The impact of COVID-19 pandemic on the geriatric inpatient unit.

OBJECTIVE: We aimed to determine the effects of the pandemic on the inpatients in the geriatric unit by comparing the demographic and clinical characteristics, reasons for hospitalization, morbidity, and mortality of the patients before and during the pandemic. METHODS: The population of this retrospective, cross-sectional study consisted of inpatients in the geriatric unit for two years (11 March 2019-10 March 2021). The patients were separated into two groups according to the hospitalization time as pre-COVID-19 and COVID-19 period. Hospitalization types, reasons for hospitalization, length of stay, demographic data, chronic diseases, drugs, developed morbidities, discharge, and 1-year mortality status of the patients were recorded. RESULTS: Three hundred and fifty patients were included in our study. The mean age was 80.4 ± 8.02. It was observed that the number of hospitalized patients decreased by ∼50% in the COVID-19 period. However, there was a significant decrease in hospitalization due to the control of chronic diseases during the COVID-19 period (p = .008). The number of inpatients from the emergency department was found to be higher during the COVID-19 period (p < .001). Regarding the presence of geriatric syndromes, polypharmacy (p = .011) and delirium (p = .035) were found to be significantly less in the pre-COVID-19 period. The percentage of malnutrition was also detected as lower, but it was not statistically significant. In terms of 1-year mortality, although not statistically significant, the all-cause mortality rate was higher during the COVID-19 period (p = .08). CONCLUSIONS: Pandemic has greatly affected the geriatric unit. The prognosis of the patients has worsened and mortality rates have increased. Physiological and psychological deterioration caused by quarantine measures, worsening chronic diseases, and immunosenescence affected the prognosis of geriatric patients. This adds to the previous literature by proving the fact that older individuals are the most vulnerable group in the pandemic.

Antibody responses to COVID-19 vaccines in older adults.

Because of the senescence of the immune system, antibody response to the COVID-19 vaccines may differ from older to younger adults. The study aim compares the titers of SARS-CoV-2 IgG antibody of patients ≥60 years who received three doses of CoronaVac vaccine and those who received two doses of CoronaVac+1 dose of Pfizer-BioNTech after 1 month of the last vaccination. Patients ≥60 years who received the CoronaVac vaccine between March 1, 2021, and April 30, 2021, who did not have COVID-19 disease before the first dose of vaccination and were negative for COVID-19 antibodies, whose antibodies were tested before the third dose of vaccination, and who did not have any COVID-19 disease during the follow-up were included. The demographic characteristics and comorbidities of patients were recorded. An immunofluorescence assay (IFA) fast test and a chemiluminescent microparticle immunoassay (Abbott) were used to measure SARS-CoV-2 quantitative antibody levels at the first month after the third-dose vaccine. Totally 81 patients, 41 patients in third dose of the CoronaVac group (female:male 18:23, mean age 69.4 ± 8.5), and 40 patients in third dose of the Pfizer-BioNTech group (female:male 15:25, mean age 69.9 ± 9.1) were included. The patients' comorbidities in the groups were similar. The titers of IgG antibodies to SARS-CoV-2 measured according to both IFA and Abbott Kit at first month the third dose vaccination was significantly higher in the Pfizer-BioNTech group (p ≥ 0.001, p = 0.012, respectively). The results report that the formed immunity in the first month after the two doses of CoronaVac+1 dose Pfizer-BioNTech vaccine was higher than three doses of CoronaVac vaccine in older adults.

Does the COVID-19 seroconversion in older adults resemble the young?

High antibody titers have been found to correlate with the severity of coronavirus disease 2019 (COVID-19) disease. Therefore, antibody titers may be higher in older adults, whose disease is known to have a more severe course than younger ones. This study aimed to compare the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin G (IgG) antibody level in the reverse transcription-polymerase chain reaction (RT-PCR) to test positive older adults with young. Patients aged ≥18 with positive RT-PCR and checked serum IgG antibodies between November 1, 2020 and January 13, 2021 were included. The IgG antibody levels and the time between RT-PCR positivity with the antibody levels were recorded. A total of 1071 patients were divided into two groups as Group 1 <60 years old (n = 902) and Group 2 ≥60 years old (n = 169). The SARS-CoV-2 IgG antibody titers were higher in Group 2 (p = 0.001). This height was present in the first 3 months after positive RT-PCR. While the antibody titers were compared by dividing Group 2 into the three groups according to age ranges (60-69, 70-79, and ≥80 years), the antibody titer was higher in ≥80 years patients (p = 0.044). High COVID-19 IgG antibody levels may be associated with the severity of the disease. Also, the humoral immunity advantage was seen in the first 3 months in the older patients, which suggests that older adults with COVID-19 may develop reinfection in the long term.

Factors affecting mortality in geriatric patients hospitalized with COVID-19

Background/aim: We aimed to investigate the factors affecting the mortality of patients aged 65 years or older who were hospitalized with the diagnosis of new coronavirus pneumonia (COVID-19). Materials and methods: This is a retrospective study of patients 65 years old or older with COVID-19 who were hospitalized in Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty Hospital, between March 11 and May 28, 2020. Demographic, clinical, treatment, and laboratory data were extracted from electronic medical records. We used univariate and multivariate logistic regression methods to explore the risk factors for in-hospital death. Results: A total of 218 patients (112 men, 106 women) were included, of whom 166 were discharged and 52 died in hospital. With univariate analysis, various clinical features and laboratory variables were found to be significantly different (i.e. P < 0.05). In multivariate logistic regression analysis the following were independently associated with mortality: present malignancy [odds ratio (OR) = 4.817, 95% confidence interval (CI) = 1.107­20.958, P: 0.036]; dyspnea (OR = 4.652, 95% CI = 1.473­14.688, P: 0.009); neutrophil/lymphocyte ratio (NLR; OR = 1.097, 95% CI = 1.012­1.188, P: 0.025); the highest values of C-reactive protein (CRP; OR = 1.006, 95% CI = 1.000­1.012, P: 0.049), lactate dehydrogenase (LDH; OR = 1.002, 95% CI = 1.001­1.004, P: 0.003), and creatinine levels (OR = 1.497, 95% CI = 1.126­1.990, P: 0.006); oxygen saturation (SpO2) values on admission (OR = 0.897, 95% CI = 0.811­0.993, P: 0.036); and azithromycin use (OR = 0.239, 95% CI = 0.065­0.874, P: 0.031). Conclusion: The presence of malignancy; symptoms of dyspnea; high NLR; highest CRP, LDH, and creatinine levels; and low SpO2 on admission predicted mortality. On the other hand, azithromycin use was found to be protective against mortality. Knowing the causes predicting mortality will be important to treat future cases more successfully.