission, and clinical outcomes according to frailty, as defined by the Clinical Frailty Scale (CFS), in old people hospitalized with COVID-19. MATERIALS AND METHODS: This retrospective cohort study included people aged 65 years and older and admitted with community-acquired COVID-19 from 3 March 2020 to 31 April 2021. Patients were categorized using the CFS. Primary outcomes were symptoms of COVID-19 prior to admission, mortality, readmission, admission in intensive care unit (ICU), and need for invasive mechanical ventilation. Analysis of clinical symptoms, clinical outcomes, and CFS was performed using multivariable logistic regression, and results were expressed as odds ratios (ORs) and 95% confidence intervals (CIs). RESULT(S): Of the 785 included patients, 326 (41.5%, 95% CI 38.1%-45.0%) were defined as frail (CFS >= 5 points): 208 (26.5%, 95% CI 23.5%-29.7%) presented mild-moderate frailty (CFS 5-6 points) and 118 (15.0%, 95% CI 12.7%-17.7%), severe frailty (7-9 points). After adjusting for epidemiological variables (age, gender, residence in a nursing home, and Charlson comorbidity index), frail patients were significantly less likely to present dry cough (OR 0.58, 95% CI 0.40-0.83), myalgia-arthralgia (OR 0.46, 95% CI 0.29-0.75), and anosmia-dysgeusia (OR 0.46, 95% CI 0.23-0.94). Confusion was more common in severely frail patients (OR 3.14;95% CI 1.64-5.97). After adjusting for epidemiological variables, the risk of in-hospital mortality was higher in frail patients (OR 2.79, 95% CI 1.79-4.25), including both those with mild-moderate frailty (OR 1.98, 95% CI 1.23-3.19) and severe frailty (OR 5.44, 95% CI 3.14-9.42). Readmission was higher in frail patients (OR 2.11, 95% CI 1.07-4.16), but only in mild-moderate frailty (OR 2.35, 95% CI 1.17-4.75).. CONCLUSION(S): Frail patients presented atypical symptoms (less dry cough, myalgia-arthralgia, and anosmia-dysgeusia, and more confusion). Frailty was an independent predictor for death, regardless of severity, and mild-moderate frailty was associated with readmission. Copyright © 2022. The Author(s).

3.
Journal of Clinical Investigation ; 132(24) (no pagination), 2022.
Article in English | EMBASE | ID: covidwho-2194483
4.
Critical Care Medicine ; 51(1 Supplement):512, 2023.
Article in English | EMBASE | ID: covidwho-2190655

ABSTRACT

INTRODUCTION: Social determinants of health have been under-reported in critically ill patients during the pandemic. We hypothesized that geospatial factors and baseline health status in our community would significantly impact outcomes from Covid-19 infection. METHOD(S): We conducted an urban, single-center, observational study of patients with Covid-19 infection admitted to our adult ICU over ten months (March 23, 2020 to January 21, 2021, after approval by our hospital's Institutional Review Board. Weekly prospective data on the Covid-19 study population were entered in our ICU's quality assurance database. Data specific to test our hypothesis-zip code of residence, functional status, and Canadian Frailty Score (1-7)-were collected from retrospective chart review. The studied population was dichotomized to access patients who resided in long-term care facilities or home residence. Five zip code regions based on sample size and the distance from the patient's residence to the hospital allowed random sampling. Statistical significance was determined using ANOVA and T-test as indicated. RESULT(S): A total of 300 patients were enrolled. Across the designated cohort-based zip code regions, the mean frailty score of patients who resided at home differed significantly (2.9+/- SE.98 vs. 3.8+/- SE. 1.28, p< 0.01). Favorable frailty scores of 1-2 had a combined death and hospice rate of 23%. Of the survivors, 30% were transferred to skilled nursing facilities (SNF) and 26% were discharged to home. Patients with frailty scores of 6-7 had a final mortality rate of 83%. Of the survivors, only 2% were transferred to a SNF and 6% were discharged to home. Compared to admitting frailty scores between 1-3, a frailty score of 4 or greater (which represented 35% of all Covid ICU patients admitted from home) had a 1.8 relative risk of death (p< 0.0001). CONCLUSION(S): In our adult Covid-19 population, geospatial factors were associated with significant variances in frailty determined on ICU admission. Worsening frailty scores were associated with marked differences in both survival and final disposition, with combined death and hospice rates as high as 80%. We recommend that these metrics be added to routine data reporting to help better characterize ICU populations and stimulate efforts to improve frailty in vulnerable populations.

5.
Open Forum Infectious Diseases ; 9(Supplement 2):S453, 2022.
Article in English | EMBASE | ID: covidwho-2189725

ABSTRACT

Background. The objective of this study was to characterize frailty and resilience in people evaluated for Post-Acute COVID-19 Syndrome (PACS), in relation to quality of life (QoL) and Intrinsic Capacity (IC). Methods. This cross-sectional, observational, study included consecutive people previously hospitalized for severe COVID-19 pneumonia attending Modena (Italy) PACS Clinic from July 2020 to April 2021. Four frailty-resilience phenotypes were built: 'fit/resilient', 'fit/non-resilient', 'frail/resilient' and 'frail/non-resilient'. Frailty and resilience were defined according to frailty phenotype and Connor Davidson resilience scale (CD-RISC-25) respectively. Study outcomes were: QoL assessed by means of Symptoms Short form health survey (SF-36) and health-related quality of life (EQ-5D-5L) and IC by means of a dedicated questionnaire. Their predictors including frailty-resilience phenotypes were explored in logistic regressions. Results. 232 patients were evaluated, median age was 58.0 years. PACS was diagnosed in 173 (74.6%) patients. Scarce resilience was documented in 114 (49.1%) and frailty in 72 (31.0%) individuals. Table 1 shows demographic, anthropometric and clinical characteristics, comorbidities and patient-reported outcomes according to four frailty-resilience phenotypes. With regards to study outcomes, Figure 1 depicts in radar graphs, mean scores of each domain of SF-36 (1A), EQ-5D5L (1B) and IC (1C). Figures shows polygon areas for each frailty/resilience phenotypes. Progressive increase of mean scores of each domain are plotted in the vertices of polygons, from the lowest (near the center) in frail and non-resilient, to highest (towards periphery) in fit and resilient. Multivariate logistic analyses were used to identify predictors of the total scores of SF-36 (Figure 2A), EQ-5D5L (Figure 2B) and IC (Figure 2C). Conclusion. Resilience is complementary to frailty in the identification of clinical phenotypes with different impact on wellness and QoL. Frailty and resilience should be evaluated in hospitalized COVID-19 patients to identify vulnerable individuals to prioritize urgent health interventions in people with PACS. Funding. This study is supported by a Gilead Sciences Inc. unrestricted grant.

6.
Neuro-Oncology ; 24(Supplement 7):vii18, 2022.
Article in English | EMBASE | ID: covidwho-2189422

ABSTRACT

BACKGROUND: Cancer and cancer treatments contribute to accelerated aging and frailty, which is present in over 50% of adult cancer survivors and increases vulnerability to poor outcomes. Biomarkers of frailty would allow for early identification and timely interventions. The purpose of this review is to synthesize the current literature examining biomarkers of frailty across solid tumor patients, including primary brain tumors (PBT). METHOD(S): The systematic review was conducted using preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. PubMed, Web of Science, and Embase, were searched by the medical librarian (D.C.) of all reports from the inception to December 08, 2021. Inclusion criteria were: a) English language, b) biomarkers of aging hallmarks, c) association between biomarkers and frailty. Studies were limited to human solid tumors. Two reviewers (D.S. and B.P.S.) independently screened titles, s, and full-text articles using Covidence platform with conflict resolution by the third researcher (T.S.A.). Included studies were independently evaluated for quality assessment using NIH tools for Observational Cohort, Cross-Sectional and Case-Control studies. RESULT(S): In total, 915 reports were screened and 15 full-text articles were included for the review. Studies were most commonly in breast tumors with no PBTs identified. Most were cross-sectional using small sample sizes. Fried, Balducci, and Leuven Oncogeriatric Frailty tools and cytokines (i.e. Interleukin-6 and C-reactive protein) were commonly used. Increased inflammatory response was the prevalent identified mechanism. Threats to internal validity of the studies were the use of unvalidated cut-off scores or modification of existing tools in about 50% of studies. Only six studies were rated as good using quality assessment ratings. CONCLUSION(S): Varied use of frailty measures and nonspecific blood biomarkers limited conclusions for mechanisms of frailty in cancer survivors. There are missed opportunities in neuro-oncology;inclusion of frailty assessment and biomarkers is instrumental to advancing science in PBTs.

7.
Age & Ageing ; 51(12):05, 2022.
Article in English | MEDLINE | ID: covidwho-2188209

ABSTRACT

BACKGROUND: frailty imparts a higher risk for hospitalisation, mortality and morbidity due to COVID-19 infection, but the broader impacts of the pandemic and associated public health measures on community-living people with frailty are less known.

8.
Journal of Aging and Environment ; 2022.
Article in English | Web of Science | ID: covidwho-2187953

ABSTRACT

The COVID-19 pandemic's impact on older adults (55+) living at the mid-point of the shelter-care continuum, in seniors housing (SH) and assisted living (AL), remains largely unexplored. This study compares survey responses of SH and AL residents with those of age peers living in private conventional community-based dwellings (CD) in British Columbia, Canada. Despite more SH/AL residents reporting feelings of isolation and changes to social support access, the pandemic appears to have had a greater negative impact on the routines of CD older adults. AL residents were more likely to engage in advance care planning discussions before and since the COVID-19 outbreak. These data are important for improving response to current and future disasters across the shelter-care continuum, particularly in ways to reduce the psychosocial effects of isolation or routine disruption, and strategies to increase advance care planning engagement.

9.
European Journal of Cancer ; 175(Supplement 1):S94, 2022.
Article in English | EMBASE | ID: covidwho-2184664

ABSTRACT

Background: Among women, breast cancer (BC) is the most frequently diagnosed cancer and is ranked as the leading cause of cancer death. Given that aging is one of the strongest risk factors for the development of breast cancer, older adults (65+) are disproportionately affected. At the same time, more than half of older cancer patients are considered frail or pre-frail and are at increased risk of adverse outcomes including treatment intolerance, as well as morbidity, and mortality. Frailty is thus recognized as an important metric to guide decision-making in geriatric oncology. This study characterizes the use of frailty measurements in observational studies on older women with breast cancer. Material(s) and Method(s): MEDLINE, EMBASE, and Cochrane Library were systematically queried to identify observational studies (cohort, casecontrol, cross-sectional) on older women with breast cancer which evaluate survival or mortality before or after treatment, published from 2017-2022. Studies were managed using Covidence software and assessed for inclusion with predefined criteria by independent reviewers. Data was extracted with respect to the characteristics of the studies. Frailty measurements were identified, the proportion of studies using frailty measurements was calculated, and the prevalence of frailty among BC patients was determined. Result(s): A total of 9823 studies were screened on title and after deduplication. Based on specified criteria, 217 full text studies were assessed for eligibility, 71 of which were excluded, mainly due to incorrect target population with respect to age, or incorrect outcome assessment. Overall, 146 studies were included. Preliminary results revealed that frailty status was not considered in all identified observational studies. Among studies that measured frailty, a relevant proportion of female BC patients were considered frail. Detailed results will be shown at the conference. Conclusion(s): Despite having significant prognostic importance, the use of frailty measurements is not a compulsory practice in observational studies on breast cancer in older women. Additionally, although multiple frailty screening tools have been developed, there is no gold standard measurement used to detect frailty. As a result of such heterogeneity in clinical practice, an established definition of frailty remains elusive. Efforts to create a unified definition and gold standard may improve targeted care and health outcomes for older breast cancer patients. No conflict of interest. Copyright © 2022 Elsevier Ltd. All rights reserved

10.
Value in Health ; 25(12 Supplement):S306, 2022.
Article in English | EMBASE | ID: covidwho-2181155

ABSTRACT

Objectives: Vaccination is paramount to reduce the health and economic impact of vaccine preventable diseases (VPDs), but are mainly focused on the immunization of children where COVID-19 demonstrated the importance of considering other age groups too. Providing healthcare decision makers with evidence-based assessments and recommendations is crucial but health technology assessments (HTAs) of older adult vaccination might be challenging. Method(s): Drawing upon the review of relevant literature and recent study cases, an expert panel elaborated on a list of HTA challenges and recommendations for older adult vaccination that could be instrumental to foster implementation of lifelong immunization. Result(s): Five challenges were identified for older adult vaccination: i) population characteristics, including immunosenescence, waning rates, comorbidities, changing functional status, and frailty;ii) limited surveillance data, causing a knowledge gap between population characteristics and vaccine effectiveness;iii) uncertainty in health economic value assessments - as a spill-over of the first two challenges;iv) prioritization of sub-groups might not align with health equity principles;and v) vaccination acceptance/hesitancy could prevent attaining optimal vaccination coverage and population benefits. Five concrete recommendations were issued in response to abovementioned challenges: i) introduce specific adult working groups within NITAGs as in the UK and US;ii) develop standardized/transferrable assessment methods adapted for older adults vaccination;iii) filling evidence gaps by the design of inclusive surveillance systems;iv) strengthen transparency of assessments to improve trust within healthcare and the society;and v) establish dedicated budget plans for prevention so that policy decisions - supported by adequate HTAs - can be implemented, inclusive older adults vaccination. Conclusion(s): Global interest in strengthening evidence-based policymaking for vaccination is increasing. It is therefore the right time to rethink how HTA could serve in fostering older adults' vaccination and to convey the message that implementing preventive measures and promoting lifelong immunization programs are instrumental to secure healthcare systems' sustainability. Copyright © 2022

11.
European Geriatric Medicine ; 13(Supplement 1):S433-S434, 2022.
Article in English | EMBASE | ID: covidwho-2175574

ABSTRACT

Introduction: Gorseinon Hospital (GH) is a community rehabilitation facility which offers reablement following an acute illness. Between 2015-2019 GH had median length of stay (LOS) 32 days. In 2018, 81% of patients returned to their own homes. Methodology: A retrospective review of all admissions to GH from January to December 2021 (n = 256) to identify opportunities for service improvement. Result(s): Median GH LOS was 53 days.Patients transferred from acute frailty and stroke services who received early Comprehensive Geriatric Assessment (CGA) were considered as a separate subgroup;this group (r-CGA) was compared to patients who did not receive early CGA (nr-CGA). The median overall LOS for group nr-CGA is 56 days vs r-CGA median of 51.5 days (Z = -2.591, p<0.05)0.18% of patients returned to the acute hospital. A detailed analysis showed 32.26% patients from general surgical wards returned to hospital. While the proportion of patients in the r-CGA group who returned to hospital was 16.33% and group nr-CGA 18.6%.Median LOS for COVID-19 positive patients:-79 days vs 52 days (p<0.01)0.66% of patients returned home;13% were discharged to institutional care. Conclusion(s): Patients were observed to have a longer length of stay at GH and an increased risk of being discharged to institutional care. Deconditioning associated with hospitalisation, Covid-19 infection and the lockdown periods enforced by the pandemic are potential factors. Early implementation of CGA is likely to reduce acute hospital returns and overall LOS.

12.
European Geriatric Medicine ; 13(Supplement 1):S45, 2022.
Article in English | EMBASE | ID: covidwho-2175568

ABSTRACT

Introduction: In response to COVID-19, the Fall Prevention Program (FPP) at Sunnybrook Health Sciences Centre was modified to be delivered virtually. We compared patient populations assessed for the FPP virtually versus in-person and explored how virtual delivery of care impacted accessibility. Method(s): A retrospective chart review was performed. All patients assessed virtually from the beginning of the COVID-19 pandemic until the end of ion (April 25, 2022) were compared to a historic sample of patients assessed in-person beginning in January 2019. Demographics, measures of frailty, co-morbidity, and cognition were ed. Wilcoxon Rank Sum tests and Chi-squared tests were used for continuous and categorical variables, respectively. Result(s): Thirty patients were assessed virtually and compared to 30 in-person historic controls. Median age was 80 years (IQR 75-85), 82% were female, 70% were University educated, the median Clinical Frailty Score was 5/9, and 87% used >5 medications. The normalized frailty score showed no difference between cohorts (p = 0.531). The virtual cohort showed significantly higher use of outdoor walking aids (p = 0.016), reduced accuracy with clock drawing-increased 1/3 scores (p = 0.001), and non-significant trends towards using >10 medications, requiring assistance with >3 IADLs, and higher treatment attendance. No significant differences were seen for time between assessment and treatment (p = 0.423). Key conclusions: Patients assessed virtually were similarly frail as the in-person controls but had increased use of walking aids, medications, IADL assistance, and cognitive impairment. In a Canadian context, frail and high socioeconomic status older adults continued to access treatment through virtual FPP assessments during the COVID- 19 pandemic.

13.
European Geriatric Medicine ; 13(Supplement 1):S400-S401, 2022.
Article in English | EMBASE | ID: covidwho-2175565

ABSTRACT

Introduction: The number of older people undergoing surgery is increasing.[Fowler;BritishJournalofSurgery;2019;106(8):1012-1018] Frailty in this group is associated with higher risk of postoperative morbidity and mortality.[Parmar;AnnalsofSurgery;2021;273(4):709-718][Lin;BMCGeriatrics;2016;16(1):157] Inspired by Shipway's liaison service at North Bristol,[Shipway;FutureHealthcareJournal;2018;5(2):108-116] we have introduced a Surgical Older Persons Assessment Service (SOPAS) at our large regional centre. Method(s): Prior to SOPAS, frailty was not recorded in our surgical population and Clinical Frailty Scale (CFS) was introduced to improve this. SOPAS was developed using QI methodology over multiple PDSA cycles. The service started in April 2021 and accepts referrals from surgical specialties, and also proactively screens admissions and at board rounds. We used a custom-made frailty viewer based on the Hospital Frailty Risk Score[Gilbert;Lancet;2018;391(10132):1775-1782] to analyse general surgical patients for mortality, re-admission rate, and length of stay since SOPAS' introduction. Those with Covid-19 were excluded. Result(s): SOPAS has seen over 300 patients till date. Of these, 203 general surgical patients were identified through our frailty viewer which covered April 2021 to March 2022. This has shown a reduction in mortality of 2.95% and a mean length of stay reduction of 2.82 days compared to April 2020 to March 2021. This equates to an estimated saving of approximately 573 bed days or 108,767. Conclusion(s): Introduction of SOPAS at our large regional centre has led to reductions in mortality and length of stay amongst general surgical patients. This is consistent with previous similar studies and has confirmed a significant cost saving. This data and experience will be used to further develop the service.

14.
European Geriatric Medicine ; 13(Supplement 1):S193, 2022.
Article in English | EMBASE | ID: covidwho-2175564

ABSTRACT

Introduction: The Netherlands has encountered several big waves of COVID-19 with different variants of SARS-CoV-2, treatment has been subject to change and vaccinations were introduced. Here we describe how patient characteristics, frailty and in-hospital mortality of older people with COVID-19 changed during the first three waves. Method(s): In this multi-center retrospective cohort study COVID-19 patients aged 70 years and older hospitalized in the first wave (spring 2020), second wave (autumn 2020) and third wave (autumn 2021) were included. Demographics, clinical characteristics, clinical frailty and in-hospital mortality were collected. Result(s): In total, 3061 patients (median age 79 years, 60% male) were included of whom 1772 patients in the first wave, 1041 patients in the second and 203 patients (data collection ongoing) in the third wave. Comorbidity, frailty and rate of ICU admission were comparable during all waves (median CCI 2, median CFS 4, 11% ICU admission). Patients were admitted earlier with fewer days of symptoms and had a longer length of hospital stay in the second wave compared to the first wave (median 6 days vs. 7 days p = 0.030 and median 7 days vs. 6 days, p = 0.015) which remained similar afterwards. Mortality was 37% in the first wave, decreased in the second wave to 29% (adjusted OR 0.65, CI-95: 0.53-0.79) and was the lowest in the third wave with 24% (adjusted OR 0.44, CI-95: 0.30-0.65). Key conclusions: In-hospital mortality in older people declined during the course of the COVID-19 pandemic, likely reflecting beneficial effect of new treatment options and vaccination.

15.
European Geriatric Medicine ; 13(Supplement 1):S277, 2022.
Article in English | EMBASE | ID: covidwho-2175560

ABSTRACT

Introduction: The Clinical Frailty Scale (CFS) has been widely used during the COVID-19 pandemic to aid acute medical decision-making in the hospital. We aimed to study the association of the selfreported CFS with various health domains in the general older population. Method(s): Since May 2022, older adults aged 70 +, living in the Netherlands were invited for an online or written questionnaire (ongoing data collection;embedded in the COOP-study). The selfreported CFS-instrument (10 questions) was used to divide participants into three groups: Non-frail (CFS 1-3), mildly frail (CFS 4-5) and severely frail (CFS 6-8). These CFS-groups were related to experienced health problems in the somatic, mental and social domain (i.e. >= 2 problems per domain of the validated ISCOPE-tool). Preliminary results: Out of the 536 participants (median age 75 years, 57% female and 68% higher educated), based on self-report, 65% was considered non-frail, 26% mildly frail and 9% severely frail. The nonfrail group experienced health problems in a median of 0 health domains (interquartile range (IQR): 0-1), the mildly frail in 1 (1-2) and the severely frail in 2 (2-3;p<0.001). Participants with mild or severe frailty according to the self-reported CFS had higher risks of experiencing health problems in the somatic, mental and social domain and of health problems in multiple domains compared to nonfrail participants, adjusted for age, sex and education (all associations p<0.001). Conclusion(s): Higher self-reported CFS-scores associated with higher risks of various and combined health problems. Therefore, the easyto-use CFS also seems relevant to the general older population.

16.
European Geriatric Medicine ; 13(Supplement 1):S182, 2022.
Article in English | EMBASE | ID: covidwho-2175558

ABSTRACT

Background: Few data are available on the prognosis of older patients who received corticosteroids for COVID-19. We aimed to compare the in-hospital mortality of geriatric patients hospitalized for COVID-19 who received corticosteroids or not. Method(s): We conducted a multicentric retrospective cohort study in 15 acute COVID-19 geriatric wards in the Paris area from March to April 2020 and November 2020 to May 2021. We included all consecutive patients aged 70 years and older who were hospitalized with confirmed COVID-19 in these wards. Propensity score and multivariate analyses were used. Result(s): Of the 1579 patients included (535 received corticosteroids), the median age was 86 (interquartile range 81-91) years, 56% of patients were female, the median Charlson Comorbidity Index (CCI) was 2.6 (interquartile range 1-4), and 64% of patients were frail (Clinical Frailty Score 5-9). The propensity score analysis paired 984 patients (492 with and without corticosteroids). The in-hospital mortality was 32.3% in the matched cohort. On multivariate analysis, the probability of in-hospital mortality was increased with corticosteroids use (odds ratio [OR] = 2.61 [95% confidence interval (CI) 1.63-4.20]). Other factors associated with in-hospital mortality were age (OR = 1.04 [1.01-1.07], CCI (OR = 1.18 [1.07-1.29], activities of daily living (OR = 0.85 [0.75-0.95], oxygen saturation<90% on room air (OR = 2.15 [1.45-3.17], C-reactive protein level (OR = 2.06 [1.69-2.51] and lowest lymphocyte count (OR = 0.49 [0.38-0.63]). Among the 535 patients who received corticosteroids, 68.3% had at least one corticosteroid side effect, including delirium (32.9%), secondary infections (32.7%) and decompensated diabetes (14.4%). Conclusion(s): In this multicentric matched-cohort study of geriatric patients hospitalized for COVID-19, the use of corticosteroids was significantly associated with in-hospital mortality.

17.
European Geriatric Medicine ; 13(Supplement 1):S55-S56, 2022.
Article in English | EMBASE | ID: covidwho-2175555

ABSTRACT

Introduction: SARS-COV2 placed greater emphasis on identifying frail or comorbid patients early and limiting treatment where appropriate. Resuscitation guidelines changed as cardiopulmonary resuscitation (CPR) was classified an aerosol generating procedure (AGP). We assessed the impact of these changes in our tertiary centre focussing on frail and/or comorbid patients. Method(s): Retrospective analysis of prospectively collected data from contemporaneous clinical and electronic records for all patients with a recorded cardiac arrest between June 2020 and June 2021. Data collected on features of the cardiac arrest, clinical frailty scale (CFS), Charlson comorbidity index (CCI), survival at discharge, 30 days and 12 months. The comparator was our previously published cohort between April 2017 to March 2018. Result(s): 62 patients studied compared to 113 in 2017-18. 20 patients survived to discharge, 30 days and 1 year. This 32.2% survival rate is higher than the 23.8% observed in 2017-18 but not statistically significant (p = 0.235). Rates of ROSC similar in both studies (61.3% v 60.2% p = 0.960). Median CFS was significantly lower (3.4 v 4.2, p = 0.006) as was median CCI (4.1 v 5.7, p<0.001). More patients received CPR in the cardiology department (64.5% v 38.9% p = 0.002). Discussion(s): The main factor in the reduction in resuscitation attempts is lower numbers of frail and comorbid patients receiving CPR. A higher proportion of resuscitation attempts in monitored locations and the reduction in CPR in frail and comorbid patients drive the trend towards higher survival. Conclusion(s): We have not found evidence of harm from increased advanced care planning or changing resuscitation guidelines.

18.
European Geriatric Medicine ; 13(Supplement 1):S300, 2022.
Article in English | EMBASE | ID: covidwho-2175551

ABSTRACT

Introduction: Swallowing difficulties (dysphagia) are common in frail older people and may be addressed through targeted training of the anterior neck musculature that affects the swallow. We are conducting a feasibility study to assess the willingness of patients to participate in a novel swallowing exercise rehabilitation intervention (CTAR-SwiFt), involving an exercise ball squeezed under the chin, with real-time feedback via a mobile application. Method(s): The study aims to recruit 60 medically stable patients admitted with pneumonia to the acute frailty wards at two UK hospitals. Preliminary data relating to feasibility outcomes, including rates of recruitment, retention, compliance and adverse incidents are recorded. To optimise recruitment, informal data is also collected, to assess the reasons why some patients do not meet recruitment criteria or are not willing to participate. Result(s): To date, 36 patients have been eligible, of which 16 consented to participate, with retention at 56%. Recruitment numbers are impacted by large numbers of co-morbidities in this frail elderly population, and a shortened acute admission due to the COVID-19 pandemic reducing the recruitment window. Participants prefer data collection not involving a return to the hospital site. Conclusion(s): Recruitment of participants to our intervention has been promising and is equivalent to previous studies involving similar interventions [1]. The informal data collected will help optimize recruitment in the study's later stages (and in any subsequent multicentre trial), through review of inclusion criteria, better timing of initial approach, gaining consent after discharge, and removing the requirement for a return to the hospital site.

19.
European Geriatric Medicine ; 13(Supplement 1):S403, 2022.
Article in English | EMBASE | ID: covidwho-2175550

ABSTRACT

Introduction: The role of designated geriatrician-led perioperative services for older people admitted under surgical specialities has been evolving at pace during recent years. However, these services are not yet universal across the NHS. One such service was introduced at a district-general hospital in London in early 2020. We describe a service evaluation of its impact on the care of older people admitted under emergency general surgery. Method(s): We undertook a retrospective cohort study using electronic patient records to analyse 418 patient admissions (aged>=65 years) under the care of emergency general surgery before and after the introduction of a consultant geriatrician-led Trauma and Perioperative Older People's Service (T-POPS) between 2018-2021. We looked at key outcomes outlined in National Emergency Laparotomy Audit (NELA) and British Geriatrics Society (BGS) guidelines. Result(s): There were 219 patient admissions in the pre-service (median age 79.3), and 199 in the post-service group (median age 80.4.) Pre-service implementation, 7.2% of patients were reviewed by a geriatrician during their admission which rose to 12% in those 25 patients undergoing a laparotomy. 0.45% had a clinical frailty score (CFS) documented. Post implementation, 100% of patients were reviewed by T-POPS during their admission, and 99% had a CFS documented. All were reviewed within 3 days of step-down from critical care or within 7 days of undergoing surgery. There was no difference in mortality between the two groups (p = 0.15). Conclusion(s): Introduction of T-POPS has greatly improved the standard of care for surgical patients aged>=65 as set out in NELA and BGS guidelines.

20.
European Geriatric Medicine ; 13(Supplement 1):S185, 2022.
Article in English | EMBASE | ID: covidwho-2175547

ABSTRACT

Introduction: In The Netherlands, most people aged 70 years and older have been vaccinated at least once for COVID-19. The aim of the present study was to investigate differences in patient characteristics, disease presentation and outcomes between vaccinated and non-vaccinated patients hospitalized for COVID-19 infection in The Netherlands. Method(s): This was a multi-center retrospective cohort study in 5 hospitals in the Netherlands including all patients aged 70 years and more, hospitalized with COVID-19 infection from September 1st 2021 to December 31st 2021 (third wave). Data were collected on demographics, co-morbidity, indicators of disease severity, Clinical Frailty Scale (CFS) and in-hospital mortality. At conference presentation, we expect 500 inclusions. Result(s): A total of 131 vaccinated patients (median age 80 (IQR 75-86), 64% male) and 63 non-vaccinated patients (median age 78 (IQR 73-82), 54% male) were included. Vaccinated patients had higher Charlson Comorbidity Index than non-vaccinated patients (median 2 (IQR 1-4) versus 1 (IQR 0-3)) and higher CFS (median 4 (IQR 3-5) versus 3 (IQR 3-6)). There was no difference in disease severity at time of admission, although vaccinated patients were admitted earlier (median 6 (IQR 3-8) versus 7 (IQR 4-9) days since first symptoms). In-hospital mortality was lower in vaccinated patients (22% versus 31%). More vaccinated patients returned home after admission (79% versus 69%). Key conclusions: Older people who were vaccinated against COVID- 19 had lower in-hospital mortality, although they were older and more frail. This suggests COVID-19 vaccination is beneficial to in-hospital outcomes for older patients, also those with frailty.

SELECTION OF CITATIONS
SEARCH DETAIL