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1.
BMJ Open ; 11(6): e048503, 2021 06 18.
Article in English | MEDLINE | ID: covidwho-1276962

ABSTRACT

OBJECTIVE: To understand and report on the impact of the COVID-19 pandemic on the everyday lives of frail older persons living in nursing homes by exploring their experiences of how the pandemic-related restrictions had influenced them and in what way. DESIGN: Empirical qualitative interview study. SETTING: A publicly run nursing home in an urban area in Sweden in June 2020. The nursing home had visitor restrictions, cancelled activities and physical distancing requirements since March 2020. PARTICIPANTS: A total of 10 persons, 85-100 years, living in a Swedish nursing home during the COVID-19 pandemic, were recruited through nursing home management and interviewed in June 2020 using medically approved visors and physical distancing. ANALYSIS: Interviews were analysed using thematic analysis, which involves familiarisation, coding and definition of themes. Transcripts were coded into data-driven categories before being organised into categories that described and explained the data. RESULTS: The analysis resulted in the main theme 'It is like living in a bubble', that describes everyday life in the nursing home during the pandemic as a world of its own in which the older persons felt both protected and isolated. This is described in four subthemes: living 1 day at a time, without fear of the virus; feeling taken care of; having limited freedom and missing out on the little extras. CONCLUSIONS: Contributing to the growing area of COVID-19-related research, our findings provide novel insights into how pandemic-related restrictions in nursing homes represent a risk of isolating older people from the outside world and diminishing their freedom. Put in relation to the previous research, these findings could be applied beyond the pandemic, to develop research and practice that puts focus on how to support older people to decide for themselves how to spend the rest of their lives.


Subject(s)
COVID-19 , Pandemics , Aged , Aged, 80 and over , Humans , Nursing Homes , Qualitative Research , SARS-CoV-2 , Sweden/epidemiology
2.
BMJ Open ; 11(6): e046799, 2021 06 18.
Article in English | MEDLINE | ID: covidwho-1276961

ABSTRACT

INTRODUCTION: There is an urgent need to idenfy treatments for COVID-19 that reduce illness duration and hospital admission in those at higher risk of a longer illness course and complications. METHODS AND ANALYSIS: The Platform Randomised trial of INterventions against COVID-19 In older peoPLE trial is an open-label, multiarm, prospective, adaptive platform, randomised clinical trial to evaluate potential treatments for COVID-19 in the community. A master protocol governs the addition of new interventions as they become available, as well as the inclusion and cessation of existing intervention arms via frequent interim analyses. The first three interventions are hydroxychloroquine, azithromycin and doxycycline. Eligible participants must be symptomatic in the community with possible or confirmed COVID-19 that started in the preceding 14 days and either (1) aged 65 years and over or (2) aged 50-64 years with comorbidities. Recruitment is through general practice, health service helplines, COVID-19 'hot hubs' and directly through the trial website. Participants are randomised to receive either usual care or a study drug plus usual care, and outcomes are collected via daily online symptom diary for 28 days from randomisation. The research team contacts participants and/or their study partner following days 7, 14 and 28 if the online diary is not completed. The trial has two coprimary endpoints: time to first self-report of feeling recovered from possible COVID-19 and hospital admission or death from possible COVID-19 infection, both within 28 days from randomisation. Prespecified interim analyses assess efficacy or futility of interventions and to modify randomisation probabilities that allocate more participants to interventions with better outcomes. ETHICS AND DISSEMINATION: Ethical approval Ref: 20/SC/0158 South Central - Berkshire Research Ethics Committee; IRAS Project ID: 281958; EudraCT Number: 2020-001209-22. Results will be presented to policymakers and at conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: ISRCTN86534580.


Subject(s)
COVID-19 , Aged , Humans , Hydroxychloroquine , Prospective Studies , Randomized Controlled Trials as Topic , SARS-CoV-2 , Treatment Outcome
3.
J Am Heart Assoc ; 10(13): e018086, 2021 07 06.
Article in English | MEDLINE | ID: covidwho-1270912

ABSTRACT

Background Despite its clinical significance, the risk of severe infection requiring hospitalization among outpatients with severe acute respiratory syndrome coronavirus 2 infection who receive angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) remains uncertain. Methods and Results In a propensity score-matched outpatient cohort (January-May 2020) of 2263 Medicare Advantage and commercially insured individuals with hypertension and a positive outpatient SARS-CoV-2, we determined the association of ACE inhibitors and ARBs with COVID-19 hospitalization. In a concurrent inpatient cohort of 7933 hospitalized with COVID-19, we tested their association with in-hospital mortality. The robustness of the observations was assessed in a contemporary cohort (May-August). In the outpatient study, neither ACE inhibitors (hazard ratio [HR], 0.77; 0.53-1.13, P=0.18) nor ARBs (HR, 0.88; 0.61-1.26, P=0.48) were associated with hospitalization risk. ACE inhibitors were associated with lower hospitalization risk in the older Medicare group (HR, 0.61; 0.41-0.93, P=0.02), but not the younger commercially insured group (HR, 2.14; 0.82-5.60, P=0.12; P-interaction 0.09). Neither ACE inhibitors nor ARBs were associated with lower hospitalization risk in either population in the validation cohort. In the primary inpatient study cohort, neither ACE inhibitors (HR, 0.97; 0.81-1.16; P=0.74) nor ARBs (HR, 1.15; 0.95-1.38, P=0.15) were associated with in-hospital mortality. These observations were consistent in the validation cohort. Conclusions ACE inhibitors and ARBs were not associated with COVID-19 hospitalization or mortality. Despite early evidence for a potential association between ACE inhibitors and severe COVID-19 prevention in older individuals, the inconsistency of this observation in recent data argues against a role for prophylaxis.


Subject(s)
Angiotensin Receptor Antagonists/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , COVID-19/mortality , Hospitalization , Hypertension/complications , Hypertension/mortality , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/complications , COVID-19/therapy , Cohort Studies , Female , Hospital Mortality , Humans , Hypertension/drug therapy , Male , Middle Aged , Propensity Score , Young Adult
4.
Psychogeriatrics ; 21(5): 730-737, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1269761

ABSTRACT

BACKGROUND: A curfew for elderly people was announced in Turkey to protect the geriatric population during the COVID-19 pandemic. Although this may have the beneficial effect of preventing infection, psychological distress may also increase with prolongation of the pandemic. METHODS: Geriatric patients were interviewed by telephone due to the ongoing curfew. Demographical characteristics, comorbidities, personal risk perception of COVID-19, common concerns related to COVID-19, and experiences of delayed hospital admission due to the pandemic were recorded. The Hospital Anxiety and Depression Scale (HADS) was used to assess psychological distress, anxiety, and depression. RESULTS: Participants (n = 136; 82 females, 60.3%) had a mean age of 73.4 ± 5.9 years. The most common comorbidity was hypertension (75%). Approximately 80% of the participants reported a decrease in physical activity during the curfew period. The HADS scores indicated rates of anxiety as 25.7% and depression as 16.9%. Anxiety was significantly more common in females than males (P = 0.002). Sleep problems (P = 0.000), fatigue (P = 0.000), and hopelessness (P = 0.000) were more common in participants with depression and anxiety. Logistic regression analyses showed an association between a delay in hospital admission and the presence of depression (P = 0.0029, R2  = 0.146). Personal risk perception of COVID-19 was statistically significantly higher among patients with anxiety (P = 0.0027, R2  = 0.157). CONCLUSION: Decreased adaptation to external and internal factors among older individuals may facilitate unfavourable outcomes of the pandemic. These results indicate that the geriatric population was mentally and physically affected by the restrictions and isolation.


Subject(s)
COVID-19 , Pandemics , Aged , Anxiety/epidemiology , Attitude , Cross-Sectional Studies , Depression/epidemiology , Female , Humans , Male , SARS-CoV-2
5.
BMC Public Health ; 21(1): 1103, 2021 06 09.
Article in English | MEDLINE | ID: covidwho-1262501

ABSTRACT

BACKGROUND: There are no pharmacological interventions currently available to prevent the transmission of SARS-CoV-2 or to treat COVID-19. The development of vaccines against COVID-19 is essential to contain the pandemic. we conducted a cross-sectional survey of Shanghai residents to understand residents' willingness to be vaccinated with any future COVID-19 vaccines and take measures to further improve vaccination coverage. METHODS: We conducted a cross-sectional survey using self-administered anonymous questionnaires from 1 July to 8 September 2020. The main outcome was willingness of participants, and any children or older individuals living with them, to receive future COVID-19 vaccines. Logistic regression analyses were used to explore potential factors associated with vaccination willingness. RESULTS: A total of 1071 participants were asked about their willingness to receive future COVID-19 vaccines, for themselves and at least 747 children and 375 older individuals (≥60 years old) living with them. The highest proportion of expected willingness to vaccinate was among participants (88.6%), followed by children (85.3%) and older individuals (84.0%). The main reasons for reluctance to vaccinate among 119 participants were doubts regarding vaccine safety (60.0%) and efficacy (28.8%). Participants with a self-reported history of influenza vaccination were more likely to accept COVID-19 vaccines for themselves [adjusted odds ratio (OR) = 1.83; 95% confidence interval (CI): 1.19-2.82], their children (adjusted OR = 2.08; 95%CI: 1.30-3.33), and older individuals in their household (adjusted OR = 2.12; 95%CI: 1.14-3.99). Participants with older individuals in their families were less willing to vaccinate themselves (adjusted OR = 0.59; 95%CI: 0.40-0.87) and their children (adjusted OR = 0.58; 95%CI: 0.38-0.89). CONCLUSIONS: Participants were more reluctant to accept COVID-19 vaccines for older individuals living with them. The presence of older individuals in the home also affected willingness of participants and their children to be vaccinated.


Subject(s)
COVID-19 , Influenza Vaccines , Vaccines , COVID-19 Vaccines , Child , China/epidemiology , Cross-Sectional Studies , Humans , Middle Aged , SARS-CoV-2 , Vaccination
6.
Endocrine ; 73(2): 243-254, 2021 08.
Article in English | MEDLINE | ID: covidwho-1261819

ABSTRACT

Coronavirus disease 2019 (COVID-19) advances to affect every part of the globe and remains a challenge to the human race. Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) was shown to affect many organs and organ systems including the thyroid gland as these parts highly express angiotensin-converting enzyme 2 (ACE2) protein, which functions as a receptor for initially entering the virus into the cells. Furthermore, some categories of the population including older people and persons with comorbidities are prone to be more vulnerable to COVID-19 and its complications. Recent reports showed that SARS-CoV-2 infection could cause Graves' disease (autoimmune hyperthyroidism) in post-COVID-19 patients. Factors that may boost the mortality risk of COVID-19 patients are not completely known yet and a clear perception of the group of vulnerable people is also essential. This review briefly summarizes the features of Graves' disease such as symptoms, risk factors, including environmental, genetic, immunological, and other factors, associated disorders, and therapeutic options. It comprehensively describes the recent advances in SARS-CoV-2-induced Graves' disease and the pivotal role of autoimmune factors in inducing the disease. The review also discusses the possible risks of SARS-CoV-2 infection and associated COVID-19 in people with hyperthyroidism. Furthermore, it explains thyroid disease and its association with the severity of COVID-19.


Subject(s)
COVID-19 , Graves Disease , Aged , Comorbidity , Graves Disease/epidemiology , Humans , Peptidyl-Dipeptidase A , Risk Factors , SARS-CoV-2
7.
Mol Neurobiol ; 58(9): 4535-4563, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1252224

ABSTRACT

Coronavirus disease 2019 (COVID-19) is a devastating viral infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The incidence and mortality of COVID-19 patients have been increasing at an alarming rate. The mortality is much higher in older individuals, especially the ones suffering from respiratory distress, cardiac abnormalities, renal diseases, diabetes, and hypertension. Existing evidence demonstrated that SARS-CoV-2 makes its entry into human cells through angiotensin-converting enzyme 2 (ACE-2) followed by the uptake of virions through cathepsin L or transmembrane protease serine 2 (TMPRSS2). SARS-CoV-2-mediated abnormalities in particular cardiovascular and neurological ones and the damaged coagulation systems require extensive research to develop better therapeutic modalities. As SARS-CoV-2 uses its S-protein to enter into the host cells of several organs, the S-protein of the virus is considered as the ideal target to develop a potential vaccine. In this review, we have attempted to highlight the landmark discoveries that lead to the development of various vaccines that are currently under different stages of clinical progression. Besides, a brief account of various drug candidates that are being tested to mitigate the burden of COVID-19 was also covered. Further, in a dedicated section, the impact of SARS-CoV-2 infection on neuronal inflammation and neuronal disorders was discussed. In summary, it is expected that the content covered in this article help to understand the pathophysiology of COVID-19 and the impact on neuronal complications induced by SARS-CoV-2 infection while providing an update on the vaccine development.


Subject(s)
COVID-19 Vaccines , COVID-19/complications , Inflammation/etiology , Neurodevelopmental Disorders/etiology , SARS-CoV-2/pathogenicity , Angiotensin-Converting Enzyme 2/physiology , Animals , Antiviral Agents/therapeutic use , COVID-19/drug therapy , COVID-19/physiopathology , COVID-19/prevention & control , COVID-19/therapy , COVID-19 Vaccines/adverse effects , Cell Line , Comorbidity , Cytokine Release Syndrome/etiology , Female , Hormesis , Humans , Immunization, Passive , Infectious Disease Transmission, Vertical , Mice , Models, Neurological , Murine hepatitis virus/pathogenicity , Nervous System/virology , Nervous System Diseases/epidemiology , Nervous System Diseases/etiology , Organ Specificity , Organoids , Pregnancy , Pregnancy Complications, Infectious/virology , Receptors, Virus/physiology , SARS-CoV-2/genetics , SARS-CoV-2/physiology , Serine Endopeptidases/physiology , Spike Glycoprotein, Coronavirus/physiology
8.
J Alzheimers Dis Rep ; 4(1): 537-551, 2020 Dec 28.
Article in English | MEDLINE | ID: covidwho-1256348

ABSTRACT

Coronavirus Disease 2019 (COVID-19) pandemic-triggered mortality is significantly higher in older than in younger populations worldwide. Alzheimer's disease (AD) is related to aging and was recently reported to be among the major risk factors for COVID-19 mortality in older people. The symptomatology of COVID-19 indicates that lethal outcomes of infection rely on neurogenic mechanisms. The present review compiles the available knowledge pointing to the convergence of COVID-19 complications with the mechanisms of autonomic dysfunctions in AD and aging. The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is prone to neuroinvasion from the lung along the vagus nerve up to the brainstem autonomic nervous centers involved in the coupling of cardiovascular and respiratory rhythms. The brainstem autonomic network allows SARS-CoV-2 to trigger a neurogenic switch to hypertension and hypoventilation, which may act in synergy with aging- and AD-induced dysautonomias, along with an inflammatory "storm". The lethal outcomes of COVID-19, like in AD and unhealthy aging, likely rely on a critical hypoactivity of the efferent vagus nerve cholinergic pathway, which is involved in lowering cardiovascular pressure and systemic inflammation tone. We further discuss the emerging evidence supporting the use of 1) the non-invasive stimulation of vagus nerve as an additional therapeutic approach for severe COVID-19, and 2) the demonstrated vagal tone index, i.e., heart rate variability, via smartphone-based applications as a non-serological low-cost diagnostic of COVID-19. These two well-known medical approaches are already available and now deserve large-scale testing on human cohorts in the context of both AD and COVID-19.

9.
Stud Health Technol Inform ; 281: 694-698, 2021 May 27.
Article in English | MEDLINE | ID: covidwho-1247800

ABSTRACT

The Covid-19 pandemic has globally introduced a new crisis with severe consequences and led to a series of pandemic-related containment measures, including social distancing and self-isolation may cause significant impact on mental health. This study describes a social care initiative that was actualized during the Covid-19 outbreak with regard to the potential benefits in older adults' quality of life through the use of the Integrated Healthcare System Long Lasting Memories Care (LLM Care), and specifically the web-based cognitive training software. Online questionnaires, assessing various psychosocial and mental health domains, were distributed to 28 older adults before and after the interaction with the software aiming at evaluating the potential positive effect and usability of cognitive training software. Overall, the study demonstrates that the interaction with the web-based cognitive training software during the pandemic plays a significant role in maintaining mental health among older people, through improvements in well-being.


Subject(s)
COVID-19 , Pandemics , Aged , Disease Outbreaks/prevention & control , Humans , Quality of Life , SARS-CoV-2 , Social Support
10.
Exp Gerontol ; 151: 111423, 2021 08.
Article in English | MEDLINE | ID: covidwho-1242982

ABSTRACT

The coronavirus disease 2019 (COVID-19) is a new infectious respiratory disease, which has caused a pandemic that has become the world's leading public health emergency, threatening people of all ages worldwide, especially the elderly. Complications of COVID-19 are closely related to an upregulation of the inflammatory response revealed by the pro-inflammatory profile of plasma cytokines (to the point of causing a cytokine storm), which is also a contributing cause of the associated coagulation disorders with venous and arterial thromboembolisms, causing multiple organ dysfunction and failure. In severe fulminant cases of COVID-19, there is an activation of coagulation and consumption of clotting factors leading to a deadly disseminated intravascular coagulation (DIC). It is well established that human immune response changes with age, and also that the pro-inflammatory profile of plasma cytokines is upregulated in both healthy and diseased elderly people. In fact, normal aging is known to be associated with a subclinical, sterile, low-grade, systemic pro-inflammatory state linked to the chronic activation of the innate immune system, a phenomenon known as "inflammaging". Inflammaging may play a role as a condition contributing to the co-occurrence of the severe hyper-inflammatory state (cytokine storm) during COVID-19, and also in other severe infections (sepsis) in older people. Moreover, we must consider the impact of inflammation on coagulation due to the crosstalk between inflammation and coagulation. The systemic inflammatory state and coagulation disorders are closely related, a phenomenon that here we call "coagul-aging" (Giunta S.). In this review, we discuss the various degrees of inflammation in older adults after being infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and the adverse effects of aging on the inflammatory response and coagulation system. It is important to note that although there is no gender difference in susceptibility to COVID-19 infection, however, due to differences in angiotensin-converting enzyme 2 (ACE2) expression, innate immunity, and comorbidities, older men exhibit more severe disease and higher mortality than older women. There are currently no FDA-approved specific antiviral drugs that can be used against the virus. Therapies used in patients with COVID-19 consist of remdesivir, dexamethasone, low-molecular-weight heparin, in addition to monoclonal antibodies against the spike protein of SARS-CoV-2 in the early phase of the disease. Future pharmacological research should also consider targeting the possible role of the underlying scenario of inflammaging in healthy older people to prevent or mitigate disease complications. It is worth mentioning that some specific cytokine antagonists and traditional Chinese medicine preparations can reduce the elderly's inflammatory state.


Subject(s)
Blood Coagulation Disorders , COVID-19 , Aged , Aging , Cytokine Release Syndrome , Female , Humans , Male , SARS-CoV-2
11.
Ageing Res Rev ; 69: 101373, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1242880

ABSTRACT

The coronavirus disease 19 (COVID-19) is relevant in older people. Attention was given to the nursing homes in which frailer people are usually admitted. In this review, we discuss the approaches for daily problems found in nursing home as geriatricians and potentially new research directions. We start with the problem of the older people affected by dementia and Behavioral and Psychological Symptoms of Dementia for which also the execution of a simple diagnostic test (such as nasopharyngeal swab) could be problematic. Another important problem is the management of wandering patients for which the re-organization of the spaces and vaccination could be the solutions. The relationship with families is another important problem, also from a medico-legal point of view, that can be faced using video conferencing tools. Moreover, we discussed the importance of stratifying prognosis in older nursing home residents for the best management and therapeutically approach, including palliative care, also using telemedicine and the inclusion of prognostic tools in daily clinical practice. Finally, we approached the therapeutical issues in older people that suggests the necessity of future research for finding older-friendly medications.


Subject(s)
COVID-19 , Dementia , Aged , Dementia/therapy , Geriatricians , Humans , Nursing Homes , SARS-CoV-2
12.
JAMA Netw Open ; 4(5): e2111417, 2021 05 03.
Article in English | MEDLINE | ID: covidwho-1242694

ABSTRACT

Importance: Infection with COVID-19 has been associated with long-term symptoms, but the frequency, variety, and severity of these complications are not well understood. Many published commentaries have proposed plans for pandemic control that are primarily based on mortality rates among older individuals without considering long-term morbidity among individuals of all ages. Reliable estimates of such morbidity are important for patient care, prognosis, and development of public health policy. Objective: To conduct a systematic review of studies examining the frequency and variety of persistent symptoms after COVID-19 infection. Evidence Review: A search of PubMed and Web of Science was conducted to identify studies published from January 1, 2020, to March 11, 2021, that examined persistent symptoms after COVID-19 infection. Persistent symptoms were defined as those persisting for at least 60 days after diagnosis, symptom onset, or hospitalization or at least 30 days after recovery from the acute illness or hospital discharge. Search terms included COVID-19, SARS-CoV-2, coronavirus, 2019-nCoV, long-term, after recovery, long-haul, persistent, outcome, symptom, follow-up, and longitudinal. All English-language articles that presented primary data from cohort studies that reported the prevalence of persistent symptoms among individuals with SARS-CoV-2 infection and that had clearly defined and sufficient follow-up were included. Case reports, case series, and studies that described symptoms only at the time of infection and/or hospitalization were excluded. A structured framework was applied to appraise study quality. Findings: A total of 1974 records were identified; of those, 1247 article titles and abstracts were screened. After removal of duplicates and exclusions, 92 full-text articles were assessed for eligibility; 47 studies were deemed eligible, and 45 studies reporting 84 clinical signs or symptoms were included in the systematic review. Of 9751 total participants, 5266 (54.0%) were male; 30 of 45 studies reported mean or median ages younger than 60 years. Among 16 studies, most of which comprised participants who were previously hospitalized, the median proportion of individuals experiencing at least 1 persistent symptom was 72.5% (interquartile range [IQR], 55.0%-80.0%). Individual symptoms occurring most frequently included shortness of breath or dyspnea (26 studies; median frequency, 36.0%; IQR, 27.6%-50.0%), fatigue or exhaustion (25 studies; median frequency, 40.0%; IQR, 31.0%-57.0%), and sleep disorders or insomnia (8 studies; median 29.4%, IQR, 24.4%-33.0%). There were wide variations in the design and quality of the studies, which had implications for interpretation and often limited direct comparability and combinability. Major design differences included patient populations, definitions of time zero (ie, the beginning of the follow-up interval), follow-up lengths, and outcome definitions, including definitions of illness severity. Conclusions and Relevance: This systematic review found that COVID-19 symptoms commonly persisted beyond the acute phase of infection, with implications for health-associated functioning and quality of life. Current studies of symptom persistence are highly heterogeneous, and future studies need longer follow-up, improved quality, and more standardized designs to reliably quantify risks.


Subject(s)
COVID-19/complications , Dyspnea/etiology , Fatigue/etiology , Sleep Wake Disorders/etiology , COVID-19/virology , Hospitalization , Humans , Pandemics , SARS-CoV-2 , Survivors
13.
Bone Jt Open ; 2(5): 314-322, 2021 May.
Article in English | MEDLINE | ID: covidwho-1232454

ABSTRACT

AIMS: Hip fracture is a common condition of the older, frailer person. This population is also at risk from SARS-CoV-2 infection. It is important to understand the impact of coexistent hip fracture and SARS-CoV-2 for informed decision-making at patient and service levels. METHODS: We undertook a systematic review and meta-analysis of observational studies of older (> 60 years) people with fragility hip fractures and outcomes with and without SARS-CoV-2 infection during the first wave of the COVID-19 pandemic. The primary outcome was early (30-day or in-hospital) mortality. Secondary outcomes included length of hospital stay and key clinical characteristics known to be associated with outcomes after hip fracture. RESULTS: A total of 14 cohort and five case series studies were included (692 SARS-CoV-2 positive, 2,585 SARS-CoV-2 negative). SARS-CoV-2 infection was associated with an overall risk ratio (RR) for early mortality of 4.42 (95% confidence interval (CI) 3.42 to 5.82). Early mortality was 34% (95% CI 30% to 38%) and 9% (95% CI 8% to 10%) in the infected and noninfected groups respectively. Length of stay was increased in SARS-CoV-2 infected patients (mean difference (MD) 5.2 days (3.2 to 7.2)). Age (MD 1.6 years (0.3 to 2.9)); female sex (RR 0.83 (95% CI 0.65 to 1.05)); admission from home (RR 0.51 (95% CI 0.26 to 1.00)); presence of dementia (RR 1.13 (95% CI 0.94 to 1.43)); and intracapsular fracture (RR 0.89 (95% CI 0.71 to 1.11)) were not associated with SARS-CoV-2 infection. There were statistically, but not clinically, significantly greater Nottingham Hip Fracture Scores in infected compared with non-infected patients (MD 0.7 (0.4 to 0.9)). CONCLUSION: SARS-CoV-2 infection is associated with worse outcomes after hip fracture. This is not explained by differences in patient characteristics. These data can be used to support informed decision-making and may help track the impact of widespread adoption of system-level and therapeutic changes in management of the COVID-19 pandemic. Cite this article: Bone Jt Open 2021;2(5):314-322.

14.
Sci Rep ; 11(1): 9679, 2021 05 06.
Article in English | MEDLINE | ID: covidwho-1220211

ABSTRACT

There is not in Argentina publications regarding the presentation of patients with COVID-19 requiring hospitalized and emergency care in vulnerable populations (lower incomes and less education tend at greater risk for poor health status and healthcare access), and it has few reports in developing countries. The objective is to determine whether in the care of vulnerable patients, to succeed against COVID-19, multiple public health tools and interventions will be needed to minimize morbidity and mortality. The study is a prospective cohort investigation of patients with lab-confirmed COVID-19, who required to any of the Health Centers response from April 8, 2020, to August 18, 2020. In Buenos Aires Metropolitan Area (AMBA), April 8, 2020 the virus was identified in patients hospitalized in the "Southeast Network" (SN), AMBA. SN covering an area of 661 square kilometers, with 1.8 million inhabitants residing in urban, and rural areas. A total of 14 health centers with different levels of care complexity provide care to patients in the region. The information of each patient with COVID-19 evaluated by SN, was incorporated in an Epidemiological Dashboard. The investigation was designed and reported with consideration of observational studies in epidemiology. We describe the hospitals presentation and care of persons who required SN response and were ultimately diagnosed with COVID-19. From April 8, 2020, to August 18, 2020, were included 1495 patients with lab-confirmed COVID-19 in SN. A total of 58% patients were men, and the mean age (SD) was 48.9 (15.59) years. Eighty one percent patients with pre-existing diseases, most frequent hypertension and diabetes, but hypertension, chronic lung disease, and cardiovascular disease presented higher risk. A total of 13% were hospitalized in Intensive Therapy Unit. The mortality of the cohort was 9.77%. Mortality was higher for patients aged 65 or more (OR 5.09), and for those had some pre-existing disease (OR 2.61). Our observations are consistent with reports demonstrating older persons, and those with comorbidities have the highest risk of mortality related to COVID-19. However, unlike other reports from developed or some developing countries, the mortality in our study is lower. This finding may be related to age of our cohort is younger than other published. Also, the health system was able to respond to the demand.


Subject(s)
COVID-19/diagnosis , COVID-19/epidemiology , SARS-CoV-2/isolation & purification , Adult , Aged , Argentina/epidemiology , COVID-19/mortality , Female , Hospitalization , Humans , Male , Middle Aged , Prospective Studies , Public Health , Vulnerable Populations
15.
Healthcare (Basel) ; 9(5)2021 Apr 29.
Article in English | MEDLINE | ID: covidwho-1217063

ABSTRACT

Coronavirus disease 2019 (COVID-19) has affected people's social lives by inhibiting their movement; this seriously impacts the lives of older people in particular. Rural older people may have been particularly affected because they live dispersedly and in isolation. This study explored rural older people's perceptions of how COVID-19 has impacted their social lives. This qualitative study assessed participants who were 65 years and older and residing in rural Japanese communities. Five focus group discussions were conducted with 53 participants to explore their perceptions and challenges during COVID-19. Data were analyzed using thematic analysis, and four themes were developed: the beginning of suffering, social cognitive suppression, reflection on rural contexts, and critical approaches to the pandemic based on rural standards. The daily activities of rural older people were suppressed due to social norms and pandemic-related standard precautionary measures based on urban areas. Specific infection control standards for rural areas and the provision of direct information to individuals in the community to sustain social support are needed. To effectively maintain rural social support, as well as the trust and accountability of rural citizens, constant dialog among local governments and rural citizens is required.

16.
Clin Nutr ; 2021 May 04.
Article in English | MEDLINE | ID: covidwho-1213096

ABSTRACT

BACKGROUND & AIMS: Nutritional predisposition to severe coronavirus disease 2019 (COVID-19) remains unclear. Zinc deficiency could be critical since it is associated with a higher susceptibility to infections. We evaluated the prevalence of hypozincemia in the early stage of COVID-19, its association with risk factors for severe COVID-19 and its prognostic value for hospitalization for respiratory complications within 10 days. METHODS: For 152 COVID-19 patients and 88 non-COVID-19 patients admitted to COVID-19 screening centers, national early warning score for COVID-19 (NEWS) and laboratory analyses were performed to identify the risk for severe COVID-19. Multivariable logistic regression analysis assessed whether hypozincemia was an independent predictor of hospitalization for respiratory complications within 10 days (primary judgment criterion). The secondary judgment criteria were high NEWS score (≥7), comorbidities and biomarkers associated with severe COVID-19. RESULTS: Hypozincemia was more frequent in COVID-19 patients compared to non-COVID-19 patients (27.6% vs 11.4%; p = 0.003). Older patients (≥65 years) and medically assisted nursing home residents were at higher risk of hypozincemia (p < 0.01). Hypozincemia was associated with a worse NEWS score (p < 0.01) and lymphopenia (p < 0.001). Hypozincemia was independently associated with hospitalization for respiratory complications within 10 days (OR = 10.9, 95% CI = 2.3-51.6, p = 0.002). CONCLUSIONS: In the early stage of COVID-19, the prevalence of hypozincemia exceeded 20%. Hypozincemia was an independent predictor of hospitalization for respiratory complications within 10 days. This may suggest the importance of early detection and treatment of zinc deficiency in the nutritional management of COVID-19, especially in older people. Therefore, intervention and adjuvant treatment trials are strongly needed.

17.
Eur J Ageing ; 18(2): 185-194, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1210716

ABSTRACT

Physical distancing is intended to mitigate the spread of the SARS-CoV-2 virus. However, the impact of a decrease in face-to-face contacts on non-physical social contacts of older people remains unclear. In particular, we focus on intergenerational contacts that are especially relevant for older people's mental health. Our analyses rely on an online quota sampling survey conducted in France, Italy and Spain during April 14-24, 2020. We considered the subsample of individuals aged 50 + (N = 4207). We calculated post-stratification weights based on official statistics and used logistic regressions to analyze how changes in intergenerational contacts differed by socioeconomic factors and to what extent non-physical contacts (via phone, social media, etc.) have compensated the reduction in face-to-face contacts. Finally, the change in digital devices' use has been explored as a consequence of both decreased physical intergenerational contacts (PIC) and increased non-physical intergenerational contacts (NPIC). We found that about 50% of older people have increased their NPIC during the first lockdown. Younger individuals, those with medium level of education, and those economically better off displayed higher probabilities of increased NPIC as compared to their counterparts. NPIC increased especially for individuals whose face-to-face contacts decreased, particularly so if this happened with respect to contacts with children. A large share of older people has increased their use of video calls and instant messages, while only some increased the use of social media. These findings are relevant to understand how intergenerational contacts changed during the pandemic and may be central to better plan future outbreak responses. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10433-021-00621-x.

18.
J Alzheimers Dis ; 80(4): 1395-1399, 2021.
Article in English | MEDLINE | ID: covidwho-1194581

ABSTRACT

The rapid emergence of COVID-19 has had far-reaching effects across all sectors of health and social care, but none more so than for residential long-term care homes. Mortality rates of older people with dementia in residential long-term care homes have been exponentially higher than the general public. Morbidity rates are also higher in these homes with the effects of government-imposed COVID-19 public health directives (e.g., strict social distancing), which have led most residential long-term care homes to adopt strict 'no visitor' and lockdown policies out of concern for their residents' physical safety. This tragic toll of the COVID-19 pandemic highlights profound stigma-related inequities. Societal assumptions that people living with dementia have no purpose or meaning and perpetuate a deep pernicious fear of, and disregard for, persons with dementia. This has enabled discriminatory practices such as segregation and confinement to residential long-term care settings that are sorely understaffed and lack a supportive, relational, and enriching environment. With a sense of moral urgency to address this crisis, we forged alliances across the globe to form Reimagining Dementia: A Creative Coalition for Justice. We are committed to shifting the culture of dementia care from centralized control, safety, isolation, and punitive interventions to a culture of inclusion, creativity, justice, and respect. Drawing on the emancipatory power of the imagination with the arts (e.g., theatre, improvisation, music), and grounded in authentic partnerships with persons living with dementia, we aim to advance this culture shift through education, advocacy, and innovation at every level of society.


Subject(s)
COVID-19/epidemiology , COVID-19/therapy , Communicable Disease Control/trends , Dementia/epidemiology , Dementia/therapy , Long-Term Care/trends , COVID-19/psychology , Communicable Disease Control/methods , Dementia/psychology , Homes for the Aged/trends , Humans , Long-Term Care/methods , Nursing Homes/trends
19.
Geriatr Nurs ; 42(5): 1222-1229, 2021.
Article in English | MEDLINE | ID: covidwho-1171415

ABSTRACT

Coronavirus disease-2019 (COVID-19) had an unprecedented effect all over the world, especially in older individuals. The aim is to evaluate the social isolation, loneliness and quality of life of elderly individuals during the COVID-19 pandemic and to map suggestions to reveal and improve the current situation. This was a scoping review. Articles since December 2019 to March 2021 published on PubMed, Scopus, ProQuest, Cochrane Library, CINAHL databases with the following MeSh terms ('COVID-19', 'coronavirus', 'quality of life' 'aging', 'older people', 'elderly', 'loneliness' and 'social isolation) in English were included. The research, by consensus, resulted in seven studies selected for full reading, including three descriptive and cross-sectional studies, a quasi-experimental study, a pre-post pilot program, an editorial note and a correspondence. In generally, these recommendations were grouped as evaluating the current state of loneliness and isolation in elderly people, making more use of technology opportunities, using cognitive behavioral therapies and different individual intervention components.


Subject(s)
COVID-19 , Pandemics , Aged , Communicable Disease Control , Cross-Sectional Studies , Humans , Loneliness , Quality of Life , SARS-CoV-2 , Social Isolation
20.
Arch Gerontol Geriatr ; 95: 104411, 2021.
Article in English | MEDLINE | ID: covidwho-1163370

ABSTRACT

BACKGROUND: Malnutrition among older people is one of the serious public health problem worldwide. Nutritional status and levels of nutrients of older patients with COVID-19 effect on COVID-19 outcomes. The purpose of this systematic review was to identify the prevalence of malnutrition and levels of nutrients associated with outcomes of the older patients with COVID-19. MATERIALS AND METHODS: A literature search was performed using PubMed, Science direct and Google scholar database using specific keywords related to the aims. All related articles published on COVID-19 during 2020 were retrieved. PRISMA Statement was followed. The quality of the study was assessed using the quality assessment tools of the National Heart, Lung, and Blood Institute of the National Institutes of Health. RESULTS: Of the 2979 studies found, a total of eight studies were included in this review. Of these studies, three provided data on nutritional status and outcomes of COVID-19 among older patients with COVID-19. The prevalence of malnutrition among older patients with COVID-19 was high and it was associated with negative outcomes including hospital deaths and transfer to intensive care units. Five studies provided data on nutrients and outcomes of COVID-19. Low albumin, vitamin D, magnesium ,vitamin B12, Se status were associated with malnutrition, oxygen therapy and/or intensive care support of the patients, survival of COVID -19. CONCLUSIONS: Extra care should be provided to older patients with COVID-19 to minimize the prevalence of malnutrition and negative outcomes of COVID-19.


Subject(s)
COVID-19 , Malnutrition , Aged , Humans , Malnutrition/epidemiology , Nutritional Status , SARS-CoV-2 , Vitamins
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