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in category geriatric medicine

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1: The effects of ARBs, ACEIs and statins on clinical outcomes of COVID-19 infection among nursing home residents
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Posted 15 May 2020

The effects of ARBs, ACEIs and statins on clinical outcomes of COVID-19 infection among nursing home residents
2,615 downloads medRxiv geriatric medicine

Anton De Spiegeleer, Antoon Bronselaer, James T Teo, Geert Byttebier, Guy De Tre, Luc Belmans, Richard Dobson, Evelien Wynendaele, Christophe Van De Wiele, Filip Vandaele, Diemer Van Dijck, Daniel Bean, David Fedson, Bart De Spiegeleer

Background. COVID-19 infection has limited preventive or therapeutic drug options at this stage. Some of common existing drugs like angiotensin-converting enzyme inhibitors (ACEi), angiotensin II receptor blockers (ARB) and the HMG-CoA reductase inhibitors (statins) have been hypothesised to impact on disease severity. However, up till now, no studies investigating this association were conducted in the most vulnerable and affected population groups, i.e. older people residing in nursing homes. The purpose of this study has been to explore the association of ACEi/ARB and/or statins with clinical manifestations in COVID-19 infected older people residing in nursing homes. Methods and Findings. We undertook a retrospective multi-centre cohort study in two Belgian nursing homes that experienced similar COVID-19 outbreaks. COVID-19 diagnoses were based on clinical suspicion and/or viral presence using PCR of nasopharyngeal samples. A total of 154 COVID-19 positive subjects was identified. The outcomes were defined as 1) serious COVID-19 defined as a long-stay hospital admission (length of stay [≥] 7 days) or death (at hospital or nursing home) within 14 days of disease onset, and 2) asymptomatic, i.e. no disease symptoms in the whole study-period while still being PCR diagnosed. Disease symptoms were defined as any COVID-19-related clinical symptom (e.g. coughing, dyspnoea, sore throat) or sign (low oxygen saturation and fever) for [≥] 2 days out of 3 consecutive days. Logistic regression models with Firth corrections were applied on these 154 subjects to analyse the association between ACEi/ARB and/or statin use with the outcomes. Age, sex, functional status, diabetes and hypertension were used as covariates. Sensitivity analyses were conducted to evaluate the robustness of our statistical significant findings. We found a statistically significant association between statin intake and the absence of symptoms during COVID-19 infection (unadjusted OR 2.91; CI 1.27-6.71; p=0.011), which remained statistically significant after adjusting for age, sex, functional status, diabetes mellitus and hypertension. The strength of this association was considerable and clinically important. Although the effects of statin intake on serious clinical outcome (long-stay hospitalisation or death) were in the same beneficial direction, these were not statistically significant (OR 0.75; CI 0.25-1.85; p=0.556). There was also no statistically significant association between ACEi/ARB and asymptomatic status (OR 1.52; CI 0.62-3.50; p=0.339) or serious clinical outcome (OR 0.79; CI 0.26-1.95; p=0.629). Conclusions. Our data indicate that statin intake in old, frail people could be associated with a considerable beneficial effect on COVID-19 related clinical symptoms. The role of statins and any interaction with renin-angiotensin system drugs need to be further explored in larger observational studies as well as randomised clinical trials.

2: Functional and cognitive outcomes after COVID-19 delirium
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Posted 09 Jun 2020

Functional and cognitive outcomes after COVID-19 delirium
1,791 downloads medRxiv geriatric medicine

Benjamin C Mcloughlin, Amy Miles, Thomas E Webb, Paul Knopp, Clodagh Eyres, Ambra Fabbri, Fiona Humphries, Daniel Davis

Purpose To ascertain delirium prevalence and outcomes in COVID-19. Methods We conducted a point-prevalence study in a cohort of COVID-19 inpatients at University College Hospital. Delirium was defined by DSM-IV criteria. The primary outcome was all-cause mortality at 4 weeks; secondary outcomes were physical and cognitive function. Results In 71 patients, 31 (42%) had delirium, of which only 19 had been recognised by the clinical team. At 4 weeks, 20 (28%) had died, 26 (36%) were interviewed by telephone and 21 (30%) remained as inpatients. Physical function was substantially worse in people after delirium (-39 points on functional scale/166, 95% CI -92 to -21, p=0.01) (Table 2). Mean cognitive scores at follow-up were similar and delirium was not associated with mortality in this sample. Conclusions Our findings indicate that delirium is common, yet under-recognised. Delirium is associated with functional impairments in the medium-term.

3: For-profit nursing homes and the risk of COVID-19 outbreaks and resident deaths in Ontario, Canada
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Posted 27 May 2020

For-profit nursing homes and the risk of COVID-19 outbreaks and resident deaths in Ontario, Canada
1,727 downloads medRxiv geriatric medicine

Nathan M Stall, Aaron Jones, Kevin Antoine Brown, Paula A Rochon, Andrew P Costa

Background: Nursing homes have become the epicentre of the coronavirus disease 2019 (COVID-19) pandemic in Canada. Previous research demonstrates that for-profit nursing homes deliver inferior care across a variety of outcome and process measures, raising the question of whether for-profit homes have had worse COVID-19 outcomes than non-profit homes. Methods: We conducted a retrospective cohort study of all nursing homes in Ontario, Canada from March 29-May 20, 2020 using a COVID-19 outbreak database maintained by the Ontario Ministry of Long-Term Care. We used hierarchical logistic and count-based methods to model the associations between nursing home profit status (for-profit, non-profit or municipal) and nursing home COVID-19 outbreaks, COVID-19 outbreak sizes, and COVID-19 resident deaths. Results: The analysis included all 623 Ontario nursing homes, of which 360 (57.7%) were for-profit, 162 (26.0%) were non-profit, and 101 (16.2%) were municipal homes. There were 190 (30.5%) COVID-19 nursing home outbreaks involving 5218 residents (mean of 27.5 +/- 41.3 residents per home), resulting in 1452 deaths (mean of 7.6 +/- 12.7 residents per home) with an overall case fatality rate of 27.8%. The odds of a COVID-19 outbreak was associated with the incidence of COVID-19 in the health region surrounding a nursing home (adjusted odds ratio [aOR], 1.94; 95% confidence interval [CI] 1.23-3.09) and number of beds (aOR, 1.40; 95% CI 1.20-1.63), but not profit status. For-profit status was associated with both the size of a nursing home outbreak (adjusted risk ratio [aRR], 1.96; 95% CI 1.26-3.05) and the number of resident deaths (aRR, 1.78; 95% CI 1.03-3.07), compared to non-profit homes. These associations were mediated by a higher prevalence of older nursing home design standards in for-profit homes. Interpretation: For-profit status is associated with the size of a COVID-19 nursing home outbreak and the number of resident deaths, but not the likelihood of outbreaks. Differences between for profit and non-profit homes are largely explained by older design standards, which should be a focus of infection control efforts and future policy.

4: Single nuclei profiling identifies cell specific markers of skeletal muscle aging, sarcopenia and senescence
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Posted 26 Jan 2021

Single nuclei profiling identifies cell specific markers of skeletal muscle aging, sarcopenia and senescence
1,632 downloads medRxiv geriatric medicine

Kevin Perez, Julia McGuirr, Chandani Limbad, Mark Tarnopolsky, Joshua P Nederveen, Mats I Nilsson, Judith Campisi, Simon Melov

Aging is accompanied by a loss of muscle mass and function, termed sarcopenia, which causes numerous morbidities and economic burdens in human populations. Mechanisms implicated in age-related sarcopenia include inflammation, muscle stem cell depletion, mitochondrial dysfunction and loss of motor neurons, but whether there are key drivers of sarcopenia is not yet known. To gain deeper insights into age-related sarcopenia, we performed transcriptome profiling on lower limb muscle biopsies from 72 young, old and sarcopenic subjects using bulk RNA-seq (N = 72) and single-nuclei RNA-seq (N = 17). This combined approach revealed novel changes in gene expression that occur with age and sarcopenia in multiple cell types comprising mature skeletal muscle. Notably, we found increased expression of the genes MYH8 and PDK4, and decreased expression of the gene IGFN1, in old muscle. We validated key genes in fixed human muscle tissue using digital spatial profiling. We also identified a small population of nuclei that express CDKN1A, present only in aged samples, consistent with p21-driven senescence in this subpopulation. Overall, our findings identify unique cellular subpopulations in aged and sarcopenic skeletal muscle, which will facilitate the development of new therapeutic strategies to combat age-related sarcopenia.

5: Journals in Aging, Geriatrics, and Gerontology: A Survey
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Posted 22 Nov 2019

Journals in Aging, Geriatrics, and Gerontology: A Survey
1,300 downloads medRxiv geriatric medicine

Robert J. Wolff, Hannah L. Bowser

Aging, geriatrics, gerontology, and related areas are important areas of research as the population of older people increases in relationship to the total population. Researchers in these fields would benefit from guidance regarding sources for publishing and finding relevant scholarly journals and articles. Multiple database sites of journals were searched to provide a list of relevant publications. This list was expanded via perusal of published citation lists and searches in general search engines. A total of 243 journals were identified and examined. Of those journals, 198 journals are currently publishing and 45 journals have ceased publication. In terms of publication medium, 39% of the currently publishing journals are online-only, 4% are print-only and 59% of the journals publish both online and in print. Journals with aging in the title represent 36%, geriatrics 30% and gerontology 23%. Less than 10% have been identified as predatory journals. An expected increase in journals in the broad field of aging is indicated by the 49% of listed titles beginning in 2000 or later. This recent increase in available journals provides a need for the information listed in this paper.

6: Outcomes from COVID-19 across the range of frailty: excess mortality in fitter older people
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Posted 24 May 2020

Outcomes from COVID-19 across the range of frailty: excess mortality in fitter older people
1,300 downloads medRxiv geriatric medicine

Amy Miles, Thomas E Webb, Benjamin C Mcloughlin, Imran Mannan, Arshad Rather, Paul Knopp, Daniel Davis

Purpose Our aim was to quantify the mortality from COVID-19 and identify any interactions with frailty and other demographic factors. Methods Hospitalised patients aged [≥]70 were included, comparing COVID-19 cases with non-COVID-19 controls admitted over the same period. Frailty was prospectively measured and mortality ascertained through linkage with national and local statutory reports. Results In 217 COVID-19 cases and 160 controls, older age and South Asian ethnicity, though not socioeconomic position, were associated with higher mortality. For frailty, differences in effect size were evident between cases (HR 1.02, 95%CI 0.93-1.12) and controls (HR 1.99, 95%CI 1.46-2.72), with an interaction term (HR 0.51, 95%CI 0.37-0.71) in multivariable models. Conclusions Our findings suggest that (i) frailty is not a good discriminator of prognosis in COVID-19 and (ii) pathways to mortality may differ in fitter compared with frailer older patients.

7: Diagnostic Accuracy of the 4AT for delirium detection: systematic review and meta-analysis.
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Posted 12 Jun 2020

Diagnostic Accuracy of the 4AT for delirium detection: systematic review and meta-analysis.
1,272 downloads medRxiv geriatric medicine

Zoë Tieges, Alasdair M.J. MacLullich, Atul Anand, Claire Brookes, Marica Cassarino, Margaret O'Connor, Damien Ryan, Thomas Saller, Rakesh C. Arora, Yue Chang, Kathryn Agarwal, George Taffet, Terry Quinn, Susan D. Shenkin, Rose Galvin

Objective: Detection of delirium in hospitalised older adults is recommended in national and international guidelines. The 4 'A's Test (4AT) is a short (<2 min) instrument for delirium detection that is used internationally as a standard tool in clinical practice. We performed a systematic review and meta-analysis of diagnostic test accuracy of the 4AT for delirium detection. Methods: We searched MEDLINE, EMBASE, PsycINFO, CINAHL, clinicaltrials.gov and the Cochrane Central Register of Controlled Trials, from 2011 (year of 4AT release on the website www.the4AT.com) until 21 December 2019. Inclusion criteria were: older adults ([&ge;]65y); diagnostic accuracy study of the 4AT index test when compared to delirium reference standard (standard diagnostic criteria or validated tool). Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Pooled estimates of sensitivity and specificity were generated from a bivariate random effects model. Results: 17 studies (3721 observations) were included. Settings were acute medicine, surgery, a care home, and the emergency department. Three studies assessed performance of the 4AT in stroke. The overall prevalence of delirium was 24.2% (95% CI 17.8-32%; range 10.5-61.9%). The pooled sensitivity was 0.88 (95% CI 0.80-0.93) and the pooled specificity was 0.88 (95% CI 0.82-0.92). Excluding the stroke studies, the pooled sensitivity was 0.86 (95% CI 0.77-0.92) and the pooled specificity was 0.89 (95% CI 0.83-0.93). The methodological quality of studies varied but was moderate to good. Conclusions: The 4AT shows good diagnostic test accuracy for delirium in the 17 available studies. These findings support its use in routine clinical practice in delirium detection.

8: Genetic and Phenotypic Evidence for the Causal Relationship Between Aging and COVID-19
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Posted 07 Aug 2020

Genetic and Phenotypic Evidence for the Causal Relationship Between Aging and COVID-19
1,124 downloads medRxiv geriatric medicine

Kejun Ying, Ranran Zhai, Timothy V. Pyrkov, Marco Mariotti, Peter O. Fedichev, Xia Shen, Vadim N. Gladyshev

Epidemiological studies have revealed that the elderly and those with co-morbidities are most susceptible to COVID-19. To understand the genetic link between aging and the risk of COVID-19, we conducted a multi-instrument Mendelian randomization analysis and found that the genetic variation that leads to a longer lifespan is significantly associated with a lower risk of COVID-19 infection. The odds ratio is 0.32 (95% CI: 0.18 to 0.57; P = 1.3 x 10-4) per additional 10 years of life, and 0.62 (95% CI: 0.51 to 0.77; P = 7.2 x 10-6) per unit higher log odds of surviving to the 90th percentile age. On the other hand, there was no association between COVID-19 susceptibility and healthspan (the lifespan free of the top seven age-related morbidities). To examine the relationship at the phenotypic level, we applied various biological aging clock models and detected an association between the biological age acceleration and future incidence and severity of COVID-19 infection for all subjects as well as for the individuals free of chronic disease. Biological age acceleration was also significantly associated with the risk of death in COVID-19 patients. Our findings suggest a causal relationship between aging and COVID-19, defined by genetic variance, the rate of aging, and the burden of chronic diseases.

9: Delirium is a presenting symptom of COVID-19 in frail, older adults: a cohort study of 322 hospitalised and 535 community-based older adults
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Posted 17 Jun 2020

Delirium is a presenting symptom of COVID-19 in frail, older adults: a cohort study of 322 hospitalised and 535 community-based older adults
986 downloads medRxiv geriatric medicine

Maria Beatrice Zazzara, Rose S. Penfold, Amy L Roberts, Karla Lee, Hannah Dooley, Carole H Sudre, Carly Welch, Ruth C. E. Bowyer, Alessia Visconti, Massimo Mangino, Maxim B. Freydin, Julia Sarah El-Sayed Moustafa, Kerrin Small, Benjamin Murray, Marc Modat, Jonathan Wolf, Sébastien Ourselin, Finbarr C. Martin, Claire J Steves, Mary Ni Lochlainn

Background: Frailty, increased vulnerability to physiological stressors, is associated with adverse outcomes. COVID-19 exhibits a more severe disease course in older, co-morbid adults. Awareness of atypical presentations is critical to facilitate early identification. Objective: To assess how frailty affects presenting COVID-19 symptoms in older adults. Design: Observational cohort study of hospitalised older patients and self-report data for community-based older adults. Setting: Admissions to St Thomas' Hospital, London with laboratory-confirmed COVID-19. Community-based data for 535 older adults using the COVID Symptom Study mobile application. Subjects: Hospital cohort: patients aged 65 and over (n=322); unscheduled hospital admission between March 1st, 2020 - May 5th, 2020; COVID-19 confirmed by RT-PCR of nasopharyngeal swab. Community-based cohort: participants aged 65 and over enrolled in the COVID Symptom Study (n=535); reported test-positive for COVID-19 from March 24th (application launch)- May 8th, 2020. Methods: Multivariate logistic regression analysis performed on age-matched samples from hospital and community-based cohorts to ascertain association of frailty with symptoms of confirmed COVID-19. Results: Hospital cohort: significantly higher prevalence of delirium in the frail sample, with no difference in fever or cough. Community-based cohort: significantly higher prevalence of probable delirium in frailer, older adults, and fatigue and shortness of breath. Conclusions: This is the first study demonstrating higher prevalence of delirium as a COVID-19 symptom in older adults with frailty compared to other older adults. This emphasises need for systematic frailty assessment and screening for delirium in acutely ill older patients in hospital and community settings. Clinicians should suspect COVID-19 in frail adults with delirium.

10: Increased Prescribing of Psychotropic Medications to Ontario Nursing Home Residents during the COVID-19 Pandemic
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Posted 30 Nov 2020

Increased Prescribing of Psychotropic Medications to Ontario Nursing Home Residents during the COVID-19 Pandemic
959 downloads medRxiv geriatric medicine

Nathan M Stall, Jonathan S. Zipursky, Jagadish Rangrej, Aaron Jones, Andrew P Costa, Michael P Hillmer, Kevin Antoine Brown

In this population-based study of all Ontario nursing home residents, we found increased prescribing of psychotropic drugs at the onset of the COVID-19 pandemic that persisted through September 2020. Increases in prescribing were out of proportion to expected secular trends, and distinct from observed prescribing changes in other drugs during the pandemic. Our findings underscore the urgency of balancing infection prevention and control measures in nursing homes with the mental wellbeing of residents.

11: The consistent burden in published estimates of delirium occurrence in medical inpatients over four decades: a systematic review and meta-analysis study
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Posted 29 Aug 2019

The consistent burden in published estimates of delirium occurrence in medical inpatients over four decades: a systematic review and meta-analysis study
870 downloads medRxiv geriatric medicine

Kate Gibb, Anna Seeley, Terry Quinn, Najma Siddiqi, Susan D Shenkin, Kenneth Rockwood, Daniel Davis

IntroductionDelirium is associated with a wide range of adverse patient safety outcomes. We sought to identify if trends in healthcare complexity were associated with changes in reported delirium in adult medical patients in the general hospital over the last four decades. MethodsWe used identical criteria to a previous systematic review, including studies using DSM and ICD-10 criteria for delirium diagnosis. Random effects meta-analysis pooled estimates across studies, meta-regression estimated temporal changes, funnel plots assessed publication bias. ResultsOverall delirium occurrence was 23% (95% CI 19%-26%) (33 studies). There was no change between 1980-2019, nor was case-mix (average age of sample, proportion with dementia) different. There was evidence of increasing publication bias over time. DiscussionThe incidence and prevalence of delirium in hospitals appears to be stable, though publication bias may mask true changes. Nonetheless, delirium remains a challenging and urgent priority for clinical diagnosis and care pathways.

12: Unequal impact of structural health determinants and comorbidity on COVID-19 severity and lethality in older Mexican adults: Looking beyond chronological aging
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Posted 18 May 2020

Unequal impact of structural health determinants and comorbidity on COVID-19 severity and lethality in older Mexican adults: Looking beyond chronological aging
855 downloads medRxiv geriatric medicine

Omar Yaxmehen Bello-Chavolla, Armando González-Díaz, Neftali Eduardo Antonio-Villa, Carlos Alberto Fermín-Martínez, Alejandro Márquez-Salinas, Arsenio Vargas-Vázquez, Jessica Paola Bahena-López, Carmen García-Peña, Carlos A Aguilar-Salinas, Luis Miguel Gutiérrez-Robledo

BACKGROUND: COVID-19 has had a disproportionate impact on older adults. The population of Mexico is younger, yet the impact of COVID-19 on older adults is comparable to countries with older population structures. Here, we aim to identify health and structural determinants that increase susceptibility to COVID-19 in older Mexican adults beyond chronological aging. METHODS: We analyzed confirmed COVID-19 cases in older adults using data from the General Directorate of Epidemiology of Mexican Ministry of Health. We modeled risk factors for increased COVID-19 severity and mortality, using mixed models to incorporate multilevel data concerning healthcare access and marginalization. We also evaluated structural factors and comorbidity profiles compared to chronological age for improving COVID-19 mortality risk prediction. RESULTS: We analyzed 7,029 confirmed SARS-CoV-2 cases in adults aged [&ge;]60 years. Male sex, smoking, diabetes, and obesity were associated with pneumonia, hospitalization and ICU admission in older adults, CKD and COPD were associated with hospitalization. High social lag indexes and access to private care were predictors of COVID-19 severity and mortality. Age was not a predictor of COVID-19 severity in individuals without comorbidities and structural factors and comorbidities were better predictors of COVID-19 lethality and severity compared to chronological age. COVID-19 baseline lethality hazards were heterogeneously distributed across Mexican municipalities, particularly when comparing urban and rural areas. CONCLUSIONS: Structural factors and comorbidity explain excess risk for COVID-19 severity and mortality over chronological age in older Mexican adults. Clinical decision-making related to COVID-19 should focus away from chronological aging onto more a comprehensive geriatric care approach.

13: Asymptomatic carriage rates and case-fatality of SARS-CoV-2 infection in residents and staff in Irish nursing homes
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Posted 12 Jun 2020

Asymptomatic carriage rates and case-fatality of SARS-CoV-2 infection in residents and staff in Irish nursing homes
795 downloads medRxiv geriatric medicine

Sean P Kennelly, Adam H Dyer, Ruth Martin, Siobhan M Kennelly, Alan Martin, Desmond O'Neill, Aoife Fallon

Background: SARS-CoV-2 has disproportionately affected nursing home (NH) residents. In Ireland, the first NH case of COVID-19 occurred on 16/03/2020. A national point-prevalence testing program of all NH residents and staff took place from 18/04/2020-05/05/2020. Aims: To examine characteristics of NHs across three Community Health Organisations (CHOs) in Ireland, proportions with COVID-19 outbreaks, staff and resident, symptom-profile and resident case-fatality. Methods: Forty-five NHs surveyed across three CHOs requesting details on occupancy, size, COVID-19 outbreak, timing of outbreak, total symptomatic/asymptomatic cases, and outcomes for residents from 29/02/2020-22/05/2020. Results: Surveys were returned from (62.2%, 28/45) of NHs (2043 residents, 2303 beds). Three-quarters (21/28) had COVID-19 outbreaks (1741 residents, 1972 beds). Median time from first case of COVID-19 in Ireland to first case in these NHs was 27.0 days. Resident COVID-19 incidence was (43.9%, 764/1741): laboratory-confirmed (40.1%, 710/1741) with (27.2%, 193/710 asymptomatic), and clinically-suspected (3.1%, 54/1741). Resident case-fatality was (27.6%, 211/764) for combined laboratory-confirmed/clinically-suspected COVID-19. Similar proportions of residents in NH with an early outbreak (<28days) versus a later outbreak developed confirmed/suspected COVID-19. A lower proportion of residents in NHs with early outbreaks had recovered compared to those with late outbreaks (37.4% vs 61.7%; X2=56.9, p<0.001). Among 675 NH staff across twenty-four sites who had confirmed/suspected COVID-19 (23.6%, 159/675) were asymptomatic. There was a significant correlation between the proportion of staff with symptomatic COVID-19 and resident numbers with confirmed/suspected COVID-19 (Spearmans rho=0.81, p<0.001). Conclusion: This study demonstrates COVID-19 impact on NH residents and staff. High infection rates lead to challenges in care provision.

14: COVID-19 Infection Risk amongst 14,104 Vaccinated Care Home Residents: A national observational longitudinal cohort study in Wales, United Kingdom, December 2020 to March 2021
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Posted 24 Mar 2021

COVID-19 Infection Risk amongst 14,104 Vaccinated Care Home Residents: A national observational longitudinal cohort study in Wales, United Kingdom, December 2020 to March 2021
766 downloads medRxiv geriatric medicine

Joe Hollinghurst, Laura North, Malorie Perry, Ashley Akbari, Mike B Gravenor, Ronan A Lyons, Richard Fry

Background: Vaccinations for COVID-19 have been prioritised for older people living in care homes. However, vaccination trials included limited numbers of older people. Aim: We aimed to study infection rates of SARS-CoV-2 for older care home residents following vaccination and identify factors associated with increased risk of infection. Study Design and Setting: We conducted an observational data-linkage study including 14,104 vaccinated older care home residents in Wales (UK) using anonymised electronic health records and administrative data. Methods: We used Cox proportional hazards models to estimate hazard ratios (HRs) for the risk of testing positive for SARS-CoV-2 infection following vaccination, after landmark times of either 7 or 21-days post-vaccination. We adjusted hazard ratios for age, sex, frailty, prior SARS-CoV-2 infections and vaccination type. Results: We observed a small proportion of care home residents with positive PCR tests following vaccination 1.05% (N=148), with 90% of infections occurring within 28-days. For the 7-day landmark analysis we found a reduced risk of SARS-CoV-2 infection for vaccinated individuals who had a previous infection; HR (95% confidence interval) 0.54 (0.30,0.95), and an increased HR for those receiving the Pfizer-BioNTECH vaccine compared to the Oxford-AstraZeneca; 3.83 (2.45,5.98). For the 21-day landmark analysis we observed high HRs for individuals with low and intermediate frailty compared to those without; 4.59 (1.23,17.12) and 4.85 (1.68,14.04) respectively. Conclusions: Increased risk of infection after 21-days was associated with frailty. We found most infections occurred within 28-days of vaccination, suggesting extra precautions to reduce transmission risk should be taken in this time frame.

15: Frailty and mortality in hospitalized older adults with COVID-19: retrospective observational study
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Posted 27 May 2020

Frailty and mortality in hospitalized older adults with COVID-19: retrospective observational study
748 downloads medRxiv geriatric medicine

Robert De Smet, Bea Mellaerts, Hannelore Vandewinckele, Peter Lybeert, Eric Frans, Sara Ombelet, Wim Lemahieu, Rolf Symons, Erwin Ho, Johan Frans, Annick Smismans, Michael R Laurent

Background: Older adults with coronavirus disease 2019 (COVID-19) face an increased risk of adverse health outcomes including mortality. Ethical guidelines consider allocation of limited resources based on likelihood of survival, frailty, co-morbidities and age. However, the association of frailty with clinical outcomes in older COVID-19 patients remains unclear. Objectives: To determine the association between frailty and short-term mortality in older adults hospitalized for COVID-19. Design: Retrospective single-center observational study. Setting and participants: N = 81 patients with COVID-19 confirmed by reverse-transcriptase polymerase chain reaction (RT-PCR), at the Geriatrics department of Imelda general hospital, Belgium. Measurements: Frailty was graded according to the Rockwood Clinical Frailty Scale (CFS). Demographic, biochemical and radiological variables, co-morbidities, symptoms and treatment were extracted from electronic medical records. Results: Participants (N = 48 women, 59%) had a median age of 85 years (range 65 - 97 years), median CFS score of 7 (range 2 - 9), and 42 (52%) were long-term care residents. Within six weeks, eighteen patients died. Mortality was significantly but weakly associated with age (Spearman r = 0.241, P = 0.03) and CFS score (r = 0.282, P = 0.011), baseline lactate dehydrogenase (LDH) (r = 0.301, P = 0.009), lymphocyte count (r = -0.262, P = 0.02) and RT-PCR Ct value (r = -0.285, P = 0.015). Mortality was not associated with long-term care residence, dementia, delirium or polypharmacy. In multivariable logistic regression analyses, CFS, LDH and RT-PCR Ct values (but not age) remained independently associated with mortality. Both age and frailty had poor specificity to predict survival. A multivariable model combining age, CFS, LDH and viral load significantly predicted survival. Conclusions and implications: Although their prognosis is worse, even the oldest and most severely frail patients may benefit from hospitalization for COVID-19, if sufficient resources are available.

16: Photo-Integrated Conversation Moderated by Robots for Cognitive Health in Older Adults: A Randomized Controlled Trial
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Posted 21 Aug 2019

Photo-Integrated Conversation Moderated by Robots for Cognitive Health in Older Adults: A Randomized Controlled Trial
746 downloads medRxiv geriatric medicine

Mihoko Otake-Matsuura, Seiki Tokunaga, Kumi Watanabe, Masato S Abe, Takuya Sekiguchi, Hikaru Sugimoto, Taishiro Kishimoto, Takashi Kudo

Background and ObjectivesSocial interaction might prevent or delay dementia, but little is known about the specific effects of various social activity interventions on cognition. This study conducted a single-site randomized controlled trial (RCT) of Photo-Integrated Conversation moderated by a Robot (PICMOR), a group conversation intervention program for resilience against cognitive decline and dementia. Research Design and MethodsIn the RCT, PICMOR was compared to an unstructured group conversation condition. Sixty-five community-living older adults participated in this study. The intervention was provided once a week for 12 weeks. Primary outcome measures were the cognitive functions; process outcome measures included the linguistic characteristics of speech to estimate interaction quality. Baseline and post-intervention data were collected. PICMOR contains two key features: (i) photos taken by the participants are displayed and discussed sequentially; and (ii) a robotic moderator manages turn-taking to make sure that participants are allocated the same amount of time. ResultsAmong the primary outcome measures (i.e., cognitive functions), verbal fluency significantly improved in the intervention group. Among the process outcome measures (i.e., linguistic characteristics of speech), the amount of speech and richness of words were larger for the intervention group. Discussion and ImplicationsThis study demonstrated for the first time the positive effects of a robotic social activity intervention on cognitive function in healthy older adults via RCT. The group conversation generated by PICMOR may improve participants cognitive function controlling the amount of speech produced to make it equal. PICMOR is available and accessible to community-living older adults.

17: Presenting features of COVID-19 in older people: relationships with frailty, inflammation and mortality
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Posted 09 Jun 2020

Presenting features of COVID-19 in older people: relationships with frailty, inflammation and mortality
737 downloads medRxiv geriatric medicine

Paul Knopp, Amy Miles, Thomas E Webb, Benjamin C Mcloughlin, Imran Mannan, Nadia Raja, Bettina Wan, Daniel Davis

Purpose To describe the clinical features of COVID-19 in older adults, and relate these to outcomes. Methods Cohort study of 217 individuals ([&ge;]70 years) hospitalised with COVID-19, followed up for allcause mortality. Secondary outcomes included cognitive and physical function at discharge. C-reactive protein and neutrophil : lymphocyte ratio were used as measures of immune activity. Results Cardinal COVID-19 symptoms (fever, dyspnoea, cough) were common but not universal. Inflammation on hospitalisation was lower in frail older adults. Fever, dyspnoea, delirium and inflammation were associated with mortality. Delirium at presentation was an independent risk factor for cognitive decline at discharge. Conclusions COVID-19 may present without cardinal symptoms as well as implicate a possible role for agerelated changes in immunity in mediating the relationship between frailty and mortality.

18: Effect of a simple exercise programme on hospitalisation-associated disability in older patients: a randomised controlled trial.
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Posted 08 Oct 2019

Effect of a simple exercise programme on hospitalisation-associated disability in older patients: a randomised controlled trial.
729 downloads medRxiv geriatric medicine

Javier Ortiz-Alonso, Natalia Bustamante-Ara, Pedro L. Valenzuela, María T. Vidán, Gabriel Rodríguez-Romo, Jennifer Mayordomo-Cava, Marianna Javier-González, Mercedes Hidalgo-Gamarra, Myriel Lopéz-Tatis, María Isabel Valades-Malagón, Alejandro Santos-Lozano, Alejandro Lucia, José Antonio Serra-Rexach

ObjectiveHospitalisation-associated disability (HAD, defined as the loss of ability to perform one or more basic activities of daily living [ADL] independently at discharge) is a frequent condition among older patients. The present study aimed to assess whether a simple inpatient exercise programme decreases the incidence of HAD in acutely hospitalised very old patients. DesignIn this randomized controlled trial (Activity in GEriatric acute CARe, AGECAR) participants were assigned to a control or intervention (exercise) group, and were assessed at baseline, admission, discharge, and 3 months thereafter. Setting and participants268 patients (mean age 88 years, range 75-102) admitted to an acute care for elders (ACE) unit of a Public Hospital were randomized to a control (n=125) or intervention (exercise) group (n=143). MethodsBoth groups received usual care, and patients in the intervention group also performed simple supervised exercises (walking and rising from a chair, for a total daily duration of [~]20 min). We measured incident HAD at discharge and after 3 months (primary outcome); and Short Physical Performance Battery (SPPB), ambulatory capacity, number of falls, re-hospitalisation and death during a 3-month follow-up (secondary outcomes). ResultsMedian duration of hospitalisation was 7 days (interquartile range 4 days). Compared with admission, the intervention group had a lower risk of HAD at discharge (odds ratio [OR]: 0.32; 95% confidence interval [CI]: 0.11-0.92) and at 3-months follow-up (OR 0.24; 95% CI: 0.08-0.74) than controls during follow-up. No intervention effect was noted for the other secondary endpoints (all p>0.05), although a trend towards a lower mortality risk was observed in the intervention group (p=0.078). Conclusion and implicationsThese findings demonstrate that a simple inpatient exercise programme significantly decreases the risk of HAD in acutely hospitalised, very old patients. Trial registrationNCT0137489 (https://clinicaltrials.gov/ct2/show/NCT01374893). Brief summaryA simple inpatient intervention consisting of walking and rising from a chair ([~]20 minutes/day) considerably decreases the risk of hospitalisation-associated disability in acutely hospitalised older patients.

19: Deconditioning in people living with dementia during the COVID-19 pandemic: findings from the Promoting Activity, Independence and Stability in Early Dementia (PrAISED) process evaluation
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Posted 17 Nov 2020

Deconditioning in people living with dementia during the COVID-19 pandemic: findings from the Promoting Activity, Independence and Stability in Early Dementia (PrAISED) process evaluation
664 downloads medRxiv geriatric medicine

Claudio Di Lorito, Tahir Masud, John Gladman, Maureen Godfrey, Marianne Dunlop, Rowan H. Harwood

BackgroundRestrictions introduced in response to the COVID-19 pandemic led to increased risk of deconditioning in the general population. No empirical evidence of this effect however has been empirically gathered in people living with dementia. ObjectiveThis study aims to identify the causes and effects of COVID-19-related deconditioning in people living with dementia. DesignLongitudinal phenomenological qualitative study. SubjectsParticipants living with dementia, their carers and therapists involved in the Promoting Activity, Independence and Stability in Early Dementia (PrAISED) process evaluation during the COVID-19 pandemic. MethodsQualitative interviews with participants were conducted remotely at two time points. The data were analysed through deductive thematic analysis. ResultsTwenty-four participants living with dementia, 19 carers and 15 therapists took part in the study. A self-reinforcing pattern was common, whereby lockdown made the person apathetic, demotivated, socially-disengaged, and frailer. This reduced activity levels, which in turn reinforced the effects of deconditioning over time. Without external supporters, most participants lacked the motivation / cognitive abilities to keep active. Provided the proper infrastructure and support, some participants could use tele-rehabilitation to combat deconditioning. ConclusionThe added risks and effects of deconditioning on people with dementia require considerable efforts from policy makers and clinicians to ensure that they initiate and maintain physical activity in prolonged periods of social distancing. Delivering rehabilitation in the same way as before the pandemic might not be feasible or sustainable and innovative approaches must be found. Digital support for this population has shown promising results, but still remains a challenge.

20: Atypical Presentations of COVID-19 in Care Home Residents presenting to Secondary Care: A UK Single Centre Study
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Posted 08 Jul 2020

Atypical Presentations of COVID-19 in Care Home Residents presenting to Secondary Care: A UK Single Centre Study
662 downloads medRxiv geriatric medicine

Mark James Rawle, Deborah Lee Bertfield, Simon Edward Brill

Background: The United Kingdom (UK) care home population has experienced high mortality during the COVID-19 pandemic. Atypical presentations of COVID-19 are being reported in older adults and may pose difficulties for early isolation and treatment, particularly in institutional care settings. We aimed to characterise the presenting symptoms and associated mortality of COVID-19 in older adults, with a focus on care home residents and older adults living in the community. Methods: This was a retrospective cohort study of consecutive inpatients over 80 years old hospitalised with PCR confirmed COVID-19 between 10th March 2020 and 8th April 2020. Symptoms at presentation, including those associated with frailty, were analysed. Differences between community dwelling and care home residents, and associations with mortality, were assessed using between-group comparisons and logistic regression. Results: Care home residents were less likely to experience cough (46.9% vs 72.9%, p=0.002) but more likely to present with delirium (51.6% vs 31.4%, p=0.018), particularly hypoactive delirium (40.6% vs 24.3%, p=0.043). Mortality was more likely in the very frail (OR 1.25, 95% CI 1.00, 1.58, p=0.049) and those presenting with anorexia (OR 3.20, 95% CI 1.21, 10.09, p=0.028). There were no differences in either mortality or length of stay between those admitted from care homes and community dwelling older adults. Conclusion: COVID-19 in those over 80 does not always present with typical symptoms, particularly in those admitted from institutional care. These individuals have a reduced incidence of cough and increased hypoactive delirium. Individuals presenting atypically, especially with anorexia, have higher mortality.

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