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1.
JAMA Netw Open ; 5(1): e2146168, 2022 01 04.
Article in English | MEDLINE | ID: covidwho-1620079

ABSTRACT

Importance: The association of COVID-19 not requiring hospitalization with functional mobility in community-dwelling adults above and beyond the impact of the pandemic control measures implemented in 2020 remains to be elucidated. Objective: To evaluate the association between a COVID-19 diagnosis and change in mobility and physical function of adults in Canada aged 50 years or older during the initial pandemic lockdown. Design, Setting, and Participants: This population-based cohort study used data from the Canadian Longitudinal Study on Aging (CLSA) COVID-19 study. This study was launched on April 15, 2020, and the exit questionnaires were completed between September and December 2020. Prepandemic data from the first CLSA follow-up (2015-2018) were also used. Respondents included middle-aged and older community-dwelling participants residing in Canadian provinces. Data were analyzed from February to May 2021. Exposures: The assessment for self-reported COVID-19 status was adapted from the Public Health Agency of Canada and the Centers for Disease Control and Prevention case definition available at the time of data collection; cases were classified as confirmed or probable, suspected, or non-COVID-19. Main Outcomes and Measures: Changes in mobility since the start of the COVID-19 pandemic were assessed using global rating of change in mobility scales at the COVID-19 exit questionnaire. Participant-reported new onset of difficulty in 3 physical function tasks was also examined. Results: Among 51 338 participants at baseline, 21 491 participants (41.9%) were 65 years or older and 26 155 participants (51.0%) were women and 25 183 (49.1%) were men. Of 2748 individuals with confirmed or probable or suspected COVID-19, 113 (94.2%) were not hospitalized. Individuals with confirmed or probable COVID-19 had higher odds of worsening mobility in terms of ability to engage in household activity (odds ratio [OR], 1.89; 95% CI, 1.11-3.22), physical activity (OR, 1.91; 95% CI, 1.32-2.76), and standing up after sitting in a chair (OR, 2.33; 95% CI, 1.06-5.11) compared with adults without COVID-19 during the same pandemic time period. Similar results were found for suspected COVID-19 status (eg, household activity: OR, 2.09; 95% CI, 1.82-2.41). Conclusions and Relevance: This cohort study among older adults in Canada found that receiving a COVID-19 diagnosis was significantly associated with worse mobility and functioning outcomes even in the absence of hospitalization. These findings suggest that interventions may be needed for individuals with mild to moderate COVID-19 who do not require hospitalization.


Subject(s)
COVID-19/complications , Exercise , Geriatric Assessment , Independent Living , Mobility Limitation , Pandemics , Physical Functional Performance , Activities of Daily Living , Aged , Aged, 80 and over , COVID-19 Testing , Canada , Cohort Studies , Communicable Disease Control , Female , Hospitalization , Humans , Longitudinal Studies , Male , Middle Aged , Movement , Odds Ratio , SARS-CoV-2 , Self Report
2.
Nutrients ; 14(1)2022 Jan 05.
Article in English | MEDLINE | ID: covidwho-1613923

ABSTRACT

Elderly people are particularly vulnerable to COVID-19, with a high risk of developing severe disease and a reduced immune response to the COVID-19 vaccine. A randomized, placebo-controlled, double-blind trial to assess the effect of the consumption of the probiotic Loigolactobacillus coryniformis K8 CECT 5711 on the immune response generated by the COVID-19 vaccine in an elderly population was performed. Two hundred nursing home residents >60 yrs that had not COVID-19 were randomized to receive L. coryniformis K8 or a placebo daily for 3 months. All volunteers received a complete vaccination schedule of a mRNA vaccine, starting the intervention ten days after the first dose. Specific IgG and IgA antibody levels were analyzed 56 days after the end of the immunization process. No differences between the groups were observed in the antibody levels. During the intervention, 19 subjects had COVID-19 (11 receiving K8 vs. 8 receiving placebo, p = 0.457). Subgroup analysis in these patients showed that levels of IgG were significantly higher in those receiving K8 compared to placebo (p = 0.038). Among subjects >85 yrs that did not get COVID-19, administration of K8 tended to increase the IgA levels (p = 0.082). The administration of K8 may enhance the specific immune response against COVID-19 and may improve the COVID-19 vaccine-specific responses in elderly populations.


Subject(s)
COVID-19 Vaccines/immunology , COVID-19/prevention & control , Geriatric Assessment/methods , Immunity/immunology , Lactobacillus/immunology , Probiotics/administration & dosage , Aged , Aged, 80 and over , COVID-19/immunology , Double-Blind Method , Female , Humans , Male , SARS-CoV-2
3.
Med Sci Monit ; 27: e935496, 2021 Dec 21.
Article in English | MEDLINE | ID: covidwho-1599426

ABSTRACT

BACKGROUND The COVID-19 pandemic can affect the elderly population's general health. This study aimed to compare the effects of a remote home-based exercise program to improve the mental state, balance, and physical function and to prevent falls in adults aged 65 years and older during the COVID-19 pandemic in Seoul, Korea. MATERIAL AND METHODS Seventy participants were randomly assigned to an experimental group of 35 participants who underwent a remote home-based fall prevention exercise program and a control group of 35 participants. The experimental group performed an exercise program twice weekly for 8 weeks from June 2 to July 21, 2021. The Geriatric Depression Scale, 5 times sit to stand test, grip strength, 10-m walk test, gait analysis, Timed Up and Go test, and static balance test were assessed before and after the 8-week program. RESULTS The group-by-time interaction effect was statistically significant for the Geriatric Depression Scale, five times sit to stand test, grip strength, 10-meter walk, gait speed, step length, stride length, Timed Up and Go test, and static balance test (P<0.05). Compared with the control group, the experimental group showed a significant effect in all dependent variables except dynamic balance (P<0.05). CONCLUSIONS In this population, the remote home-based fall prevention exercise program resulted in a significant improvement in physical function, psychological factors, and balance during the COVID-19 pandemic. The findings may have implications for community public health measures to protect the vulnerable during future epidemics and pandemics of infectious disease.


Subject(s)
Accidental Falls/prevention & control , Telemedicine , Aged , Aged, 80 and over , COVID-19/epidemiology , Exercise , Exercise Therapy , Female , Geriatric Assessment , Hand Strength , Health Services for the Aged , Humans , Male , Postural Balance , Seoul/epidemiology , Walking Speed
4.
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
5.
Asian J Psychiatr ; 66: 102897, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1504234

ABSTRACT

OBJECTIVES: Study was aimed to assess magnitude of mental health problems among geriatric population during COVID19 pandemic. METHODOLOGY: Study was a cross-sectional observational study, total of 106 participants (Age ≥60 years) of either gender included in study. Mental health variables depressive and anxiety were assessed using GDS and HAM-A. RESULTS: On GDS, 20(18.87%) patients had depressive symptoms and on HAM-A, 24(22.6%) patients were having anxiety symptoms. CONCLUSION: Study highlight that Geriatric population have significant mental health issues during COVID19 pandemic, it should not be overlooked. It's necessary to provide elderly psychological intervention measures to improve their wellbeing.


Subject(s)
COVID-19 , Mental Health , Aged , Anxiety/diagnosis , Anxiety/epidemiology , Cross-Sectional Studies , Depression/diagnosis , Depression/epidemiology , Geriatric Assessment , Humans , Middle Aged , Pandemics , SARS-CoV-2
6.
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
7.
BMC Geriatr ; 21(1): 610, 2021 10 29.
Article in English | MEDLINE | ID: covidwho-1486553

ABSTRACT

BACKGROUND: The infection by SARS-CoV-2 (COVID-19) has been especially serious in older patients. The aim of this study is to describe baseline and clinical characteristics, hospital referrals, 60-day mortality, factors associated with hospital referrals and mortality in older patients living in nursing homes (NH) with suspected COVID-19. METHODS: A retrospective observational study was performed during March and April 2020 of institutionalized patients assessed by a liaison geriatric hospital-based team. Were collected all older patients living in 31 nursing homes of a public hospital catchment area assessed by a liaison geriatric team due to the suspicion of COVID-19 during the first wave, when the hospital system was collapsed. Sociodemographic variables, comprehensive geriatric assessment, clinical characteristics, treatment received including care setting, and 60-days mortality were recorded from electronic medical records. A logistic regression analysis was performed to analyze the factors associated with mortality. RESULTS: 419 patients were included in the study (median age 89 years old, 71.6 % women, 63.7 % with moderate-severe dependence, and 43.8 % with advanced dementia). 31.1 % were referred to the emergency department in the first assessment, with a higher rate of hospital referral in those with better functional and mental status. COVID-19 atypical symptoms like functional decline, delirium, or eating disorders were frequent. 36.9% had died in the 60 days following the first call. According to multivariate logistic regression age (p 0.010), Barthel index <60 (p 0.002), presence of tachypnea (p 0.021), fever (p 0.006) and the use of ceftriaxone (p 0.004) were associated with mortality. No mortality differences were found between those referred to the hospital or cared at the nursing home. CONCLUSIONS AND IMPLICATIONS: 31% of the nursing home patients assessed by a liaison geriatric hospital-based team for COVID-19 were referred to the hospital, being more frequently referred those with a better functional and cognitive situation. The 60-days mortality rate due to COVID-19 was 36.8% and was associated with older age, functional dependence, the presence of tachypnea and fever, and the use of ceftriaxone. Geriatric comprehensive assessment and coordination between NH and the hospital geriatric department teams were crucial.


Subject(s)
COVID-19 , Aged , Aged, 80 and over , Female , Geriatric Assessment , Humans , Male , Nursing Homes , Referral and Consultation , SARS-CoV-2
8.
Int J Environ Res Public Health ; 18(20)2021 10 10.
Article in English | MEDLINE | ID: covidwho-1480714

ABSTRACT

The association between the Short Physical Performance Battery (SPPB) score and several adverse health outcomes, including mortality, has been reported in the scientific literature. We conducted a comprehensive literature review of studies on the relationship between SPPB and mortality. The current paper synthesizes the characteristics and main findings of longitudinal studies available in the literature that investigated the role of the SPPB in predicting mortality in older adults. The studies (n = 40) are from North America, South America, Europe, and Asia; the majority (n = 16) were conducted with community-dwelling older adults and reported an association between lower SPPB scores and a higher risk of mortality, and between higher SPPB scores and higher survival. Nevertheless, few studies have analyzed the accuracy of the instrument to predict mortality. The only study that established cut-off points was conducted with older adults discharged from an acute care hospital. Although an SPPB score lower than 10 seems to predict all-cause mortality, further studies showing cut-off points in specific settings and loco-regional specificities are still necessary.


Subject(s)
Independent Living , Physical Functional Performance , Aged , Asia , Europe , Geriatric Assessment , Humans , Longitudinal Studies
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
11.
J Nutr Health Aging ; 25(9): 1064-1069, 2021.
Article in English | MEDLINE | ID: covidwho-1410085

ABSTRACT

OBJECTIVES: To develop and cross-validate self-administered Rapid Geriatric Assessment (SA-RGA) app against administered Rapid Geriatric Assessment (A-RGA) to identify seniors with geriatric syndromes such as frailty, sarcopenia, and anorexia of ageing who may benefit from targeted intervention. DESIGN: Prospective observational study. SETTING: Primary Care and Community. PARTICIPANTS: A-RGA and SA-RGA app were administered to older adults ≥ 60 years old from December 2020 to April 2021. MEASUREMENTS: The RGA app screens for frailty (FRAIL), sarcopenia (SARC-F), anorexia of aging (SNAQ) and cognition (Rapid Cognitive Screen) with assisted management pathway. Patient Health Questionnaire 9 is administered for those who score positive for fatigue. The diagnostic performance of SA-RGA was compared against A-RGA as a reference by calculating the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) and positive likelihood ratio (+LR). RESULTS: 123 participants with a mean age of 71 ± 5.9 years completed both the SA-RGA and A-RGA. Questions on fatigue, 5 or more illnesses, loss of weight and falls in the past year performed better with high sensitivity, specificity, NPV and +LR than self-functional assessment where SA-RGA participants reported lower prevalence on the FRAIL scale aerobic and resistance components, and higher prevalence on the SARC-F strength and rising from a chair components. CONCLUSION: The SA-RGA app performed well in certain domains such as assessment for weight loss, falls, number of chronic illness and fatigue. Self-functional assessment can be improved further by removing ambiguity in wordings such as "some" or "a lot" and replacing it with functional difficulty scale. SA-RGA has the potential to be incorporated in the eHEALTH platforms worldwide for early identifications of older adults at risk and to reduce health inequalities, at the same time building community resilience in the era of Covid-19 pandemic.


Subject(s)
COVID-19 , Mobile Applications , Sarcopenia , Aged , Cross-Sectional Studies , Geriatric Assessment , Humans , Pandemics , Reproducibility of Results , SARS-CoV-2 , Sarcopenia/diagnosis , Sarcopenia/epidemiology , Surveys and Questionnaires
12.
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
13.
J Am Geriatr Soc ; 69(2): 293-299, 2021 02.
Article in English | MEDLINE | ID: covidwho-1388322

ABSTRACT

OBJECTIVES: The aims of this study are to report the prevalence of delirium on admission to the unit in patients hospitalized with SARS-CoV-2 infection, to identify the factors associated with delirium, and to evaluate the association between delirium and in-hospital mortality. DESIGN: Multicenter observational cohort study. SETTINGS: Acute medical units in four Italian hospitals. PARTICIPANTS: A total of 516 patients (median age 78 years) admitted to the participating centers with SARS-CoV-2 infection from February 22 to May 17, 2020. MEASUREMENTS: Comprehensive medical assessment with detailed history, physical examinations, functional status, laboratory and imaging procedures. On admission, delirium was determined by the Diagnostic and Statistical Manual of Mental Disorders (5th edition) criteria, 4AT, m-Richmond Agitation Sedation Scale, or clinical impression depending on the site. The primary outcomes were delirium rates and in-hospital mortality. RESULTS: Overall, 73 (14.1%, 95% confidence interval (CI) = 11.0-17.3%) patients presented delirium on admission. Factors significantly associated with delirium were dementia (odds ratio, OR = 4.66, 95% CI = 2.03-10.69), the number of chronic diseases (OR = 1.20, 95% CI = 1.03; 1.40), and chest X-ray or CT opacity (OR = 3.29, 95% CI = 1.12-9.64 and 3.35, 95% CI = 1.07-10.47, for multiple or bilateral opacities and single opacity vs no opacity, respectively). There were 148 (33.4%) in-hospital deaths in the no-delirium group and 43 (58.9%) in the delirium group (P-value assessed using the Gray test <.001). As assessed by a multivariable Cox model, patients with delirium on admission showed an almost twofold increased hazard ratio for in-hospital mortality with respect to patients without delirium (hazard ratio = 1.88, 95% CI = 1.25-2.83). CONCLUSION: Delirium is prevalent and associated with in-hospital mortality among older patients hospitalized with SARS-CoV-2 infection.


Subject(s)
COVID-19/mortality , Delirium/diagnosis , Delirium/mortality , Inpatients/statistics & numerical data , Aged , Aged, 80 and over , Cohort Studies , Comorbidity , Female , Geriatric Assessment , Hospital Mortality , Humans , Intensive Care Units , Italy/epidemiology , Male , Prevalence , Risk Factors
14.
J Am Geriatr Soc ; 69(10): 2759-2765, 2021 10.
Article in English | MEDLINE | ID: covidwho-1365085

ABSTRACT

Telecommunication assisted forensic assessments of capacity and mistreatment by geriatricians with expertise in elder abuse and self-neglect are helping to meet the demand for such forensic services for Adult Protective Services (APS) clients in remote and underserved areas of Texas. The use of synchronous audiovisual assisted interviews instead of in-person interviews with clients to provide capacity assessments has become more important with the arrival of the COVID-19 pandemic. There is growing interest in establishing similar programs in other states using geriatrician faculty from medical schools to serve the clients of their state Adult Protective Services agencies. The arrangement between APS and the geriatricians at McGovern Medical School in Houston, Texas is novel. The structure of the arrangement is important for the success of the program. Legal, ethical, and practical considerations are discussed in this article, including approaches to the Health Insurance Portability and Accountability Act, physician liability, state law, and resource limitations. It is hoped that sharing how one such collaboration has addressed these important issues will suggest approaches for the structuring of similar programs.


Subject(s)
COVID-19 , Elder Abuse , Forensic Medicine , Geriatric Assessment/methods , Telemedicine , Aged , COVID-19/epidemiology , COVID-19/prevention & control , Communicable Disease Control/methods , Elder Abuse/diagnosis , Elder Abuse/ethics , Elder Abuse/legislation & jurisprudence , Elder Abuse/prevention & control , Forensic Medicine/ethics , Forensic Medicine/legislation & jurisprudence , Forensic Medicine/methods , Humans , Organizational Innovation , Program Evaluation , SARS-CoV-2 , Telecommunications/organization & administration , Telemedicine/ethics , Telemedicine/legislation & jurisprudence , Telemedicine/methods , United States/epidemiology , Vulnerable Populations
15.
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
16.
Geriatr Gerontol Int ; 21(8): 755-756, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1343864
17.
BMJ Open ; 11(7): e047945, 2021 07 19.
Article in English | MEDLINE | ID: covidwho-1318030

ABSTRACT

OBJECTIVE: To evaluate the pattern of frailty across several of social stratifiers associated with health inequalities. DESIGN, SETTING AND PARTICIPANTS: Cross-sectional baseline data on 51 338 community-living women and men aged 45-85 years from the population-based Canadian Longitudinal Study on Aging (collected from September 2011 to May 2015) were used in this study. PRIMARY OUTCOMES AND MEASURES: A Frailty Index (FI) was constructed using self-reported chronic conditions, psychological function and cognitive status and physical functioning variables. Social stratifiers were chosen based on the Pan-Canadian Health Inequalities Reporting Initiative, reflecting key health inequalities in Canada. Unadjusted and adjusted FIs and domain-specific FIs (based on chronic conditions, physical function, psychological/cognitive deficits) were examined across population strata. RESULTS: The overall mean FI was 0.13±0.08. It increased with age and was higher in women than men. Higher mean FIs were found among study participants with low income (0.20±0.10), who did not complete secondary education (0.17±0.09) or had low perceived social standing (0.18±0.10). Values did not differ by Canadian province of residence or urban/rural status. After simultaneously adjusting for population characteristics and other covariates, income explained the most heterogeneity in frailty, especially in younger age groups; similar patterns were found for men and women. The average frailty for people aged 45-54 in the lowest income group was greater than that for those aged 75-85 years. The heterogeneity in the FI among income groups was greatest for the psychological/cognitive domain. CONCLUSIONS: Our results suggest that especially in the younger age groups, psychological/cognitive deficits are most highly associated with both overall frailty levels and the gradient in frailty associated with income. If this is predictive of later increases in the other two domains (and overall frailty), it raises the question whether targeting mental health factors earlier in life might be an effective approach to mitigating frailty.


Subject(s)
Frailty , Health Status Disparities , Aged , Aging , Canada/epidemiology , Cross-Sectional Studies , Female , Frail Elderly , Frailty/epidemiology , Geriatric Assessment , Humans , Longitudinal Studies , Male
19.
Sensors (Basel) ; 20(20)2020 Oct 14.
Article in English | MEDLINE | ID: covidwho-1308405

ABSTRACT

The present paper describes a system for older people to self-administer the 30-s chair stand test (CST) at home without supervision. The system comprises a low-cost sensor to count sit-to-stand (SiSt) transitions, and an Android application to guide older people through the procedure. Two observational studies were conducted to test (i) the sensor in a supervised environment (n = 7; m = 83.29 years old, sd = 4.19; 5 female), and (ii) the complete system in an unsupervised one (n = 7; age 64-74 years old; 3 female). The participants in the supervised test were asked to perform a 30-s CST with the sensor, while a member of the research team manually counted valid transitions. Automatic and manual counts were perfectly correlated (Pearson's r = 1, p = 0.00). Even though the sample was small, none of the signals around the critical score were affected by harmful noise; p (harmless noise) = 1, 95% CI = (0.98, 1). The participants in the unsupervised test used the system in their homes for a month. None of them dropped out, and they reported it to be easy to use, comfortable, and easy to understand. Thus, the system is suitable to be used by older adults in their homes without professional supervision.


Subject(s)
Exercise Test , Geriatric Assessment/methods , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Sitting Position , Standing Position
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