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2.
Arch Gerontol Geriatr ; 98: 104562, 2022.
Article in English | MEDLINE | ID: covidwho-1525686

ABSTRACT

BACKGROUND: Globally, lifestyles have changed to prevent the spread of coronavirus disease 2019 (COVID-19). Therefore, we aimed to understand health and lifestyle conditions associated with frailty transition over 6 months and devise a method for identifying frailty among community-dwelling older people during the COVID-19 pandemic. METHOD: This community-based prospective cohort study was conducted from May to July 2020 (baseline) and November 2020 to January 2021 (follow-up) in Japan, with 1,953 community-dwelling older people (≥65 years) at baseline. To identify transition from non-frailty at baseline to frailty at follow-up, the Frailty Screening Index was used. For predicting frailty transition, two self-reported questionnaires assessing health and lifestyle conditions were employed. RESULTS: Overall, 706 individuals returned the baseline and follow-up questionnaires. Among the 492 non-frail older people at baseline, there was a 9.8% increase in frailty transition. The adjusted model for frailty transition by age, sex, multimorbidity, and living arrangements indicated that forgetfulness (odds ratio [OR] 2.74, 95% confidence interval [CI]: 1.00 to 7.51), falls in the past year (OR 2.26, 95% CI: 1.08 to 4.74), and subjective leg muscle weakness (OR 1.83, 95% CI: 1.05 to 3.21) were predictors of frailty transition. The combination of age ≥75 years and subjective leg muscle weakness showed moderate sensitivity, specificity, and % accuracy (0.688, 0.696, and 69.5%, respectively). CONCLUSIONS: Approximately 10% of older people showed new transitions to frailty over 6 months during the COVID-19 pandemic. A combination of age and subjective leg muscle weakness is a feasible measure to optimally identify frailty transition.


Subject(s)
COVID-19 , Frailty , Aged , Frail Elderly , Frailty/epidemiology , Geriatric Assessment , Humans , Independent Living , Japan/epidemiology , Pandemics , Prospective Studies , SARS-CoV-2
3.
Arch Gerontol Geriatr ; 98: 104555, 2022.
Article in English | MEDLINE | ID: covidwho-1525684

ABSTRACT

OBJECTIVES: We examined the association between social frailty and depressive symptoms among community-dwelling older adults during the coronavirus disease 2019 pandemic. Additionally, we investigated whether home exercise habits moderated the impact of social frailty on depressive symptoms. METHODS: This cross-sectional study included 1,103 community-dwelling older adults (54.0% female, mean age [standard deviation] = 81.1 [5.0] years) from a semi-urban area of Japan who completed a mailed questionnaire survey in October 2020. Social frailty status was categorized as non-social frailty, pre-social frailty, and social frailty, which was assessed by financial difficulties, living alone, lack of social activity, and contact with neighbors. Depressive symptoms were defined as a Kessler 6 score ≥5. We performed a multivariable logistic regression analysis to examine the association between social frailty and depressive symptoms, and also conducted stratified analysis of home exercise habits during the pandemic. RESULTS: A total of 309 (28.0%) participants had depressive symptoms. Compared with non-social frailty, social frailty was associated with depressive symptoms (odds ratio [OR] = 1.80, 95% confidence interval [95%CI] = 1.16-2.79, p = 0.009). A similar relationship was observed in those who did not exercise at home (OR = 2.10, 95%CI = 1.14-3.84, p =0.017). However, no such relationship was observed in those who did exercise at home (OR = 1.50, 95%CI = 0.79-2.85, p =0.213). CONCLUSIONS: Social frailty was associated with a risk of depressive symptoms during the pandemic. In addition, our findings suggested that home exercise may buffer the association between social frailty and depressive symptoms.


Subject(s)
COVID-19 , Frailty , Aged , Cross-Sectional Studies , Depression/epidemiology , Female , Frail Elderly , Frailty/epidemiology , Habits , Humans , Independent Living , Japan/epidemiology , Male , Pandemics , SARS-CoV-2
4.
Semin Oncol ; 48(4-6): 279-282, 2021.
Article in English | MEDLINE | ID: covidwho-1510651

ABSTRACT

BACKGROUND: COVID-19 infection increases mortality in hematological malignancies. In a large meta-analysis, patients aged 60 years and older had a significantly higher risk of death than patients under 60 years of age [1]. Furthermore, a high risk of death and reduced survival in patients receiving B cell depletion therapy with prolonged COVID-19 infection was reported in a recent study [2]. High-grade B-cell lymphomas are classified as morphologically aggressive lymphomas with the presence of a high mitotic index and Ki-67 proliferation rates. They demonstrate aggressive behavior clinically as well as morphologically, and COVID-19 infection is an important factor that increases mortality in these patients. Herein, we present an elderly patient with a diagnosis of high-grade B-cell lymphoma, in whom a complete response was observed after prolonged COVID-19 infection. CASE SUMMARY: An 81-year-old female patient received her first cycle of R-CHOP (rituximab, cyclophosphamide, vincristine, and prednisolone) treatment after being diagnosed with high- grade B-cell lymphoma. After being discharged from the hospital, the patient was referred to the emergency department with complaints of fever and fatigue when she came for the second cycle of chemotherapy. Her COVID-19 PCR test was found positive. She was admitted to the infectious diseases service and favipiravir treatment was started. On the 24th day of hospitalization, it was decided to perform interim FDG-PET/CT (Fluorodeoxyglucose - Positron Emission Tomography/Computed Tomography) scan at a time that her PCR (Polymerase Chain Reaction) test was still positive. A complete metabolic response was detected in her imaging. On the 26th day, the PCR test became negative and the patient was transferred to the oncology service and received the second cycle of R-CHOP treatment. CONCLUSION: Our case emphasizes that antitumor effect could be seen in a patient with SARS-CoV-2 infection and a hematologic malignancy. It also highlights being alert to prolonged COVID-19 infection in patients receiving B-cell depletion therapy.


Subject(s)
COVID-19/complications , Cyclophosphamide/therapeutic use , Frail Elderly , Lymphoma, B-Cell/complications , Lymphoma, B-Cell/drug therapy , Prednisone/therapeutic use , Rituximab/therapeutic use , Vincristine/therapeutic use , Aged, 80 and over , Amides/therapeutic use , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Female , Humans , Positron Emission Tomography Computed Tomography , Pyrazines/therapeutic use , SARS-CoV-2
5.
Psychogeriatrics ; 21(6): 892-901, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1494845

ABSTRACT

BACKGROUND: The study aim was to identify depressed mood and frailty and its related factors in older people during the coronavirus disease 19 pandemic. METHODS: Since 2010, we have conducted questionnaire surveys on all older residents, who are not certified in the long-term care insurance, living in one district of Tokyo municipality. These residents are divided into two groups by birth month, that is those born between April and September and those born between October and March, and each group completes the survey every 2 years (in April and May). Study participants were older residents who were born between April and September and who completed the survey in spring 2018 and in spring 2020, the pandemic period. Depressed mood and frailty were assessed using the Kihon Checklist, which is widely used by local governments in Japan. We had no control group in this study. RESULTS: A total of 1736 residents responded to both surveys. From 2018 to 2020, the depressed mood rate increased from 29% to 38%, and frailty increased from 10% to 16%. The incidence of depressed mood and frailty was 25% and 11%, respectively. Incidence of depressed mood was related to subjective memory impairment and difficulty in device usage, and incidence of frailty was related to being older, subjective memory impairment, lack of emotional social support, poor subjective health, and social participation difficulties. CONCLUSIONS: Older people with subjective memory impairment may be a high-risk group during the coronavirus pandemic. Telephone outreach for frail older people could be an effective solution. We recommend extending the scope of the 'reasonable accommodation' concept beyond disability and including older people to build an age-friendly and crisis-resistant community.


Subject(s)
COVID-19 , Frailty , Aged , Frail Elderly , Frailty/diagnosis , Frailty/epidemiology , Geriatric Assessment , Humans , Independent Living , Japan/epidemiology , Pandemics , SARS-CoV-2 , Tokyo/epidemiology
6.
Infect Control Hosp Epidemiol ; 41(5): 499-504, 2020 05.
Article in English | MEDLINE | ID: covidwho-1452452

ABSTRACT

OBJECTIVE: Older adults often have atypical presentation of illness and are particularly vulnerable to influenza and its sequelae, making the validity of influenza case definitions particularly relevant. We sought to assess the performance of influenza-like illness (ILI) and severe acute respiratory illness (SARI) criteria in hospitalized older adults. DESIGN: Prospective cohort study. SETTING: The Serious Outcomes Surveillance Network of the Canadian Immunization Research Network undertakes active surveillance for influenza among hospitalized adults. METHODS: Data were pooled from 3 influenza seasons: 2011/12, 2012/13, and 2013/14. The ILI and SARI criteria were defined clinically, and influenza was laboratory confirmed. Frailty was measured using a validated frailty index. RESULTS: Of 11,379 adult inpatients (7,254 aged ≥65 years), 4,942 (2,948 aged ≥65 years) had laboratory-confirmed influenza. Their median age was 72 years (interquartile range [IQR], 58-82) and 52.6% were women. The sensitivity of ILI criteria was 51.1% (95% confidence interval [CI], 49.6-52.6) for younger adults versus 44.6% (95% CI, 43.6-45.8) for older adults. SARI criteria were met by 64.1% (95% CI, 62.7-65.6) of younger adults versus 57.1% (95% CI, 55.9-58.2) of older adults with laboratory-confirmed influenza. Patients with influenza who were prefrail or frail were less likely to meet ILI and SARI case definitions. CONCLUSIONS: A substantial proportion of older adults, particularly those who are frail, are missed by standard ILI and SARI case definitions. Surveillance using these case definitions is biased toward identifying younger cases, and does not capture the true burden of influenza. Because of the substantial fraction of cases missed, surveillance definitions should not be used to guide diagnosis and clinical management of influenza.


Subject(s)
Influenza, Human/diagnosis , Influenza, Human/epidemiology , Aged , Aged, 80 and over , Bias , Canada/epidemiology , Female , Frail Elderly , Hospitalization , Humans , Immunization , Laboratories, Hospital , Male , Prospective Studies , Research , Sensitivity and Specificity , Sentinel Surveillance
7.
BMJ Open ; 11(10): e052552, 2021 10 07.
Article in English | MEDLINE | ID: covidwho-1462969

ABSTRACT

INTRODUCTION: Almost 60% of antibiotics in frail elderly are prescribed for alleged urinary tract infections (UTIs). A substantial part of this comprises prescriptions in case of non-specific symptoms or asymptomatic bacteriuria, for which the latest guidelines promote restrictiveness with antibiotics. We aim to reduce inappropriate antibiotic use for UTIs through an antibiotic stewardship intervention (ASI) that encourages to prescribe according to these guidelines. To develop an effective ASI, we first need a better understanding of the complex decision-making process concerning suspected UTIs in frail elderly. Moreover, the implementation approach requires tailoring to the heterogeneous elderly care setting. METHODS AND ANALYSIS: First, we conduct a qualitative study to explore factors contributing to antibiotic prescribing for UTIs in frail elderly, using semi-structured interviews with general practitioners, nursing staff, patients and informal caregivers. Next, we perform a pragmatic cluster randomised controlled trial in elderly care organisations. A multifaceted ASI is implemented in the intervention group; the control group receives care as usual. The ASI is centred around a decision tool that promotes restrictive antibiotic use, supported by a toolbox with educational materials. For the implementation, we use a modified participatory-action-research approach, guided by the results of the qualitative study. The primary outcome is the number of antibiotic prescriptions for suspected UTIs. We aim to recruit 34 clusters with in total 680 frail elderly residents ≥70 years. Data collection takes place during a 5-month baseline period and a 7-month follow-up period. Finally, we perform a process evaluation. The study has been delayed for 6 months due to COVID-19 and is expected to end in July 2021. ETHICS AND DISSEMINATION: Ethical approvals and/or waivers were obtained from the ethical committees in Poland, the Netherlands, Norway and Sweden. The results will be disseminated through publication in peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER: NCT03970356.


Subject(s)
Antimicrobial Stewardship , COVID-19 , Respiratory Tract Infections , Urinary Tract Infections , Aged , Anti-Bacterial Agents/therapeutic use , Frail Elderly , Humans , Inappropriate Prescribing/prevention & control , Randomized Controlled Trials as Topic , Respiratory Tract Infections/drug therapy , SARS-CoV-2 , Urinary Tract Infections/drug therapy
8.
Lit Med ; 38(2): 349-370, 2020.
Article in English | MEDLINE | ID: covidwho-1450722

ABSTRACT

This enquiry considers how the dignity of the frail elderly is objectively grounded, socially constructed, and subjectively experienced. The lives of the frail trouble public consciousness. A terror of old age, felt by young or old, is liable to form a toxic affective culture of social death. Against such threats, the dignity of the frail requires defense. However, empathy- and capacities-based approaches to dignity fail to give a compelling account of humanity's membership in shared community. By contrast, the poetry of the Psalms and New Testament puts terror to flight by articulating how dignity is found within God's steadfast, worth-bestowing love which tenderly accompanies humanity in its shared dustiness from the womb to old age and beyond. The blessed dignity these sources describe is found to be more conceptually robust and affectively compelling than an individualistic eudaimonism. Cultivating an ecology of dignity in practice is finally shown to depend on a compassion which grows from the same fertile, imaginative ground.


Subject(s)
Empathy , Fear/psychology , Frail Elderly/psychology , Respect , Social Isolation/psychology , Aged , COVID-19 , Humans , SARS-CoV-2
9.
Crit Care ; 25(1): 344, 2021 09 23.
Article in English | MEDLINE | ID: covidwho-1438302

ABSTRACT

BACKGROUND: The primary aim of this study was to assess the outcome of elderly intensive care unit (ICU) patients treated during the spring and autumn COVID-19 surges in Europe. METHODS: This was a prospective European observational study (the COVIP study) in ICU patients aged 70 years and older admitted with COVID-19 disease from March to December 2020 to 159 ICUs in 14 European countries. An electronic database was used to register a number of parameters including: SOFA score, Clinical Frailty Scale, co-morbidities, usual ICU procedures and survival at 90 days. The study was registered at ClinicalTrials.gov (NCT04321265). RESULTS: In total, 2625 patients were included, 1327 from the first and 1298 from the second surge. Median age was 74 and 75 years in surge 1 and 2, respectively. SOFA score was higher in the first surge (median 6 versus 5, p < 0.0001). The PaO2/FiO2 ratio at admission was higher during surge 1, and more patients received invasive mechanical ventilation (78% versus 68%, p < 0.0001). During the first 15 days of treatment, survival was similar during the first and the second surge. Survival was lower in the second surge after day 15 and differed after 30 days (57% vs 50%) as well as after 90 days (51% vs 40%). CONCLUSION: An unexpected, but significant, decrease in 30-day and 90-day survival was observed during the second surge in our cohort of elderly ICU patients. The reason for this is unclear. Our main concern is whether the widespread changes in practice and treatment of COVID-19 between the two surges have contributed to this increased mortality in elderly patients. Further studies are urgently warranted to provide more evidence for current practice in elderly patients. TRIAL REGISTRATION NUMBER: NCT04321265 , registered March 19th, 2020.


Subject(s)
COVID-19/mortality , Critical Illness/mortality , Pneumonia, Viral/mortality , Aged , Aged, 80 and over , Comorbidity , Europe/epidemiology , Female , Frail Elderly , Humans , Intensive Care Units , Male , Organ Dysfunction Scores , Pandemics , Pneumonia, Viral/virology , Prospective Studies , SARS-CoV-2 , Survival Analysis
10.
Geriatr Gerontol Int ; 21(11): 1053-1059, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1438005

ABSTRACT

AIM: The coronavirus disease 2019 (COVID-19) pandemic remains a major global public health issue, and it has led to restrictions in physical and social activities among community-dwelling people, including frail older adults. This study aimed to determine the impact of the pandemic on the subjective health status and characteristics of community-dwelling frail older adults by assessing their knowledge of infection, behaviors and negative psychological response. METHODS: During October 2019, 720 older adults participated in "The Otassha Study." A year after the COVID-19 outbreak, between June 29 and July 31, 2020, a health status questionnaire, comprising questions concerning knowledge about infection, behaviors and psychological responses during the pandemic, was sent to all participants of the health examination in 2019. Respondents were divided into the robust and frail groups, and their responses were compared. RESULTS: Although the self-reported health status of the older adults in both groups was worse in 2020 than in 2019, differences were not observed in the degree of deterioration between the groups. Those in the frail group had fewer resources of information related to COVID-19 and had fewer coping behaviors for health maintenance compared with the robust group. CONCLUSION: Information gathering and actions aimed at health maintenance tended to be weaker among older adults with frailty, although the influence of COVID-19 on subjective health status did not differ significantly between robust and frail adults. Therefore, robust and frail older adults may need to adopt different countermeasures to prevent worse health during this pandemic. Geriatr Gerontol Int 2021; 21: 1053-1059.


Subject(s)
COVID-19 , Frail Elderly , Aged , Cross-Sectional Studies , Diagnostic Self Evaluation , Geriatric Assessment , Health Status , Humans , Japan/epidemiology , Pandemics , SARS-CoV-2
12.
Front Public Health ; 9: 721634, 2021.
Article in English | MEDLINE | ID: covidwho-1430746

ABSTRACT

Background: Emergency rooms (ERs) overcrowded by older adults have been the focus of public health policies during the recent COVID-19 outbreak too. This phenomenon needed a change in the nursing care of older frail people. Health policies have tried to mitigate the frequent use of ER by implementing community care to meet the care demands of older adults. The present study aimed to investigate the predictors of emergency room access (ERA) and not-urgent emergency room access (NUERA) of community-dwelling frail older adults in order to provide an indication for out-of-hospital care services. Method: Secondary analysis of an observational longitudinal cohort study was carried out. The cohort consisted of 1,246 community-dwelling frail older adults (over 65 years) in the Latium region in Italy. The ER admission rate was assessed over 3 years from the administration of the functional geriatric evaluation (FGE) questionnaire. The ordinal regression model was used to identify the predictors of ERA and NUERA. Moreover, the ERA and NUERA rate per 100 observations/year was analyzed. Results: The mean age was 73.6 (SD ± 7.1) years, and 53.4% were women. NUERAs were the 39.2% of the ERAs; robust and pre-frail individuals (79.3% of the sample) generated more than two-third of ERAs (68.17%), even if frails and very frails showed the higher ER rates per observation/year. The ordinal logistic regression model highlighted a predictive role on ERAs of comorbidity (OR = 1.13, p < 0.001) and frailty level (OR = 1.29; p < 0.001). Concerning NUERAs, social network (OR 0.54, P = 0.015) and a medium score of pulmo-cardio-vascular function (OR 1.50, P = 0.006) were the predictors. Conclusion: Comorbidity, lack of social support, and functional limitations increase both ERA and NUERA rates generated by the older adult population. Overall, bio-psycho-social frailty represents an indicator of the frequency of ERAs. However, to reduce the number of ERAs, intervention should focus mainly on the robust and pre-frail needs for prevention and care.


Subject(s)
COVID-19 , Frail Elderly , Aged , Emergency Service, Hospital , Female , Humans , Longitudinal Studies , SARS-CoV-2
13.
Int J Environ Res Public Health ; 18(18)2021 09 09.
Article in English | MEDLINE | ID: covidwho-1409562

ABSTRACT

The purpose of this study is to grasp the management situation of "Kayoinoba" under the conditions of self-quarantine due to the COVID-19 pandemic. It is also to clarify the efficacy of "Kayoinoba" using the Kihon Checklist (KCL) for the assessment of mental and physical functions in the elderly. The respondents were 136 elderly people aged 65 years and over who lived in A City, a standard rural area in Japan. The age, gender, living style, affluence for living, and the frequency of participation in "Kayoinoba" were examined by using the KCL as a self-completed questionnaire. Finally, 101 respondents were included in the final analysis. There was no difference in the participation status before and after the spread of COVID-19. The frailty ratio tended to decrease from 23.8% to 19.8% between the two periods, but there was no difference in the frailty ratio. It is suggested that the participants in "Kayoinoba" may have suppressed the deterioration of mental and physical conditions, excluding physical activity. This would prevent the frailty of the elderly, even during self-quarantine due to the spread of COVID-19.


Subject(s)
COVID-19 , Frailty , Aged , Frail Elderly , Frailty/epidemiology , Frailty/prevention & control , Geriatric Assessment , Humans , Japan/epidemiology , Pandemics , SARS-CoV-2
14.
Health Aff (Millwood) ; 40(9): 1368-1376, 2021 09.
Article in English | MEDLINE | ID: covidwho-1406758

ABSTRACT

Different staffing configurations in primary and geriatric care practices could have implications for how best to deliver services that are essential for a growing population of older adults. Using data from a 2018 survey of physicians (MDs) and nurse practitioners (NPs) working in primary and geriatric care, we assessed whether different configurations were associated with better or worse performance on a number of standard process measures indicative of comprehensive, high-quality primary care. Practices with a large concentration of MDs had the highest estimated labor costs. Practices high in NPs and physician assistants (PAs) were most common in states that grant full scope of practice to NPs. The high-NP/PA configuration was associated with a 17-percentage-point greater probability of facilitating patient visits and a 26-percentage-point greater probability of providing the full bundle of primary care services compared with the high-MD model. Team-based configurations had a 27.7-percentage-point greater probability of providing the full bundle of primary care services. The complex needs of older adults may be best served by team-based practices with a broad provider mix that can provide a range of services in the office and the community.


Subject(s)
Geriatrics , Nurse Practitioners , Physician Assistants , Aged , Frail Elderly , Humans , Primary Health Care , United States , Workforce
16.
J Palliat Care ; 37(1): 8-12, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1378109

ABSTRACT

While the whole population is at risk from infection with the coronavirus, older people-often frail and subject to multimorbidity-are at the highest risk for the severe and fatal disease. Despite strict infection control and social distancing measures, frail adults in long-term care facilities may be at particular risk of transmission of respiratory illness. Treatment decisions are often complex attributed to the heterogeneity of this population with regards to different geriatric domains such as functional status, comorbidity, and poly-pharmacy. While measures must be taken to prevent the novel coronavirus from spreading through these facilities, it is also essential that residents with coronavirus disease 2019 (COVID-19) have access to the symptom management and support they want and deserve. What most nursing home residents want during the course of their illness is to be able to stay in their facilities, to be surrounded by the people they love most, and to feel relief from their physical and emotional pain. By addressing the limited access to hospice and palliative care delivery in nursing homes, we can prevent unnecessary suffering and pain from COVID-19 as well as lay the groundwork for improving care for all residents moving forward.


Subject(s)
COVID-19 , Frail Elderly , Aged , Disease Outbreaks/prevention & control , Humans , Long-Term Care , Palliative Care , SARS-CoV-2
17.
J Nephrol ; 34(5): 1387-1403, 2021 10.
Article in English | MEDLINE | ID: covidwho-1366435

ABSTRACT

BACKGROUND: Patients undergoing in-centre haemodialysis (HD) are particularly exposed to the dire consequences of COVID-19. The present systematic scoping review aims to identify the extent, range, and nature of articles related to COVID-19 and maintenance HD: it reports specifically the prevalence of the COVID-19 pandemic in the HD population, implementation of strategies for the prevention, mitigation and containment of the COVID-19 pandemic in HD centres, demographic and clinical characteristics, and outcomes of the pediatric and adult HD patients. METHODS: A multi-step systematic search of the literature in Pubmed, Scopus, Ovid Medline, Embase and Web of Science, published between December 1, 2019, and January 30, 2021 was performed. Two authors separately screened the titles and abstracts of the documents and ruled out irrelevant articles. A report of the papers that met inclusion criteria was performed; then, a descriptive analysis of the characteristics of the included articles and a narrative synthesis of the results were performed. RESULTS: The review process ended with the inclusion of 145 articles. Most of them were based on single-centre experiences, which spontaneously developed best practices. Most studies were conducted in high-income countries (69.7%) and a part of them (9.6%) were not in English. Prevalence of COVID-19 among dialysis patients accounted for 0%-37.6%. Preventive measures were reported in 54% of the included articles, with particular emphasis on education, triage, hygiene, and containment measures. Patients experienced a heterogeneous spectrum of symptoms that led 35%-88.2% of them to hospital admission. Median and mean hospital length of stay ranged from 8 to 28.5 and 16.2 to 22 days, respectively. Admission to intensive care units varied widely across studies (from 2.6% to 70.5%) and was associated with high mortality (42.8%-100%). Overall, prognosis was poor in 0%-47% of the hospitalized patients. CONCLUSIONS: This systematic scoping review provides an overview of the current knowledge on the impact of COVID-19 on the frail world of HD patients. Furthermore, it may help to implement the existing strategies of COVID-19 prevention and provide a list of unmet needs (safe transport, testing, shelter). Finally, it may be a stimulus for performing systematic reviews and meta-analyses which will form the basis for evidence-based guidelines.


Subject(s)
COVID-19 , Pandemics , Adult , Aged , Child , Frail Elderly , Humans , Renal Dialysis/adverse effects , SARS-CoV-2
18.
J Am Med Dir Assoc ; 22(9): 1845-1852.e1, 2021 09.
Article in English | MEDLINE | ID: covidwho-1345368

ABSTRACT

OBJECTIVES: To evaluate, in a cohort of adults aged ≥80 years, the overlapping effect of clinical severity, comorbidities, cognitive impairment, and frailty, for the in-hospital death risk stratification of COVID-19 older patients since emergency department (ED) admission. DESIGN: Single-center prospective observational cohort study. SETTING AND PARTICIPANTS: The study was conducted in the ED of a teaching hospital that is a referral center for COVID-19 in central Italy. We enrolled all patients with aged ≥80 years old consecutively admitted to the ED between April 2020 and March 2021. METHODS: Clinical variables assessed in the ED were evaluated for the association with all-cause in-hospital death. Evaluated parameters were severity of disease, frailty, comorbidities, cognitive impairment, delirium, and dependency in daily life activities. Cox regression analysis was used to identify independent risk factors for poor outcomes. RESULTS: A total of 729 patients aged ≥80 years were enrolled [median age 85 years (interquartile range 82-89); 346 were males (47.3%)]. According to the Clinical Frailty Scale, 61 (8.4%) were classified as fit, 417 (57.2%) as vulnerable, and 251 (34.4%) as frail. Severe disease [hazard ratio (HR) 1.87, 95% confidence interval (CI) 1.31-2.59], ≥3 comorbidities (HR 1.54, 95% CI 1.11-2.13), male sex (HR 1.46, 95% CI 1.14-1.87), and frailty (HR 6.93, 95% CI 1.69-28.27) for vulnerable and an overall HR of 12.55 (95% CI 2.96-53.21) for frail were independent risk factors for in-hospital death. CONCLUSIONS AND IMPLICATIONS: The ED approach to older patients with COVID-19 should take into account the functional and clinical characteristics of patients being admitted. A sole evaluation based on the clinical severity and the presence of comorbidities does not reflect the complexity of this population. A comprehensive evaluation based on clinical severity, multimorbidity, and frailty could effectively predict the clinical risk of in-hospital death for patients with COVID-19 aged ≥80 years at the time of ED presentation.


Subject(s)
COVID-19 , Frailty , Adult , Aged , Emergency Service, Hospital , Frail Elderly , Frailty/diagnosis , Frailty/epidemiology , Geriatric Assessment , Hospital Mortality , Humans , Infant, Newborn , Male , Prospective Studies , Risk Assessment , SARS-CoV-2
19.
Geriatr Gerontol Int ; 21(8): 755-756, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1343864
20.
J Prim Care Community Health ; 12: 21501327211034807, 2021.
Article in English | MEDLINE | ID: covidwho-1329102

ABSTRACT

Coordination of primary care is essential to improving care delivery within health systems, especially for older adults with increased health/social needs. A program jointly funded by the Canadian Foundation for Healthcare Improvement and Canadian Frailty Network, was implemented in a nurse practitioner-led clinic to address the gap in frailty care for older adults. The clinic was situated within a health and social services organization with a mandate to enhance the quality of life of older adults living in the community. Through this program, a frailty assessment pathway and social/clinical prescriptions were implemented with necessary adaptations as a result of COVID-19.


Subject(s)
Frail Elderly , Frailty , Primary Health Care , Aged , COVID-19 , Canada , Humans , Quality of Life
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