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1.
Int J Environ Res Public Health ; 19(6)2022 03 19.
Article in English | MEDLINE | ID: covidwho-1760607

ABSTRACT

Restrictive measures due to the COVID-19 pandemic may cause problems in the physical, social, and psychological functioning of older people, resulting in increased frailty. In this cross-sectional study, we aimed to assess the prevalence and characteristics of frailty, to examine differences in perceived COVID-19-related concerns and threats between frail and non-frail people and to identify variables associated with frailty in the first wave of the COVID-19 pandemic, in Dutch older people aged ≥ 65 years. We used data from the Lifelines COVID-19 Cohort Study. The Groningen Frailty Indicator (GFI) was used, with a score ≥ 4 indicating frailty. Frailty was described per domain (i.e., physical, cognitive, social, and psychological). The association between demographic, health and lifestyle variables and frailty was determined with logistic regression analyses. Frailty was present in 13% of the 11,145 participants that completed the GFI. Most items contributing to a positive frailty score were found within the social domain, in the frail (51%) and the non-frail (59%) persons. For items related to concerns and threats, a significantly higher proportion of frail people reported being worried or feeling threatened. In conclusion, during Corona restrictions, prevalence of frailty was considerable in older people from the Northern Netherlands, with one in eight being frail. Frailty was characterized by social problems and frail people were more often worried and felt threatened by the COVID-19 pandemic.


Subject(s)
COVID-19 , Frailty , Aged , COVID-19/epidemiology , Cohort Studies , Cross-Sectional Studies , Frail Elderly/psychology , Frailty/epidemiology , Frailty/psychology , Geriatric Assessment/methods , Humans , Netherlands/epidemiology , Pandemics
2.
Aging Clin Exp Res ; 34(4): 945-949, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1748379

ABSTRACT

OBJECTIVE: Exploring the association between frailty and mortality in a cohort of patients with COVID-19 respiratory insufficiency treated with continuous positive airway pressure. METHODS: Frailty was measured using a Frailty Index (FI) created by using the baseline assessment data on comorbidities and body mass index and baseline blood test results (including pH, lactate dehydrogenase, renal and liver function, inflammatory indexes and anemia). FI > 0.25 identified frail individuals. RESULTS: Among the 159 included individuals (81% men, median age of 68) frailty was detected in 69% of the patients (median FI score 0.3 ± 0.08). Frailty was associated to an increased mortality (adjusted HR 1.99, 95% CI 1.02-3.88, p = 0.04). CONCLUSIONS: Frailty is highly prevalent among patients with COVID-19, predicts poorer outcomes independently of age. A personalization of care balancing the risk and benefit of treatments (especially the invasive ones) in such complex patients is pivotal.


Subject(s)
COVID-19 , Frailty , Respiratory Insufficiency , Aged , Comorbidity , Continuous Positive Airway Pressure , Female , Frail Elderly , Frailty/epidemiology , Geriatric Assessment/methods , Humans , Male , Respiratory Insufficiency/therapy
3.
Aging Clin Exp Res ; 34(4): 939-944, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1748378

ABSTRACT

AIMS: The study assesses the reliability of fr-AGILE, a validated rapid tool used for the evaluation of multidimensional frailty in older adults hospitalized with COVID-19. METHODS: Two different staff members independently assessed the presence of frailty in 144 patients aged ≥ 65 years affected by COVID-19 using the fr-AGILE tool. The internal consistency of fr-AGILE was evaluated by examining the item-total correlations and the Kuder-Richardson (KR) formula. The inter-rater reliability was evaluated using linear weighted kappa. RESULTS: Multidimensional frailty severity increases with age and is associated to higher use of non-invasive ventilation (p = 0.025), total severity score on chest tomography (p = 0.001) and in-hospital mortality (p = 0.032). Fr-AGILE showed good internal consistency (KR-20 = 0.742) and excellent inter-rater reliability (weighted kappa = 0.752 and 0.878 for frailty score and frailty degree, respectively). CONCLUSIONS: fr-AGILE tool can quickly identify and quantify multidimensional frailty in hospital settings for older patient affected by COVID-19.


Subject(s)
COVID-19 , Frailty , Aged , Frail Elderly , Frailty/diagnosis , Geriatric Assessment/methods , Hospitals , Humans , Reproducibility of Results
4.
Int J Environ Res Public Health ; 19(3)2022 01 26.
Article in English | MEDLINE | ID: covidwho-1686733

ABSTRACT

BACKGROUND: Prompt and efficient identification and stratification of patients who are frail is important, as this cohort are at high risk of adverse healthcare outcomes. Numerous frailty screening tools have been developed to support their identification across different settings, yet relatively few have emerged for use in emergency departments (EDs). This protocol provides details for a systematic review aiming to synthesize the accumulated evidence regarding the diagnostic accuracy and clinimetric properties of frailty screening instruments to identify frail older adults in EDs. METHODS: Six electronic databases will be searched from January 2000 to March 2021. Eligible studies will include adults aged ≥60 years screened in EDs with any available screening instrument to identify frailty (even if not originally designed for this purpose). Studies, including case-control, longitudinal, and cohort studies, will be included, where instruments are compared to a reference standard to explore diagnostic accuracy. Predictive accuracy for a selection of outcomes, including mortality, institutionalization, and readmission, will be assessed. Clinical and methodological heterogeneity will be examined, and a random effects meta-analysis performed if appropriate. CONCLUSION: Understanding whether frailty screening on presentation to EDs is accurate in identifying frailty, and predicting these outcomes is important for decision-making and targeting appropriate management.


Subject(s)
Frail Elderly , Frailty , Aged , Emergency Service, Hospital , Frailty/diagnosis , Geriatric Assessment/methods , Humans , Mass Screening , Meta-Analysis as Topic , Middle Aged , Systematic Reviews as Topic
5.
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
6.
BMC Anesthesiol ; 21(1): 291, 2021 11 22.
Article in English | MEDLINE | ID: covidwho-1528676

ABSTRACT

BACKGROUND: Older adults have an increased risk of mortality from Coronavirus disease 2019 (Covid-19). Despite the high number of publications on the topic of Covid-19 pandemic, few studies have focused on the intensive care treatments of Covid-19 patients aged 80 years and older. The goal of our study is to investigate the effect of the intensive care treatments on the mortality of Covid-19 patients aged 80 years and older based on their clinical features, laboratory findings and the intensive care treatments methods. METHODS: The data of 174 patients aged 80 years and older treated from Covid-19 in intensive care unit were assessed retrospectively. The patients were divided into two groups as survivor and non-survivor. The effects of age, gender, length of stay, comorbid diseases, laboratory values, thoracic computed tomography findings, having invasive mechanical ventilation (IMV), high flow nasal cannula (HFNC) and/or non-invasive mechanical ventilation (NIMV), hemodiafiltration (HDF), anti-cytokines and plasma therapy on mortality have been investigated. RESULTS: The mean age and mean values of CRP, PCT, Ferritin, LDH were statistically significantly high in the non-survivor group. The mortality rate of the patients who had IMV was also statistically significantly higher compared to patients who had HFNC and/or NIMV. Albumin level and the rate of treatment with HFNC and/or NIMV were statistically significantly low in non-survivor group compared to the Survivor group. CONCLUSION: ICU treatments may be beneficial for the Covid-19 patients aged 80 years and older. Increased age, high levels of CRP, PCT, ferritin, and having IMV are detected as poor outcome markers.


Subject(s)
COVID-19/mortality , COVID-19/therapy , Critical Care/methods , Geriatric Assessment/methods , Age Factors , Aged, 80 and over , COVID-19/diagnostic imaging , Female , Geriatric Assessment/statistics & numerical data , Hemodiafiltration/statistics & numerical data , Humans , Length of Stay/statistics & numerical data , Lung/diagnostic imaging , Male , Oxygen Inhalation Therapy/statistics & numerical data , Respiration, Artificial/statistics & numerical data , Retrospective Studies , SARS-CoV-2 , Sex Factors , Tomography, X-Ray Computed , Turkey
7.
J Frailty Aging ; 11(2): 206-213, 2022.
Article in English | MEDLINE | ID: covidwho-1498010

ABSTRACT

BACKGROUND: Despite emerging evidence about the association between social frailty and cognitive impairment, little is known about the role of executive function in this interplay, and whether the co-existence of social frailty and cognitive impairment predisposes to adverse health outcomes in healthy community-dwelling older adults. OBJECTIVES: We aim to examine independent associations between social frailty with the MMSE and FAB, and to determine if having both social frailty and cognitive impairment is associated with worse health outcomes than either or neither condition. METHODS: We studied 229 cognitively intact and functionally independent community-dwelling older adults (mean age= 67.2±7.43). Outcome measures comprise physical activity; physical performance and frailty; geriatric syndromes; life space and quality of life. We compared Chinese Mini Mental State Examination (CMMSE) and Chinese Frontal Assessment Battery (FAB) scores across the socially non-frail, socially pre-frail and socially frail. Participants were further recategorized into three subgroups (neither, either or both) based on presence of social frailty and cognitive impairment. Cognitive impairment was defined as a score below the educational adjusted cut-offs in either CMMSE or FAB. We performed logistic regression adjusted for significant covariates and mood to examine association with outcomes across the three subgroups. RESULTS: Compared with CMMSE, Chinese FAB scores significantly decreased across the social frailty spectrum (p<0.001), suggesting strong association between executive function with social frailty. We derived three subgroups relative to relationship with socially frailty and executive dysfunction: (i) Neither, N=140(61.1%), (ii) Either, N=79(34.5%), and (iii) Both, N=10(4.4%). Compared with neither or either subgroups, having both social frailty and executive dysfunction was associated with anorexia (OR=4.79, 95% CI= 1.04-22.02), near falls and falls (OR= 5.23, 95% CI= 1.10-24.90), lower life-space mobility (odds ratio, OR=9.80, 95% CI=2.07-46.31) and poorer quality of life (OR= 13.2, 95% CI= 2.38-73.4). CONCLUSION: Our results explicated the association of executive dysfunction with social frailty, and their synergistic relationship independent of mood with geriatric syndromes, decreased life space and poorer quality of life. In light of the current COVID-19 pandemic, the association between social frailty and executive dysfunction merits further study as a possible target for early intervention in relatively healthy older adults.


Subject(s)
COVID-19 , Cognitive Dysfunction , Frailty , Aged , Cognitive Dysfunction/epidemiology , Cognitive Dysfunction/psychology , Cross-Sectional Studies , Executive Function , Frail Elderly/psychology , Frailty/diagnosis , Frailty/epidemiology , Frailty/psychology , Geriatric Assessment/methods , Humans , Independent Living/psychology , Pandemics , Quality of Life/psychology , Syndrome
8.
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
9.
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
10.
J Intellect Disabil Res ; 65(10): 879-889, 2021 10.
Article in English | MEDLINE | ID: covidwho-1285033

ABSTRACT

BACKGROUND: Social restrictions and service closures from COVID-19 have negatively impacted social inclusion and well-being for some people with intellectual disabilities (IDs). METHODS: The fourth wave of a national longitudinal study on ageing in people with ID in Ireland was interrupted during the COVID-19 outbreak. Social inclusion data for pre-existing participants interviewed before COVID-19 (n = 444) were compared with data for pre-existing participants interviewed during/after lockdown (n = 62). RESULTS: More people interviewed after lockdown reported frequent family contact. Significantly greater numbers in the post-lockdown group reported access to and use of technology than the pre-lockdown group. Technology use was higher among those living in grouped residences supported by services compared with individuals living independently or with family. CONCLUSIONS: During the early stages of the COVID-19 pandemic in Ireland, many older adults with ID stayed connected with family and reported rates of contact higher than were reported by others before COVID-19. This connection may have been supported by a significant increase in technology use during the pandemic. However, uneven use of technology may disadvantage some including individuals living with family or independently. Given that COVID-19 restrictions are likely to continue to restrict social opportunities, increased digital support may assist more people with ID to use technology to maintain their social connections.


Subject(s)
COVID-19/prevention & control , COVID-19/psychology , Intellectual Disability/psychology , Social Inclusion , Aged , Female , Geriatric Assessment/methods , Humans , Ireland , Longitudinal Studies , Male , Middle Aged , Pandemics , SARS-CoV-2
11.
J Am Geriatr Soc ; 69(10): 2722-2731, 2021 10.
Article in English | MEDLINE | ID: covidwho-1268124

ABSTRACT

OBJECTIVE: To assess the association between SARS-CoV-2 infection and decreased hand grip strength (HGS). DESIGN: Longitudinal population-based study. SETTING: Community-dwelling older adults (aged ≥60 years) living in a rural Ecuadorian village struck by the SARS-CoV-2 pandemic. PARTICIPANTS: Of 282 enrolled individuals, 254 (90%) finished the study. MEASUREMENTS: HGS was measured 3 months before (January 2020) and 9 months after the introduction of the virus into the population (January 2021). SARS-CoV-2 antibody testing was performed in two rounds: in May-June (early) and September-November (late), 2020. An independent association between SARS-CoV-2 infection and HGS decline was assessed by fitting linear mixed models for longitudinal data. Changes in HGS scores in SARS-CoV-2 seropositive subjects, according to the time elapsed since seroconversion, were compared with those who remained seronegative. RESULTS: Overall, 149 (59%) individuals became seropositive for SARS-CoV-2. The mean HGS (in kg) was 25.3 ± 8.3 at baseline and 23.7 ± 8.1 at follow-up (p = 0.028), with 140 individuals having >5% HGS decline between both measurements. The follow-up HGS measurement decreased by 1.72 kg in seropositive individuals, and by 0.57 kg in their seronegative counterparts (p < 0.001). SARS-CoV-2 seropositive individuals were 2.27 times more likely (95% CI: 1.33-3.87) to have a lower HGS measurement at the time of follow-up than those who remained seronegative. When compared with seronegative subjects, seropositive patients with early seroconversion were 3.41 times (95% CI: 1.73-6.74) more likely to have >5% HGS decline at the time of the follow-up than those with later, i.e., more recent, infections. CONCLUSIONS: This study shows an independent deleterious impact of SARS-CoV-2 on HGS that is more marked among individuals with infections that occurred more than 8 months before follow-up HGS. Results suggest the possibility of chronic damage to skeletal muscles by SARS-CoV-2.


Subject(s)
COVID-19/complications , Geriatric Assessment , Hand Strength , SARS-CoV-2/isolation & purification , Aftercare/methods , Aftercare/statistics & numerical data , Aged , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/physiopathology , COVID-19 Serological Testing/methods , Ecuador/epidemiology , Female , Geriatric Assessment/methods , Geriatric Assessment/statistics & numerical data , Health Services for the Aged/statistics & numerical data , Humans , Independent Living/statistics & numerical data , Longitudinal Studies , Male , Rural Population
12.
Geriatr., Gerontol. Aging (Impr.) ; 14(3): 203-206, 30-09-2020.
Article in English | WHO COVID, LILACS (Americas) | ID: covidwho-1175698

ABSTRACT

INTRODUCTION: During the COVID-19 pandemic, the discipline of geriatrics at the Santa Casa de Sao Paulo School of Medical Sciences of São Paulo was adapted to a web-based learning environment due to social distancing measures. OBJECTIVE: To describe the full adaptation of the discipline of geriatrics to a web-based learning tool, of two activities that were developed including the current COVID-19 to illustrate some of the main concepts of geriatric medicine. METHODS: The course was fully adapted to the open-source course management system called MOODLE. The first activity was a COVID-19 clinical case discussion, whose main objective was to include COVID-19 in the content of our course, illustrating some of the main concepts of geriatrics. The second activity was a Comprehensive Geriatric Assessment (CGA) experience, done via videoconference, which also assessed the impact of social distancing measures on the health of older adults. RESULTS: A total of 43 medical students performed both activities, and 95% of the students considered the inclusion of the COVID-19 into the discipline of geriatrics useful, 88% approved the practical experience of CGA, and 84% felt that they contributed to the health of the interviewees after contact. CONCLUSION: Adapting our discipline to a web-based learning tool, while including the current COVID-19 in our course content and a practical experience of CGA via videoconference was possible and approved by students. The adoption of this initiative may not only be an academic strategy, but also a possible way to improve the quality of life of older people during the COVID-19 pandemic


Durante a pandemia de COVID-19, a disciplina de geriatria da Faculdade de Ciências Médicas da Santa Casa de São Paulo foi adaptada a um plataforma de aprendizagem a distância devido a medidas de distanciamento social. OBJETIVO: Descrever a adaptação completa da disciplina de geriatria a uma plataforma de aprendizagem a distância de duas atividades desenvolvidas que abordaram o atual tema COVID-19 para ilustrar alguns dos principais conceitos em medicina geriátrica. METODOLOGIA: O curso foi totalmente adaptado à plataforma de aprendizagem a distância chamada MOODLE. A primeira atividade foi uma discussão de caso clínico de COVID-19, cujo objetivo principal foi incluir o tema no conteúdo de nosso curso, ilustrando alguns dos principais conceitos em geriatria. A segunda atividade foi a experiência prática da Avaliação Geriátrica Ampla (AGA), realizada por videoconferência, que também avaliou o impacto das medidas de distanciamento social na saúde de idosos. RESULTADOS: 43 estudantes de medicina realizaram as duas atividades e 95% consideraram útil a inclusão do tema COVID-19 na disciplina de geriatria, 88% aprovaram a experiência prática da AGA e 84% consideraram que contribuíam para a saúde dos entrevistados após o contato. CONCLUSÃO: A adaptação de nossa disciplina a uma plataforma de aprendizagem a distância, incluindo o tema COVID-19 no conteúdo do curso e uma experiência prática da AGA por videoconferência, foi possível e aprovada pelos alunos. A adoção dessa iniciativa pode ser não apenas uma estratégia acadêmica, mas também uma maneira possível de melhorar a qualidade de vida dos idosos durante a pandemia de COVID-19.


Subject(s)
Humans , Coronavirus Infections , Education, Distance/methods , Education, Medical/trends , Brazil , Geriatric Assessment/methods , Education, Higher
13.
Age Ageing ; 50(2): 326-334, 2021 02 26.
Article in English | MEDLINE | ID: covidwho-1114819

ABSTRACT

BACKGROUND: the coronavirus disease 2019 (COVID-19) is characterized by poor outcomes and mortality, particularly in older patients. METHODS: post hoc analysis of the international, multicentre, 'real-world' HOPE COVID-19 registry. All patients aged ≥65 years hospitalised for COVID-19 were selected. Epidemiological, clinical, analytical and outcome data were obtained. A comparative study between two age subgroups, 65-74 and ≥75 years, was performed. The primary endpoint was all cause in-hospital mortality. RESULTS: about, 1,520 patients aged ≥65 years (60.3% male, median age of 76 [IQR 71-83] years) were included. Comorbidities such as hypertension (69.2%), dyslipidaemia (48.6%), cardiovascular diseases (any chronic heart disease in 38.4% and cerebrovascular disease in 12.5%), and chronic lung disease (25.3%) were prevalent, and 49.6% were on ACEI/ARBs. Patients aged 75 years and older suffered more in-hospital complications (respiratory failure, heart failure, renal failure, sepsis) and a significantly higher mortality (18.4 vs. 48.2%, P < 0.001), but fewer admissions to intensive care units (11.2 vs. 4.8%). In the overall cohort, multivariable analysis demonstrated age ≥75 (OR 3.54), chronic kidney disease (OR 3.36), dementia (OR 8.06), peripheral oxygen saturation at admission <92% (OR 5.85), severe lymphopenia (<500/mm3) (OR 3.36) and qSOFA (Quick Sequential Organ Failure Assessment Score) >1 (OR 8.31) to be independent predictors of mortality. CONCLUSION: patients aged ≥65 years hospitalised for COVID-19 had high rates of in-hospital complications and mortality, especially among patients 75 years or older. Age ≥75 years, dementia, peripheral oxygen saturation <92%, severe lymphopenia and qSOFA scale >1 were independent predictors of mortality in this population.


Subject(s)
COVID-19 , Hospital Mortality , Hospitalization/statistics & numerical data , Aged , Aged, 80 and over , COVID-19/complications , COVID-19/mortality , COVID-19/physiopathology , COVID-19/therapy , Female , Geriatric Assessment/methods , Humans , Intensive Care Units/statistics & numerical data , International Cooperation , Male , Mortality , Multimorbidity , Prognosis , Registries/statistics & numerical data , Risk Assessment/methods , Risk Factors , SARS-CoV-2/isolation & purification
15.
J Am Geriatr Soc ; 69(3): 572-580, 2021 03.
Article in English | MEDLINE | ID: covidwho-1038385

ABSTRACT

Older adults have been markedly impacted by the coronavirus disease 19 (COVID-19) pandemic. The American Geriatrics Society previously published a White Paper on Healthy Aging in 2018 that focused on a number of domains that are core to healthy aging in older adults: health promotion, injury prevention, and managing chronic conditions; cognitive health; physical health; mental health; and social health. The potentially devastating consequences of COVID-19 on health promotion are recognized. The purpose of this article is multifold. First, members of the Healthy Aging Special Interest Group will present the significant difficulties and obstacles faced by older adults during this unprecedented time. Second, we provide guidance to practicing geriatrics healthcare professionals overseeing the care of older adults. We provide a framework for clinical evaluation and screening related to the five aforementioned domains that uniquely impact older adults. Last, we provide strategies that could enhance healthy aging in the era of COVID-19.


Subject(s)
COVID-19 , Geriatric Assessment/methods , Geriatrics/methods , Health Promotion/methods , Healthy Aging , Aged , Aged, 80 and over , Female , Humans , Male , SARS-CoV-2
16.
BMJ Open ; 11(1): e045780, 2021 01 12.
Article in English | MEDLINE | ID: covidwho-1027131

ABSTRACT

OBJECTIVES: Describing perceived limitations in everyday life, psychological burden and approval to easing of measures during the COVID-19 phases in elderly people with neurological disorders. DESIGN: Observational, prospective study SETTING: This is a monocentric study conducted at a university hospital in Germany. PARTICIPANTS: Overall, 452 elderly people participated in the NeuroGerAdh study (DRKS00016774) and were interviewed by telephone between 18 March and 30 August 2020. RESULTS: Overall, 307 (67.9%) patients had relevant limitations in daily life due to the measures. These limitations significantly decreased during the pandemic phases. At the beginning of the pandemic, people complained about restricted social contacts and mobility, which were the most common reasons for perceived limitations in daily life. Later, since June 2020, wearing a mouth-nose mask had become the main reason for perceived limitations. In the elastic net regularisation, model higher perceived limitations in daily life were among others associated with younger age and earlier pandemic phases. Higher psychological burden was mainly associated with early pandemic phase, younger age and depression.The perceived psychological burden decreased as the pandemic phases passed, even though the reasons for psychological burden (anxiety or fear of infection, insecurity and concerns) did not remarkably change during the phases. From 16 June 2020, the patients were asked whether they approve the easing of measures. Sixty-seven of 136 patients (49.3%) approved and 55 (40.4%) did not. The common reasons for disapproval were fear of increased risk of infection and irresponsible behaviour of other people. CONCLUSION: While limitations in daily life decreased during the study period, anxiety remains a common psychological burden in elderly sick people, and this needs special attention. Accordingly, most people do not approve easing of measures. Special strategies are needed to cope with changing measures during the COVID-19 pandemic.


Subject(s)
Anxiety Disorders/complications , Anxiety Disorders/psychology , COVID-19/psychology , Nervous System Diseases/complications , Nervous System Diseases/psychology , Adaptation, Psychological , Aged , Female , Geriatric Assessment/methods , Geriatric Assessment/statistics & numerical data , Germany , Humans , Interviews as Topic , Longitudinal Studies , Male , Masks , Pandemics , Prospective Studies , SARS-CoV-2 , Stress, Psychological/complications , Stress, Psychological/psychology
17.
Geriatr Gerontol Int ; 20(6): 547-558, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-998919

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has casted a huge impact on global public health and the economy. In this challenging situation, older people are vulnerable to the infection and the secondary effects of the pandemic and need special attention. To evaluate the impacts of COVID-19 on older people, it is important to balance the successful pandemic control and active management of secondary consequences. These considerations are particularly salient in the Asian context, with its diversity among countries in terms of sociocultural heritage, healthcare setup and availability of resources. Thus, the Asian Working Group for Sarcopenia summarized the considerations of Asian countries focusing on responses and difficulties in each country, impacts of health inequity related to the COVID-19 pandemic and proposed recommendations for older people, which are germane to the Asian context. More innovative services should be developed to address the increasing demands for new approaches to deliver healthcare in these difficult times and to establish resilient healthcare systems for older people. Geriatr Gerontol Int 2020; 9999: n/a-n/a.


Subject(s)
Aging/ethnology , Communicable Disease Control/standards , Coronavirus Infections/epidemiology , Geriatric Assessment/methods , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Sarcopenia/epidemiology , Aged , Aged, 80 and over , Aging/physiology , Asia/epidemiology , COVID-19 , Coronavirus Infections/prevention & control , Delivery of Health Care/organization & administration , Female , Humans , Male , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Practice Guidelines as Topic , Prevalence , Public Health , Risk Assessment , Sarcopenia/diagnosis
19.
Cancer Med ; 9(24): 9193-9204, 2020 12.
Article in English | MEDLINE | ID: covidwho-938402

ABSTRACT

Since the COVID-19 outbreak started, it has been affecting mainly older individuals. Among the most vulnerable older individuals are those with cancer. Many published guidelines and consensus papers deal with prioritizing cancer care. Given the lack of high-quality evidence for management of cancer in older patients also in normal times, it is even more stringent to provide some resources on how to avoid both undertreatment and overtreatment in this population, who as of now is twice challenged to death, due to both a greater risk of getting infected with COVID-19 as well as from cancer not adequately addressed and treated. We hereby discuss some general recommendations (implement triage procedures; perform geriatric assessment; carefully assess comorbidity; promote early integration of palliative care in oncology; acknowledge the role of caregivers; maintain active take in charge to avoid feeling of abandonment; mandate seasonal flu vaccination) and discuss practical suggestions for specific disease settings (early-stage and advanced-stage disease for solid tumors, and hematological malignancies). The manuscript provides resources on how to avoid both undertreatment and overtreatment in older patients with cancer, who as of now is twice challenged to death, due to both a greater risk of getting infected with COVID-19 as well as from cancer not adequately addressed and treated.


Subject(s)
COVID-19/prevention & control , Medical Oncology/methods , Neoplasms/therapy , SARS-CoV-2/isolation & purification , Aged , COVID-19/epidemiology , COVID-19/virology , Caregivers/standards , Caregivers/statistics & numerical data , Disease Outbreaks , Geriatric Assessment/methods , Geriatric Assessment/statistics & numerical data , Humans , Medical Oncology/standards , Medical Oncology/statistics & numerical data , Neoplasms/diagnosis , Palliative Care/methods , Palliative Care/standards , Palliative Care/statistics & numerical data , SARS-CoV-2/physiology
20.
Age Ageing ; 50(2): 326-334, 2021 02 26.
Article in English | MEDLINE | ID: covidwho-929788

ABSTRACT

BACKGROUND: the coronavirus disease 2019 (COVID-19) is characterized by poor outcomes and mortality, particularly in older patients. METHODS: post hoc analysis of the international, multicentre, 'real-world' HOPE COVID-19 registry. All patients aged ≥65 years hospitalised for COVID-19 were selected. Epidemiological, clinical, analytical and outcome data were obtained. A comparative study between two age subgroups, 65-74 and ≥75 years, was performed. The primary endpoint was all cause in-hospital mortality. RESULTS: about, 1,520 patients aged ≥65 years (60.3% male, median age of 76 [IQR 71-83] years) were included. Comorbidities such as hypertension (69.2%), dyslipidaemia (48.6%), cardiovascular diseases (any chronic heart disease in 38.4% and cerebrovascular disease in 12.5%), and chronic lung disease (25.3%) were prevalent, and 49.6% were on ACEI/ARBs. Patients aged 75 years and older suffered more in-hospital complications (respiratory failure, heart failure, renal failure, sepsis) and a significantly higher mortality (18.4 vs. 48.2%, P < 0.001), but fewer admissions to intensive care units (11.2 vs. 4.8%). In the overall cohort, multivariable analysis demonstrated age ≥75 (OR 3.54), chronic kidney disease (OR 3.36), dementia (OR 8.06), peripheral oxygen saturation at admission <92% (OR 5.85), severe lymphopenia (<500/mm3) (OR 3.36) and qSOFA (Quick Sequential Organ Failure Assessment Score) >1 (OR 8.31) to be independent predictors of mortality. CONCLUSION: patients aged ≥65 years hospitalised for COVID-19 had high rates of in-hospital complications and mortality, especially among patients 75 years or older. Age ≥75 years, dementia, peripheral oxygen saturation <92%, severe lymphopenia and qSOFA scale >1 were independent predictors of mortality in this population.


Subject(s)
COVID-19 , Hospital Mortality , Hospitalization/statistics & numerical data , Aged , Aged, 80 and over , COVID-19/complications , COVID-19/mortality , COVID-19/physiopathology , COVID-19/therapy , Female , Geriatric Assessment/methods , Humans , Intensive Care Units/statistics & numerical data , International Cooperation , Male , Mortality , Multimorbidity , Prognosis , Registries/statistics & numerical data , Risk Assessment/methods , Risk Factors , SARS-CoV-2/isolation & purification
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