Long-Term Risk of Reduced Cognitive Performance and Associated Factors in Discharged Older Adults with COVID-19: A Longitudinal Prospective Study.

BACKGROUND: Increasing numbers of reports have suggested a deterioration in cognitive performance after recovery from coronavirus disease 2019 (COVID-19), however insufficient information is available regarding long-term brain health and risk factors related to reduced cognitive performance in advanced age. We investigated the prevalence of reduced cognitive performance and its associated factors among older adults after COVID-19. METHODS: This prospective observational study enrolled older individuals (aged ≥65 years) hospitalized for COVID-19. Discharged patients were contacted after an average of 15 months and a brief battery was administered during telephone interviews to assess their mental status. RESULTS: Among the 174 patients, 77 (44.3%) showed reduced cognitive performance at follow-up. Multivariate analysis revealed that female sex, education level, and increased Deyo/Charlson Comorbidity Index score, which is an objective indicator of chronic disease burden, were independent risk factors for long-term cognitive performance. Depression and anxiety symptoms, assessed using the Patient Health Questionnaire-2 and Generalized Anxiety Disorder 2-item questionnaire at the end of the study, were not associated with reduced cognitive performance. CONCLUSION: Our findings provide key insights into discharged older adults with COVID-19 at risk of long-term cognitive impairment, and help to ascertain the factors associated with this problem.

Prevalence and risk factors of mild cognitive impairment in a tertiary care setting in Turkey.

BACKGROUND: Mild cognitive impairment (MCI) is an intermediate stage between healthy cognition and dementia, particularly Alzheimer's disease. There is limited information on the prevalence of MCI among older Turkish adults. This study aimed to determine the prevalence and risk factors of MCI in Turkey. MATERIAL AND METHODS: A cross-sectional study was conducted with community-dwelling older people who were admitted to a tertiary geriatric outpatient clinic. Information on demographics and clinical variables was obtained. We used a neuropsychological battery to assess the cognitive domains in each subject. Participants who fell below 1.5 standard deviations on 1 or more of the 5 cognitive tests were considered MCI and were classified as either single domain MCI and multiple domain MCI. Risk factors were determined using univariate and multivariate logistic regression analyses. RESULTS: A total of 259 participants were enrolled in this study. The mean age was 74.0 years (SD 7.1 years), 54% were women, and 48.3% had a low level of education (≤ 5 years). The overall prevalence of MCI was 52.1%, with 27.8% for single domain MCI and 24.3% for multiple domain MCI. The prevalence of MCI increased with age: 16.4% aged 65-74 years, 32.0% aged 75-84 years, and 40.9% ≥ 85 years. Advanced age and low educational level were risk factors for both single domain MCI (OR = 1.07; 95% CI: 1.02-1.13; p = 0.003 and OR = 3.18; 95% CI:1.7-6.1; p < 0.001) and multiple domain MCI (OR = 1.1; 95% CI:1.1-1.2; p < 0.001 and adjusted OR = 11.9; 95% CI:5.1-27.8; p < 0.001). CONCLUSION: MCI was common in older Turkish people admitted to a tertiary hospital, especially in those with advanced age and low educational level.

Geriatric syndromes in the population older than 90 years: The prevalence and association with chronic diseases.

OBJECTIVE: The aim of this study was to explore the prevalence of geriatric syndromes and comorbid conditions, as well as their interrelationships, in individuals aged 90 years and over. METHODS: This study included participants aged 90 years and older who underwent a comprehensive geriatric assessment in a tertiary geriatric outpatient clinic. Demographic and clinical characteristics were obtained using the electronic medical records. The geriatric syndrome burden was calculated by adding each syndrome, which was then stratified into one of two groups based on the median value: no or low burden (<4) and high burden (≥4). The modified Charlson comorbidity index was used to determine chronic disease burden. RESULTS: A total of 235 participants (93.2 ± 2.7 years) were recruited in this study. The mean index score was 7.3, and 46% (n = 107) of participants had a high geriatric syndrome burden. The most common geriatric syndrome was incontinence (69%), followed by polypharmacy (60%) and depression (43%). When compared to patients without such a diagnosis, the prevalence of polypharmacy was significantly higher in patients diagnosed with hypertension, chronic kidney disease, cardiovascular disease, diabetes mellitus and chronic obstructive pulmonary disease (p = 0.02, p = 0.02, p < 0.001, p = 0.008, p = 0.007, respectively). However, no chronic disease was associated with geriatric syndrome burden. CONCLUSIONS: We found that the burden of medical conditions in the older population over 90 years of age could influence general health status significantly, with a high prevalence of chronic diseases and geriatric syndromes.

Reliability and validity of the Turkish version of the elder abuse suspicion index in community-dwelling older adults.

BACKGROUND: Elder abuse is among the most important ethical issue during the management of older population. The elder abuse suspicion index (EASI) was developed for evaluating abuse in older adults. We aimed to assess the reliability and validity of the Turkish version EASI-Türkiye (TR) among older adults. METHODS: This study included 89 community-dwelling older adults. The EASI-TR and other scales, including HwalekSengstock Elder Abuse Screening Test-Türkiye (HS/EAST-TR), YGDS, Yesavage Geriatric Depression Scale (YGDS), Instrumental Activities of Daily Living (IADL), and Activities of Daily Living (ADL) were administered to all participants. Internal consistency and external validity were assessed. RESULTS: EASI-TR revealed an excellent test-retest reliability and acceptable level of internal consistency (Cronbach's α = 0.711). The item-total correlations ranged between 0.296 and 0.701, except for the second item. This test showed significant correlations with the HS/EAST-TR and IADL (p < 0.05), demonstrating good external validity. DISCUSSION: The EASI-TR appears to have acceptable reliability and validity in screening for abuse in older adults. This tool may recognize cases that require additional evaluation in managing of ethical issues.

Gait Speed is independently associated with Depression Symptoms in Mild Cognitive Impairment.

Depression symptoms are known to influence gait speed in cognitively healthy adults. In this study, we aimed to examine the relationship between gait speed and depression symptoms in older patients with mild cognitive impairment. The participants were classified as slow and normal gait speed based on the Fried criteria. A total of 152 subjects with mild cognitive impairment were included. Of these, 39.5% (n=60) had slow gait speed. Compared to normal speed group (n=92), patients with slow speed had more clinically significant depression (geriatric depression scale score ≥ 6) (p=0.004), cardiovascular disease (p=0.007), recent falls (p<0.001), and anticholinergic burden (p=0.005). Multivariable logistic regression analysis yielded statistically significant associations between slow gait speed and depression in age and gender adjusted [OR:3.30 (1.46-7.46), p=0.004] and fully adjusted [OR: 2.80 (1.10-7.08), p=0.030] models. This study showed an independent association between slow gait speed and depression symptoms in older people with mild cognitive impairment.

Psychological Burden among Community-dwelling Older Adults with and without a History of a Recent Covid-19 Infection.

OBJECTIVES: The outbreak of Covid-19's psychological burden to recovered vs. non-infected older individuals has not been compared yet. We aimed to perform a comparative analysis of psychological symptoms in community-dwelling older adults with and without a history of a Covid-19 infection. METHODS: In this study, we utilized a geriatric care unit's outpatient registry to prospectively enroll older adults with and without a history of Covid-19. An interviewer administered generalized anxiety disorder-2 (GAD-2), patient health questionnaire-2 (PHQ-2), six-item cognitive impairment (6-CIT), and post-traumatic stress disorder-5 (PTSD-5) tests over the phone. Correlation and multivariate logistic regression analyses were used to examine associations. RESULTS: The study included 120 older subjects, 46 (38.3%) reported past Covid-19 infection. Anxiety and depression were both significantly more prevalent among subjects without a history of Covid-19. Having no history of Covid-19, female gender, and psychoactive medication use showed independent associations with the risk of depression symptoms among all subjects, and female gender was additionally associated with anxiety symptoms. CONCLUSIONS: This study showed that the risk of depression symptoms was higher in a sample of older adults who were not infected with Covid-19 compared to those recovering from the disease. CLINICAL IMPLICATIONS: The impact of "fear of transmission" on the mental health of the elderly may be a significant issue to deal with. Older women are more prone to mental health risks by Covid-19.

Telemedicine interventions for older adults: A systematic review.

INTRODUCTION: Telemedicine may help improve older adults' access, health outcomes, and quality of life indicators. This review aims to provide current evidence on the effectiveness of telemedicine in the aged population. METHOD: A systematic literature search was conducted in PubMed, Google Scholar, and Web of Science electronic databases between January 2015 and September 2021 using the keywords "telemedicine" or "telehealth" and "older people" or "geriatrics" or "elderly." The articles were classified under three headings according to the purposes: feasibility, diagnosis and management of chronic diseases, and patient satisfaction. RESULTS: A total of 22 articles were included. Across most disciplines, evidence has shown that telemedicine is as effective as usual care, if not more so, in the feasibility, chronic disease management, and patient satisfaction of the elderly. However, a few studies reported challenges such as difficulty with technology, hearing problems, and the inability to perform hands-on examinations for physicians. CONCLUSION: Findings from this review support the view that health care providers can use telemedicine to manage elderly individuals in conjunction with usual health care. However, future research is needed to eliminate barriers to increasing telemedicine use among older adults.