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1.
J Am Geriatr Soc ; 2022 Oct 23.
Article in English | MEDLINE | ID: covidwho-2088267

ABSTRACT

BACKGROUND: Shelter-in-place orders during the COVID-19 pandemic created unmet health-related and access-related needs among older adults. We sought to understand the prevalence of these needs among community-dwelling older adults. METHODS: We performed a retrospective chart review of pandemic-related outreach calls to older adults between March and July 2020 at four urban, primary care clinics: a home-based practice, a safety net adult medicine clinic, an academic geriatrics practice, and a safety net clinic for adults living with HIV. Participants included those 60 or older at three sites, and those 65 or older with a chronic health condition at the fourth. We describe unmet health-related needs (the need for medication refills, medical supplies, or food) and access-related needs (ability to perform a telehealth visit, need for a call back from the primary care provider). We performed bivariate and multivariate analyses to examine the association between unmet needs and demographics, medical conditions, and healthcare utilization. RESULTS: Sixty-two percent of people had at least one unmet need. Twenty-six percent had at least one unmet health-related need; 14.0% needed medication refills, 12.5% needed medical supplies, and 3.0% had food insecurity. Among access-related needs, 33% were not ready for video visits, and 36.4% asked for a return call from their provider. Prevalence of any unmet health-related need was the highest among Asian versus White (36.4% vs. 19.1%) and in the highest versus lowest poverty zip codes (30.8% vs. 18.2%). Those with diabetes and COPD had higher unmet health-related needs than those without, and there was no change in healthcare utilization. CONCLUSIONS: During COVID, we found that disruptions in access to services created unmet needs among older adults, particularly for those who self-identified as Asian. We must foreground the needs of this older population group in the response to future public health crises.

2.
Postepy Rehabilitacji ; 36(3):19-25, 2022.
Article in English | ProQuest Central | ID: covidwho-2067006

ABSTRACT

Introduction Post-pandemic syndrome has lasting functional and psychological consequences, especially for the elderly. This timeline requires a quick search for procedures that will enable us to implement safe and non-invasive therapeutic instruments as prophylactic or adjuvant therapies for post-COVID-19 consequences. Photobiomodulation (PBM) may decrease inflammation and improve leg circulation. So, this study aims to assess the impact of PBM on post-COVID-19 functional capacity and fatigability. Material and methods Two groups of 100 elders with a positive COVID-19 history were established. The PBM group got photobiomodulation on both lower calf muscles for four weeks (diode laser, Continuous output, stationary in skin contact mode, 100mW, 808 nm, beam spot area of 0.0314 cm2, 127.39 J/cm2/point, 40 s). The control group got placebo PBM for four weeks. Both groups' exhaustion was measured using the FSS. Functional ability was evaluated using the KATZ score before and after the trial. Results After four weeks of PBM, there was a substantial suppression in the FSS level from 4.57 ± 0.26 to 3.97 ± 0.23 and the KATZ score was significantly elevated from 2.98 ± 0.79 to 3.94 ± 0.77, P value for both was < 0.05. In addition, the placebo intervention improved the FSS level and KATZ score to an acceptable level. Conclusions PBM enhanced functional capacities as evaluated by the KATZ score and fatigability perception as measured by the FSS scale in post-COVID-19 older people. Also, placebo intervention had a considerable effect on the elderly, with an 8.1 percent improvement in fatigue perception and a 19.1 percent improvement in functional ability evaluation.

3.
Drug Metab Pers Ther ; 2022 Oct 10.
Article in English | MEDLINE | ID: covidwho-2065190

ABSTRACT

OBJECTIVES: Therapy failure caused by complex population-drug-drug (PDDI) interactions including CYP3A4 can be predicted using mechanistic physiologically-based pharmacokinetic (PBPK) modeling. A synergy between ritonavir-boosted lopinavir (LPVr), ivermectin, and chloroquine was suggested to improve COVID-19 treatment. This work aimed to study the PDDI of the two CYP3A4 substrates (ivermectin and chloroquine) with LPVr in mild-to-moderate COVID-19 adults, geriatrics, and pregnancy populations. METHODS: The PDDI of LPVr with ivermectin or chloroquine was investigated. Pearson's correlations between plasma, saliva, and lung interstitial fluid (ISF) levels were evaluated. Target site (lung epithelial lining fluid (ELF)) levels of ivermectin and chloroquine were estimated. RESULTS: Upon LPVr coadministration, while the chloroquine plasma levels were reduced by 30, 40, and 20%, the ivermectin plasma levels were increased by a minimum of 425, 234, and 453% in adults, geriatrics, and pregnancy populations, respectively. The established correlation equations can be useful in therapeutic drug monitoring (TDM) and dosing regimen optimization. CONCLUSIONS: Neither chloroquine nor ivermectin reached therapeutic ELF levels in the presence of LPVr despite reaching toxic ivermectin plasma levels. PBPK modeling, guided with TDM in saliva, can be advantageous to evaluate the probability of reaching therapeutic ELF levels in the presence of PDDI, especially in home-treated patients.

4.
J Nurs Manag ; 2022 Oct 08.
Article in English | MEDLINE | ID: covidwho-2063848

ABSTRACT

AIMS: The goal of this study was to explore caregivers' experiences, perspectives, emotions, knowledge and needs in caring for older people during the COVID-19 pandemic. These included, but were not limited to, experiences in hospital care, home care and nursing home care. BACKGROUND: Because of the high mortality rate associated with the COVID-19 pandemic, senior care is critical. During the COVID-19 pandemic, caregivers caring for older people have had unique experiences potentially affecting the quality of care provided. This topic has received substantial attention since the start of the pandemic and has been studied by numerous researchers. However, experiences may differ among countries and time periods. In addition, no qualitative systematic reviews on this topic appear to have been published. EVALUATION: In this systematic review of qualitative studies, data were collected from the following electronic databases: PubMed, Web of Science, Scopus, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Science Direct and PsycINFO. Titles and abstracts were screened according to the inclusion and exclusion criteria, full texts were screened and the methodological quality of included studies was assessed with the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research by two independent reviewers. KEY ISSUE(S): A total of 141 findings were extracted and aggregated into 20 categories; 6 synthesized findings were identified. CONCLUSION: This review indicates caregivers' experiences and perceptions regarding caring for older people during the COVID-19 pandemic. The results of a qualitative systematic review show that caregivers' emotions, cognitions and knowledge have affected the quality of caregivers' senior care services during the pandemic. Caregivers caring for older adults should practise self-awareness, understanding their knowledge and attitudes to improve the quality of senior care. Moreover, health care administrators and policymakers should make concerted efforts to cultivate a better working environment. IMPLICATIONS FOR NURSING MANAGEMENT: Managers should formulate timely and effective management strategies. During the COVID-19 pandemic, the workload of caregivers has increased, thus requiring better scheduling by managers. Furthermore, managers should consider the negative emotions of caregivers and prevent negative emotions from affecting their work. Besides, virtual technology should be applied to senior care and psychological support be provided for caregivers in this special care setting.

5.
Quality in Ageing and Older Adults ; 23(3):150-162, 2022.
Article in English | ProQuest Central | ID: covidwho-2063222

ABSTRACT

Purpose>This conceptual paper aims to describe aging all over the place (AAOP), a federative framework for action, research and policy that considers older adults’ diverse experiences of place and life trajectories, along with person-centered care.Design/methodology/approach>The framework was developed through group discussions, followed by an appraisal of aging models and validation during workshops with experts, including older adults.Findings>Every residential setting and location where older adults go should be considered a “place,” flexible and adaptable enough so that aging in place becomes aging all over the place. Health-care professionals, policymakers and researchers are encouraged to collaborate around four axes: biopsychosocial health and empowerment;welcoming, caring, mobilized and supportive community;spatiotemporal life and care trajectories;and out-of-home care and services. When consulted, a Seniors Committee showed appreciation for flexible person-centered care, recognition of life transitions and care trajectories and meaningfulness of the name.Social implications>Population aging and the pandemic call for intersectoral actions and for stakeholders beyond health care to act as community leaders. AAOP provides opportunities to connect environmental determinants of health and person-centered care.Originality/value>Building on the introduction of an ecological experience of aging, AAOP broadens the concept of care as well as the political and research agenda by greater integration of community and clinical actions. AAOP also endeavors to avoid patronizing older adults and to engage society in strengthening circles of benevolence surrounding older adults, regardless of their residential setting. AAOP’s applicability is evidenced by existing projects that share its approach.

6.
Chest ; 162(4):A1084, 2022.
Article in English | EMBASE | ID: covidwho-2060766

ABSTRACT

SESSION TITLE: Atypical Cases of Sepsis SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: Pasteurella multocida is a Gram-negative coccobacillus that causes infections after animal bites or scratches. It typically manifests as cellulitis but severe infections are possible though rare. We present a case of an immunocompetent man with COVID-19 who developed septic shock due to P. multocida bacteremia and pneumonia with no evidence of wound infection. CASE PRESENTATION: A 59-year-old Hispanic man with a history of anxiety and HLD presented with 10 days of nausea, vomiting, chills, and nonproductive cough. He was initially afebrile, on room air but tachycardic. His physical exam was unremarkable. Labs revealed WBC 10x10*3/uL, procal 3.3 ng/mL, negative lactic acid, and positive COVID-19. CT chest showed a right upper lobe consolidation with bilateral patchy infiltrates. He was admitted for sepsis secondary to COVID and superimposed bacterial pneumonia. Ceftriaxone, azithromycin, remdesivir, and dexamethasone were started. Overnight, the patient desaturated to low 80s and required HFNC FiO2 65%. In the morning, FiO2 increased to 80%. ICU was called and upon their assessment, the patient was febrile, tachycardic, tachypneic, hypotensive, and saturating 87-88% on HFNC FiO2 70%. Labs showed WBC 3.1 with left shift, Cr 1.7 mg/dL, lactic acid 5 mmol/L, and procalcitonin >100. He was intubated given persistent hypoxia and increased work of breathing. Antibiotics were broadened to vancomycin, pip/tazo, and azithromycin. The patient acutely decompensated after intubation, requiring multiple high-dose pressor support. Prelim blood cultures grew Gram-negative bacteria so antibiotics were broadened to meropenem. TTE was negative for endocarditis. Pressors were eventually weaned and the patient was extubated. Blood cultures grew P. multocida in 4/4 bottles so meropenem was narrowed to penicillin. His family reported that he was living at a friend's house with cats around but was unaware of any bites or scratches and he had no history of splenectomy. No portal of entry was noted upon careful skin examination. The patient continued to improve clinically with procal that rapidly downtrended. He was eventually discharged home. DISCUSSION: The mortality for severe P. multocida presentations is about 25-30%. Severe cases are generally reported in elderly, immunocompromised, or young immunosuppressed patients. We report what is to our knowledge, the first case of a severe P. multocida infection in an immunocompetent middle-aged man in the background of a COVID-19 infection. It is unclear the degree of COVID contribution and if his bacteremia preceded the pneumonia. His morbidity was primarily driven by the P. multocida bacteremia and pneumonia given the localized right upper lobe consolidation, elevated procal that rapidly decreased with antibiotics, and quick improvement and extubation. CONCLUSIONS: P. multocida infection should be considered in any patient with septic shock and exposure to animals. Reference #1: Blain H, George M, Jeandel C. Exposure to domestic cats or dogs: risk factor for Pasteurella multocida pneumonia in older people? Journal of the American Geriatrics Society. 1998;46(10):1329-1330. Reference #2: Tseng HK, Su SC, Liu CP, Lee CM. Pasteurella multocida bacteremia due to non-bite animal exposure in cirrhotic patients: report of two cases. Journal of microbiology, immunology, and infection= Wei mian yu gan ran za zhi. 2001;34(4):293-296. Reference #3: Kofteridis DP, Christofaki M, Mantadakis E, et al. Bacteremic community-acquired pneumonia due to Pasteurella multocida. International Journal of Infectious Diseases. 2009;13(3):e81-e83. doi:10.1016/j.ijid.2008.06.023 DISCLOSURES: No relevant relationships by Joanne Lin No relevant relationships by Harjeet Singh No relevant relationships by Jose Vempilly No relevant relationships by Joshua Wilkinson

7.
Chest ; 162(4):A366, 2022.
Article in English | EMBASE | ID: covidwho-2060576

ABSTRACT

SESSION TITLE: Advances in the Management of Respiratory Infections SESSION TYPE: Original Investigations PRESENTED ON: 10/18/2022 02:45 pm - 03:45 pm PURPOSE: The factors influencing vaccine uptake are varied and understanding of patient and provider barriers to adult vaccination is limited. Given the importance of provider recommendations for improving uptake, we sought to understand knowledge, attitudes, and behaviors among primary care providers and pulmonologists concerning influenza, pneumococcal, and COVID-19 vaccination regarding their adult patients. METHODS: We conducted a survey using the REDCaps platform of 454 Mayo Clinic physicians and advanced practice providers practicing in community internal medicine, family medicine, geriatrics, and pulmonology practicing in Rochester and southeastern Minnesota. We made 3 contacts over 3 months in Fall 2021. Our survey used questions adapted from a variety of sources. Experts evaluated the survey and made revisions, iteratively changing it before IRB approval. It was tested to ensure the survey was usable and able to be understood by the intended population. Results are described combining percentages of those that “sometimes” or “often” used strategies and barriers described are as “some” or “a lot”. RESULTS: 127/454 (28%) providers responded. Most respondents reported that they specifically counseled their high-risk adults to receive the influenza vaccine (92%), the pneumococcal vaccine (87%), and the COVID-19 vaccine (100%). 64% utilize a state or regional immunization information system (IIS) to assess and record immunization data and many use a written or electronic alert when an adult patient hasn’t received their influenza (79%) or pneumococcal (73%) vaccine. Vaccine reminder-recalls are only sent a third of the time. Common misperceptions among patients reported by health care providers were that the flu vaccine would make them sick (87%), get influenza (66%) or that it was not severe enough to warrant vaccination (74%). Barriers to discussions on influenza were lack of time (47%) and other health issues taking precedence (44%). Providers were asked what strategies they used to encourage influenza vaccination. They often discussed morbidity and mortality (88%), their personal experiences (73%), effectiveness of the vaccine (91%), protection of others close to the patient (94%) and provided a statement they felt it was safer to vaccinate than to not (92%). When asked how effective these strategies were, they produced somewhat effective responses. CONCLUSIONS: Providers reported they are counseling patients on vaccines due most of the time. They readily identify numerous patient-reported concerns. They are not frequently using patient-reminder-recall systems but most use immunization information systems and provider point-of-care prompts. CLINICAL IMPLICATIONS: Despite barriers to extensive discussions of immunizations, providers still frequently discussed vaccinations with patients, utilizing written or electronic alerts, although patient reminders were rarely sent. DISCLOSURES: No relevant relationships by Jamie Felzer No relevant relationships by Robert Jacobson No relevant relationships by Young Juhn No relevant relationships by Cassie Kennedy No relevant relationships by Lila Rutten No relevant relationships by Chung-Il Wi

8.
J Geriatr Oncol ; 2022 Aug 18.
Article in English | MEDLINE | ID: covidwho-2061524

ABSTRACT

INTRODUCTION: The COVID-19 pandemic has had a considerable impact on mental health. The social distancing and stay-at-home orders have likely also impacted loneliness, social isolation, and social support. Older adults, particularly those with comorbidities such as cancer, have a greater potential to be impacted. Here we assessed loneliness, social isolation, and social support in older adults undergoing active cancer treatment during the pandemic. MATERIALS AND METHODS: A mixed methods study in which quantitative data and qualitative response items were collected in parallel was conducted in 100 older adults with cancer. Participants completed a survey by telephone with a series of validated questionnaires to assess the domains of loneliness, social isolation, and social support as well as several open-ended questions. Baseline demographics and geriatric assessments were summarized using descriptive statistics. Bivariate associations between social isolation and loneliness and social support and loneliness were described using Spearman correlation coefficients. Conventional content analysis was performed on the open-ended questions. RESULTS: In a population of older adults with cancer, 3% were noted to be severely lonely, although 27% percent screened positive as having at least one indicator of loneliness by the University of California, Los Angeles (UCLA) Three Item Loneliness Scale. There was a significant positive correlation between loneliness and social isolation (r = +0.52, p < 0.05) as well as significant negative correlation between loneliness and social support (r = -0.49, p < 0.05). There was also a significant negative correlation between loneliness and emotional support (r = -0.43, p < 0.05). There was no significant association between loneliness and markers of geriatric impairments, including comorbidities, G8 score or cognition. DISCUSSION: Reassuringly, in this cohort we found relatively low rates of loneliness and social isolation and high rates of social support. Consistent with prior studies, loneliness, social isolation, and social support were found to be interrelated domains; however, they were not significantly associated with markers of geriatric impairments. Future studies are needed to study if cancer diagnosis and treatment may mediate changes in loneliness, social isolation, and social support in the context of the pandemic as well as beyond.

9.
Nursing Older People ; 32(4):10-11, 2020.
Article in English | ProQuest Central | ID: covidwho-2058963

ABSTRACT

Face coverings are going to be with us for quite some time and will present an additional communication hurdle now compulsory to wear face coverings in hospitals, on public transport and in places where social distancing is not always possible. This means we will all need to find new ways to communicate with each other.

10.
Facets ; 7:1199-1213, 2022.
Article in English | Web of Science | ID: covidwho-2042873

ABSTRACT

Atypical disease presentations are common in older adults with COVID-19. The objective of this study was to determine the prevalence of atypical and typical symptoms in older adults with COVID-19 through progressive pandemic waves and the association of these symptoms with in -hospital mortality. This retrospective cohort study included consecutive adults aged over 65 years with confirmed COVID-19 infection who were admitted to seven hospitals in Toronto, Canada, from 1 March 2020 to 30 June 2021. The median age for the 1786 patients was 78.0 years and 847 (47.5%) were female. Atypical symptoms (as defined by geriatric syndromes) occurred in 1187 patients (66.5%), but rarely occurred in the absence of other symptoms (n = 106;6.2%). The most common atypical symptoms were anorexia (n = 598;33.5%), weakness (n = 519;2 3.9%), and delirium (n = 449;25.1%). Dyspnea (adjusted odds ratio [aOR] 2.05;95% confidence interval [CI] 1.62-2.62), tachycardia (aOR 1.87;95% CI 1.14-3.04), and delirium (aOR 1.52;95% CI 1.18-1.96) were inde-pendently associated with in-hospital mortality. In a cohort of older adults hospitalized with COVID-19 infection, atypical presentations frequently overlapped with typical symptoms. Further research should be directed at understanding the cause and clinical significance of atypical presenta-tions in older adults.

11.
Telehealth and Medicine Today ; 6(3), 2021.
Article in English | ProQuest Central | ID: covidwho-2026478

ABSTRACT

Most analysts and healthcare systems agree that telehealth volumes will continue to be markedly higher than levels prior to the COVID-19 pandemic.1 The rapid increase required clinicians, including trainees across various specialties, to practice medicine via telehealth for the first time. Research shows that very few residency programs offer formal training and education around telehealth.2,3 Although recent research has detailed telehealth training at the undergraduate medical education level, little of this research is available at the Graduate Medical Education (GME) level. [...]the Association of American Medical Colleges (AAMC) has set standards for telehealth education, outlining guidelines to create curricula.4 This contrasts with the finding that very few Accreditation Council for Graduate Medical Education (ACGME) milestones mention telehealth or competencies related to the delivery of care via this modality.5 We set out to quantify this education gap in order to better understand its impact on trainees providing care via telehealth. If the core competencies highlighted in the table are not incorporated into GME curricula, we run the risk of telehealth becoming a substandard modality of care delivery that cannot maintain the same quality of care due to a lack of appropriate training of the providers responsible for its delivery. With the incorporation of program-specific telehealth competencies, this modality of care delivery has the ability to expand access, improve outcomes of chronic disease management, and strengthen the patient–provider relationship across all specialties.

12.
Blockchain in Healthcare Today ; 5(Special Issue), 2022.
Article in English | ProQuest Central | ID: covidwho-2026456

ABSTRACT

Objective: Clinical data in the United States is highly fragmented, stored in numerous different databases, and are defined by service providers or clinical specialties rather than by individuals or their families. As a result, linking or aggregating a complete record for a patient is a major technological, legal, and operational challenge. One factor that has made clinical data integration so difficult to achieve is the lack of a universal ID for everyone. This leads to other related problems of having to prove identity at each interaction with the health system and providing basic information about demographics, insurance, payment, and medical conditions repeatedly. Traditional solutions that require complex governance, expensive technology, and risks to privacy and security of the data have failed to solve this interoperability problem adequately. We describe the technical design decisions of a patient-centric decentralized health identity management system using blockchain technology, called MediLinker, to address some of these challenges. Design: Our multi-disciplinary research group developed and implemented an identity wallet, that uses blockchain technology to manage verifiable credentials issued by healthcare clinics, banks, and insurance companies. To manage patient’s self-sovereign identity, we leveraged the Hyperledger Indy blockchain framework to store patient’s decentralized identifiers (DIDs) and the schemas or format for each credential type. In contrast, the credentials containing patient data are stored “off-ledger” in each person’s wallet and accessible via a computer or smartphone. We used Hyperledger Aries as a middleware layer (API) to connect Hyperledger Indy with the front-end, which was developed using a JavaScript framework, ReactJS (Web Application) and React Native (iOS Application). Results: MediLinker allows users to store their personal data on digital wallets, which they control. It uses decentralized trusted identity using Hyperledger Indy and Hyperledger Aries. Patients use MediLinker to register and share their information securely and in a trusted system with healthcare and other service providers. Each MediLinker wallet can have six credential types: Health ID with patient demographics, insurance, medication list including COVID-19 vaccination status, credit card, medical power of attorney (MPOA) for guardians of pediatric or geriatric patients, and research consent. The system allows for in-person and remote granting and revoking of such permissions for care, research, or other purposes without repeatedly requiring physical identity documents or enrollment information. Conclusion: We have successfully developed and tested a blockchain-based technical architecture, described in this paper, as an identity management system that may be operationalized and scaled for future implementation to improve patient experience and control over their personal information.

13.
Asian Journal of Gerontology and Geriatrics ; 17(1):6, 2022.
Article in English | ProQuest Central | ID: covidwho-2025584
14.
Asian Journal of Gerontology and Geriatrics ; 17(1):17-21, 2022.
Article in English | ProQuest Central | ID: covidwho-2025583

ABSTRACT

Objective. To evaluate the safety and effectiveness of the careful hand feeding (CHF) programme in a geriatric step-down hospital. Methods. Medical records of patients aged >65 years who received CHF in FungYiu King Hospital between February 2017 and November 2021 were retrospectively reviewed. Results. 446 patients (178 men and 268 women) aged 66 to 109 (mean, 91) years were included for analysis. 88% of patients were severely frail or very severely frail. 70% of patients had advanced dementia. 81.3% of patients had dysphagia. 44% of patients were in imminent death status (who were highly likely to die within a week) before starting CHF. Food intake during CHF was poor or very poor in 51 % of patients and satisfactory or good in 49% of patients. 90% of patients required clinically assisted hydration. The mean length of hospital stay was 19.3?16 days, and the mean duration of CHF was 14?13.5 days. 39% of patients died during the index admission;most of the remaining 61% of patients were discharged to their original placement. 27 (6%) patients had pneumonia. Independent predictors for pneumonia were the length of hospital stay (odds ratio=1.024, p=0.014) and poor/very poor intake (odds ratio=1.82, p=0.017). Conclusion. CHF is safe in a geriatric step-down hospital and avoids use of a nasogastric feeding tube in patients in their last phase of life. It fosters comfort and dignity for dying patients. Most patients can return to their original placement for CHF after discharge.

15.
Canadian Geriatrics Journal ; 25(3):300-332, 2022.
Article in English | ProQuest Central | ID: covidwho-2025214

ABSTRACT

Results: Individuals with low structural and cognitive social capital had lower SEP, higher stress levels, and worse health behaviours than those with high structural and cognitive social capital. 'Temerty Faculty of Medicine, University of Toronto, Medical Sciences Building, 2Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Li Ka Shing Knowledge Institute of St. Michael's Hospital, 3Faculty of Medicine, University of Ottawa, 4Department of Anesthesiology and Pain Medicine, University of Ottawa, 5Department of Surgery, University of Alberta. Opportunities included building in elements for program success (hospital-system buy-in, cross-specialty team collaboration, workflow integration, and built-in evaluation) and virtual care to improve rural access. Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 2.

16.
BMJ Open ; 12(9), 2022.
Article in English | ProQuest Central | ID: covidwho-2020038

ABSTRACT

PurposeThe Norwegian Registry of Persons Assessed for Cognitive Symptoms (NorCog) was established to harmonise and improve the quality of diagnostic practice across clinics assessing persons with cognitive symptoms in Norwegian specialist healthcare units and to establish a large research cohort with extensive clinical data.ParticipantsThe registry recruits patients who are referred for assessment of cognitive symptoms and suspected dementia at outpatient clinics in Norwegian specialist healthcare units. In total, 18 120 patients have been included in NorCog during the period of 2009–2021. The average age at inclusion was 73.7 years. About half of the patients (46%) were diagnosed with dementia at the baseline assessment, 35% with mild cognitive impairment and 13% with no or subjective cognitive impairment;7% received other specified diagnoses such as mood disorders.Findings to dateAll patients have a detailed baseline characterisation involving lifestyle and demographic variables;activities of daily living;caregiver situation;medical history;medication;psychiatric, physical and neurological examinations;neurocognitive testing;blood laboratory work-up;and structural or functional brain imaging. Diagnoses are set according to standardised diagnostic criteria. The research biobank stores DNA and blood samples from 4000 patients as well as cerebrospinal fluid from 800 patients. Data from NorCog have been used in a wide range of research projects evaluating and validating dementia-related assessment tools, and identifying patient characteristics, symptoms, functioning and needs, as well as caregiver burden and requirement of available resources.Future plansThe finish date of NorCog was originally in 2029. In 2021, the registry’s legal basis was reformalised and NorCog got approval to collect and keep data for as long as is necessary to achieve the purpose of the registry. In 2022, the registry underwent major changes. Paper-based data collection was replaced with digital registration, and the number of variables collected was reduced. Future plans involve expanding the registry to include patients from primary care centres.

17.
J Epidemiol Community Health ; 2022 Aug 26.
Article in English | MEDLINE | ID: covidwho-2020144

ABSTRACT

BACKGROUND: To estimate prevalence and incidence of diseases through self-reports in observational studies, it is important to understand the accuracy of participant reports. We aimed to quantify the agreement of self-reported and general practitioner-reported diseases in an old-aged population and to identify socio-demographic determinants of agreement. METHODS: This analysis was conducted as part of the AugUR study (n=2449), a prospective population-based cohort study in individuals aged 70-95 years, including 2321 participants with consent to contact physicians. Self-reported chronic diseases of participants were compared with medical data provided by their respective general practitioners (n=589, response rate=25.4%). We derived overall agreement, over-reporting/under-reporting, and Cohen's kappa and used logistic regression to evaluate the dependency of agreement on participants' sociodemographic characteristics. RESULTS: Among the 589 participants (53.1% women), 96.9% reported at least one of the evaluated chronic diseases. Overall agreement was >80% for hypertension, diabetes, myocardial infarction, stroke, cancer, asthma, bronchitis/chronic obstructive pulmonary disease and rheumatoid arthritis, but lower for heart failure, kidney disease and arthrosis. Cohen's kappa was highest for diabetes and cancer and lowest for heart failure, musculoskeletal, kidney and lung diseases. Sex was the primary determinant of agreement on stroke, kidney disease, cancer and rheumatoid arthritis. Agreement for myocardial infarction and stroke was most compromised by older age and for cancer by lower educational level. CONCLUSION: Self-reports may be an effective tool to assess diabetes and cancer in observational studies in the old and very old aged. In contrast, self-reports on heart failure, musculoskeletal, kidney or lung diseases may be substantially imprecise.

18.
Orthop Surg ; 14(10): 2527-2534, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2019565

ABSTRACT

OBJECTIVES: Concerns about the coronavirus disease 2019 (COVID-19) pandemic resulted in unprecedented challenges to the management of geriatric hip fractures. We aimed to evaluate the effects of the COVID-19 surge on the time to surgery and 1 year mortality in geriatric patients with hip fracture at a large, urban Level 1 trauma center in Beijing, and to guide the management of geriatric hip fracture patients throughout the COVID-19 pandemic. METHODS: This single-center retrospective study included consecutive patients aged ≥65 years and injured 3 weeks prior to admission. Demographic and surgical data were collected between January 20 and May 31, 2020, and from the same period in 2019. Mortality data and functional status were collected at follow-up of 1-year after surgery. The primary outcomes were time to surgery and 1 year mortality. RESULTS: There were no significant differences in sex, fracture type, and surgical pattern between the 2020 (n = 261) and 2019 time-matched (n = 307) cohorts. The time from admission to surgery was significantly delayed in the 2020 cohort compared with that in the 2019 cohort (48.9 h vs 20.5 h, p < 0.001). Fewer patients underwent surgery within 48 h in the 2020 cohort (65.5% vs 87.6%, p < 0.001). Surgical delay was also associated with an increased risk of inpatient complications (30.2% vs 20.8%, p = 0.010), however there was no significant difference in the 1-year mortality rate, nor between pre-injury and 1 year follow-up mobility as assessed by Parker score. Only approximately half of the patients in both groups completely returned to their pre-injury mobility levels. CONCLUSIONS: The COVID-19 pandemic has significantly increased the surgery waiting time for geriatric patients with hip fractures, which resulted in increased inpatient complications without a higher mortality rate within 1 year. This reinforces the importance of maintaining timely and protocolized care for geriatric hip fractures throughout any subsequent waves of the pandemic.


Subject(s)
COVID-19 , Hip Fractures , Aged , Beijing , Humans , Pandemics , Retrospective Studies
19.
Duzce Medical Journal ; 24(2):170-175, 2022.
Article in English | EMBASE | ID: covidwho-2006629

ABSTRACT

Aim: The late elderly, are the leading group of non-survivors infected with the coronavirus disease 2019 (COVID-19). Computed tomography (CT) imaging has been recognized as an important diagnostic method for COVID-19. This study aimed to determine the prognostic performance of CT imaging in patients above 75 years old. Material and Methods: After meeting the inclusion and exclusion criteria 56 elderly patients, 28 male, and 28 female were included in the study. Two radiologists interpreted CT imaging and a third experienced radiologist was in charge of reviewing the data and imaging findings in the controversial and disagreement cases. The lung score was determined for each patient, and radiologic signs were also examined. Results: The mean age of the patients was 81.4±5.0 years. Thirty-six patients survived, and 20 did not. 28 (50.0%) patients had central involvement, while 25 (44.6%) patients had diffuse involvement. Radiologic signs such as consolidation and air bronchogram were more common among non-survivors than survivors (both p=0.001). The mean lung score for the survivors was 8.75±6.21 and 13.45±6.41 for non-survivors, and the difference between the two groups was statistically significant (p=0.010). The area under the receiver operating characteristic curve for a cut-off score of 12 was 0.714 (95% CI, 0.577 to 0.827, p=0.003). Conclusion: It seems that using lung scores can play a very important role in predicting the condition of hospitalized patients over 75 years old.

20.
Aging Clin Exp Res ; 34(10): 2567-2576, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2000163

ABSTRACT

The perceptions and attitudes of health professionals toward a certain group of society are among the factors affecting the quality of health service. This study aimed to investigate the attitudes of physicians and nurses about ageism in the COVID-19 pandemic. An easy face-to-face survey was used to collect the data. It involves the questions about demographic information and geriatric perspectives, and they were taken from the University of California at Los Angeles Geriatrics Attitudes Scale (UCLA-GAS). In the study, 58.1% of participants were over 35 years old, 76.6% were women, and 50% were physicians out of 308 in total. It was found that most of the participants have worked in inpatient services and intensive care units for the longest time, where the triage issue was the most discussed topic during the pandemic. An average of 75% of the participants stated that they did not witness any ageist attitude in health care provided. In the comparative analyses conducted with the UCLA-GAS sub-dimensions, statistically significant results, which were anti-ageist and prioritized human life, were obtained. In the extraordinary periods such as pandemic, especially physicians should be able to give the treatment without feeling any social or legal concerns during their medical applications with the light of guidelines accepted scientifically, legally, and morally. Thus, health professionals will not only be away from legal concerns such as malpractice but also will not be exhausted mentally and they can provide more sufficient health service by working under these conditions.


Subject(s)
Ageism , COVID-19 , Geriatrics , Humans , Female , Aged , Male , COVID-19/epidemiology , Pandemics , Health Personnel
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