Increase in Frailty in Nursing Home Survivors of Coronavirus Disease 2019: Comparison With Noninfected Residents

The association of non-severe COVID-19 infection and progression to frailty among robust older veterans

BACKGROUND

Studies have shown that frailty was increased in hospitalized COVID-19 patients. However, it is not clear whether non-severe COVID-19 increases the risk for pre-frailty and frailty development. Our study aimed to determine the risk of developing frailty and pre-frailty in robust veterans who contracted non-severe COVID-19.

METHODS

We conducted a retrospective cohort study to assess the association of SARS-CoV-2 infection with the development of pre-frailty and frailty status among robust U.S. veterans using VA COVID-19 Shared Data Resource. We included patients 55 years and older who had at least one SARS-CoV-2 testing between March 15, 2020, and November 30, 2020, had been active patients in the past 12 months, and had a VA frailty index of zero (robust status) at the time of testing. Cox proportional hazard model was used to assess the association between COVID-19 infection and developing frailty or pre-frailty and frailty. We also assessed the association by patients' age groups, sex, and race.

FINDINGS

We identified 82070 veterans mean age 68.3 ± 7.8, 74738 (91.1%) male, 53899 (65.7%) white, 7557 (9.2%) with mild COVID-19 infection. Over the follow up period of 36 months, testing positive for COVID-19 was associated with a 66% increase in the hazard of becoming frail (adjusted HR = 1.66, 95%CI: 1.32-2.08), and a 68% increase in the hazard of becoming pre-frail (adjusted HR = 1.68, 95%CI: 1.45-1.94). Among male patients, mild COVID-19 infection was associated with a 54% increase in the hazard of becoming frail (adjusted HR = 1.54, 95% CI: 1.21-1.96), while among female patients there was a 330% increase (adjusted HR = 4.30, 95% CI: 2.13-8.64).

CONCLUSIONS AND RELEVANCE

Non-severe COVID-19 infection that occurred in robust older adults increased the risk of developing frailty. Further multi-center prospective cohort studies evaluating the mechanism of action and clinical trials of treatment options for post-COVID frailty are indicated in Veterans to support clinical care.

Adverse impacts in residential aged care facilities: The resident perspective

OBJECTIVES

Inclusion of consumer perspectives is a key component to person-centred health-care approaches. While current residential aged care systems focus on recording adverse events to meet the requirements of regulatory reporting, little is known about the views of residents. The aim of this research was to explore residents' responses on the types of incidents that have an adverse impact on them and how they are affected by these incidents.

METHODS

The study used a qualitative, inductive approach to derive themes from interviews with 20 permanent residents of aged care facilities in New South Wales and the Australian Capital Territory.

RESULTS

Four main themes surrounding adverse incidents emerged: (i) social relationships and the adverse impacts of lack of meaningful interactions, (ii) adjustment to life in the residential aged care facility and the loss of residents' former life and self-determination, (iii) the impact of COVID-19 lockdowns which meant that residents were not able to go out or interact with others and (iv) acceptance, resignation and resilience in coping with adverse incidents.

CONCLUSIONS

This research highlights the difference between health-care definition, used for incident management reporting and quality indicators, and the way residents respond when asked to describe an incident that has affected them. Resident responses discuss situations having an adverse effect on them in contrast to the way adverse events and incidents are reported and monitored. The findings suggest that within adverse event and incident management systems and resident governance systems, there is scope for incorporating periods of transitions and well-being measures that capture elements that matter to older people.

The Value of the COVID-19 Yorkshire Rehabilitation Scale in the Assessment of Post-COVID among Residents of Long-Term Care Facilities

The COVID-19 Yorkshire Rehabilitation Scale (C19-YRS) is a patient-reported outcome measure designed to assess the long-term effects of COVID-19. The scale was validated and is commonly used in the general population. In this study, we assess the utility of the C19-YRS in evaluating the post-COVID burden among residents of long-term care facilities with a mean age of 79. C19-YRS and Barthel index evaluations were performed among 144 residents of long-term care facilities reporting new or worsened symptoms or functioning three months after convalescence from COVID-19. The C19-YRS-based screening showed that 70.9% of COVID-19 convalescents had ≥1 complaint three months after recovery. The highest C19-YRS-scored symptoms (indicating a higher burden) were breathlessness, fatigue, and cognitive and continence problems; however, symptomatology was very heterogeneous, revealing a high complexity of the disease in older persons. The mean total C19-YRS score was higher in hospitalized patients (n = 78) than in the outpatient group (n = 66) (p = 0.02). The functioning subscale of the C19-YRS strongly correlated with the Barthel index, with r = -0.8001 (p < 0.0001). A moderately strong correlation existed between retrospectively reported C19-YRS-based functioning and the Barthel index score reported before illness (r = 0.7783, p < 0.0001). The C19-YRS is instrumental in evaluating the consequences of COVID-19 among long-term-care residents. The assessment allows for a broad understanding of rehabilitation needs.

Exploring Post-COVID-19 Functional Outcomes in Residents in Long-Term Care Homes in British Columbia, Canada

Research on functional outcomes in long-term care (LTC) home residents after COVID-19 infection is limited. In the current study, we examined outcomes in 1,310 LTC residents with a positive COVID-19 test in the period from March 2020 to April 2022 ("COVID" group). We also reviewed outcomes in residents in the same LTC homes without a history of COVID-19 during the same period ("No-COVID" group, n = 2,301). In a retrospective longitudinal design, we explored activities of daily living (ADLs), cognitive function, and clinical care needs over time. Change was assessed from the last assessment before contracting COVID-19 to three assessments subsequent to COVID-19, over on average seven months after infection. We found deterioration over time in ADLs and cognitive performance in both groups. The change in ADLs and clinical care needs was slightly greater in the COVID than the No-COVID group from baseline to the first follow-up assessment; in subsequent assessments, the change was similar in both groups. Overall, we observed similar functional outcomes among surviving residents in the two groups, with initially greater deterioration in ADLs and clinical care needs in residents with a history of COVID-19 followed by a trajectory resembling the one in the No-COVID residents.

National cross-sectional survey on psychological impact on French nursing homes of the first lockdown during the COVID-19 pandemic as observed by psychologists, psychomotor, and occupational therapists

Objectives

The main objective was to explore the psychological impact of the French lockdown during the first wave of the COVID-19 pandemic on nursing home residents, their relatives, and healthcare teams, as observed by mental health professionals.

Design

A national online cross-sectional survey was conducted from May 11 to June 9, 2020.

Setting and participants

Respondents were psychologists, psychomotor therapists, and occupational therapists (mental health professionals).

Results

A total of 1,062 participants responded to the survey, encompassing 59.8% psychologists, 29.2% occupational therapists, and 11% psychomotor therapists. All mental health professionals felt fear (76.1%), fatigue and exhaustion (84.5%), and inability to manage the emotional burden (78.4%). In nursing homes with COVID-19 cases, residents felt significantly sadder (83.2%), more anxious (65.0%), experienced more anorexia (53.6%), resurgence of traumatic war memories (40.2%), and were more often disoriented (75.7%). The suffering of relatives did not vary between nursing homes with and without COVID-19 cases. The nursing staff was heavily impacted emotionally and was in need of psychological support particularly when working in nursing homes in a low COVID-19 spread zone with COVID-19 cases (41.8 vs. 34.6%).

Conclusion and implications

Primary prevention must be implemented to limit the psychological consequences in the event of a new crisis and to prevent the risk of psychological decompensation of residents and teams in nursing homes.

Effects of SARS-CoV-2 infection on health and functional capacity in institutionalized older adults

OBJECTIVE

To assess the effect of SARS-CoV-2 infection on the health conditions and functional capacity of older adults living in long-term care units in Maceió City - Alagoas State.

METHODS

A prospective cohort was conducted with institutionalized older adults of both sexes. Older adults were assessed for clinical conditions (diagnosis of chronic diseases and biochemical tests), functional capacity, and nutritional status. All assessments were repeated on two occasions, maintaining a 6-month interval between them.

RESULTS

The sample was composed of 289 older adults. Of the total, 98 (33.9%) were positive for COVID-19 and eight died (2.8%). Men were more likely to have COVID-19 (OR = 3.50; p < 0.01). It was observed that the disease contributed to increasing the frequency of dependent older adults after six months (OR = 1.38; p-interaction < 0.01). It was also observed that after six months of positive diagnosis for COVID-19, there was greater weight loss (p < 0.01), reduced BMI (p < 0.01), increased mean SBP (p = 0.04), and DBP (p = 0.03).

CONCLUSION

Effects of COVID-19 in institutionalized older adults go beyond acute complications and compromise blood pressure control, functional capacity, and favor weight loss.

Long COVID in long-term care: a rapid realist review

OBJECTIVES

The goals of this rapid realist review were to ask: (a) what are the key mechanisms that drive successful interventions for long COVID in long-term care (LTC) and (b) what are the critical contexts that determine whether the mechanisms produce the intended outcomes?

DESIGN

Rapid realist review.

DATA SOURCES

Medline, CINAHL, Embase, PsycINFO and Web of Science for peer-reviewed literature and Google for grey literature were searched up to 23 February 2023.

ELIGIBILITY CRITERIA

We included sources focused on interventions, persons in LTC, long COVID or post-acute phase at least 4 weeks following initial COVID-19 infection and ones that had a connection with source materials.

DATA EXTRACTION AND SYNTHESIS

Three independent reviewers searched, screened and coded studies. Two independent moderators resolved conflicts. A data extraction tool organised relevant data into context-mechanism-outcome configurations using realist methodology. Twenty-one sources provided 51 intervention data excerpts used to develop our programme theory. Synthesised findings were presented to a reference group and expert panel for confirmatory purposes.

RESULTS

Fifteen peer-reviewed articles and six grey literature sources were eligible for inclusion. Eleven context-mechanism-outcome configurations identify those contextual factors and underlying mechanisms associated with desired outcomes, such as clinical care processes and policies that ensure timely access to requisite resources for quality care delivery, and resident-centred assessments and care planning to address resident preferences and needs. The underlying mechanisms associated with enhanced outcomes for LTC long COVID survivors were: awareness, accountability, vigilance and empathetic listening.

CONCLUSIONS

Although the LTC sector struggles with organisational capacity issues, they should be aware that comprehensively assessing and monitoring COVID-19 survivors and providing timely interventions to those with long COVID is imperative. This is due to the greater care needs of residents with long COVID, and coordinated efficient care is required to optimise their quality of life.

Consequences of contact restrictions for long-term care residents during the first months of COVID-19 pandemic: a scoping review

During the early stages of the COVID-19 pandemic, stringent measures were implemented in most countries to limit social contact between residents of long-term care facilities (LTCF) and visitors. The objective of this scoping review was to identify and map evidence of direct and indirect consequences of contact restrictions, guided by three conceptual perspectives: (1) stress and learned helplessness (i.e., failure to use coping behaviors even when they are available and actionalble); (2) social contact loss; and (3) 'total institution' (i.e., a facility operates following a fixed plan due to spelled-out rules and norms, controlled by institutional representatives). We used the framework for conducting a scoping review by Arksey and O'Malley; included were peer-reviewed manuscripts reporting on the outcomes of contact restrictions from the beginning of the pandemic until the end of 2020. After removing duplicates, 6,656 records were screened and 62 manuscripts included. Results pertaining to the stress and learned helplessness perspective primarily focused on depressive symptoms, showing substantial increases compared to the pre-pandemic period. Studies examining cognitive and functional decline, as well as non-COVID-19 related mortality, were limited in number and presented mixed findings. The majority of study outcomes related to the social contact loss perspective focused on loneliness, but the study designs did not adequately allow for comparisons with the pre-pandemic status. The evidence concerning outcomes related to the 'total Institution' perspective was inconclusive. Although detrimental effects of social isolation in the long-term care context found support particularly in the negative affect domain, other outcome areas did not allow for definitive conclusions due to considerable variations in findings and, in some cases, insufficient statistical power.

Effects of COVID-19 Lockdown on Nutritional, Functional and Frailty Biomarkers of People Living in Nursing Homes. A Prospective Study

BACKGROUND

Nursing home residences suffered a lockdown from the beginning of the COVID-19 pandemic. The present study prospectively evaluates the frailty, functional, and nutritional statuses of nursing home residents.

METHODS

Three hundred and one residents from three nursing homes took part in the study. Frailty status was measured using the FRAIL scale. Functional status was evaluated using the Barthel Index. Additionally, Short Physical Performance Batter (SPPB), SARC-F, hand-grip strength, and gait speed were also evaluated. Nutritional status was determined using the mini nutritional assessment test (MNA) and several anthropometrical and biochemical markers.

RESULTS

Mini Nutritional Assessment test scores decreased in 20% throughout the confinement (p < .001). Barthel index, SPPB and SARC-F scores also decreased, although to a lesser extent, reflecting a decrease in functional capacity. However, both anthropometric parameters, hand grip strength and gait speed, remained stable throughout confinement (p > .050 in all cases). Morning cortisol secretion significantly decreased by 40% from baseline to post-confinement. A significant reduction in daily cortisol variability was observed, which may suggest increased distress. Fifty-six residents died during the period of confinement (81.4% survival rate). Sex, FRAIL and Barthel Index scores were significant predictors of resident survival.

CONCLUSION

After the first COVID-19 blockade, several alterations in residents' frailty markers were observed, which were small and potentially reversible. However, many of the residents were pre-frail after the lockdown. This fact highlights the need for preventive strategies to reduce the impact of future social and physical stressors on these vulnerable individuals.

Identifying predictors of cognitive decline in long-term care: a scoping review

BACKGROUND

Cognitive impairment can cause social, emotional, and financial burdens on individuals, caregivers, and healthcare providers. This is especially important in settings such as long-term care (LTC) homes which largely consist of vulnerable older adults. Thus, the objective of this study is to review and summarize current research examining risk factors of cognitive decline in older adults within LTC.

METHODS

This scoping review includes primary observational research studies assessing within-person change in cognition over time in LTC or equivalent settings in high resource countries. A mean participant age of ≥ 65 years was required. Searches were conducted in Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PyscInfo on June 27th, 2022 and included articles published during or after the year 2000. Title, abstract, and full-text screening was performed by two independent reviewers using Covidence. Specific predictors along with their associated relation with cognitive decline were extracted by a team of reviewers into a spreadsheet.

RESULTS

Thirty-eight studies were included in this review. The mean sample size was 14 620. Eighty-seven unique predictors were examined in relation to cognitive decline. Dementia was the most studied predictor (examined by 9 of 38 studies), and the most conclusive, with eight of those studies identifying it as a risk factor for cognitive decline. Other predictors that were identified as risk factors included arterial stiffness (identified by 2 of 2 studies), physical frailty (2 of 2 studies), sub-syndromal delirium (2 of 2 studies), and undergoing the first wave of COVID-19 lockdowns (2 of 2 studies). ADL independence was the most conclusive protective factor (3 of 4 studies), followed by social engagement (2 of 3 studies). Many remaining predictors showed no association and/or conflicting results.

CONCLUSIONS

Dementia was the most common risk factor, while ADL independence was the most common protective factor associated with cognitive decline in LTC residents. This information can be used to stratify residents by risk severity and provide better personalized care for older adults through the targeted management of cognitive decline.

Frailty after COVID-19: The wave after?

The COVID-19 pandemic poses an ongoing public health challenge, with a focus on older adults. Given the large number of older persons who have recovered from COVID-19 and reports of long-lasting sequelae, there is reasonable concern that the COVID-19 pandemic may lead to a long-term deterioration in the health of older adults, i.e., a potential "wave of frailty." Therefore, it is critical to better understand the circumstances surrounding the development of frailty as a result of COVID-19, as well as the underlying mechanisms and factors contributing to this development. We conducted a narrative review of the most relevant articles published on the association between COVID-19 and frailty through January 2023. Although few studies to date have addressed the effects of COVID-19 on the onset and progression of frailty, the available data suggest that there is indeed an increase in frailty in the elderly as a result of COVID-19. Regarding the underlying mechanisms, a multicausal genesis can be assumed, involving both direct viral effects and indirect effects, particularly from the imposed lockdowns with devastating consequences for the elderly: decreased physical activity, altered diet, sarcopenia, fatigue, social isolation, neurological problems, inflammation, and cardiovascular morbidity are among the possible mediators. Since the COVID-19 pandemic is leading to an increase in frailty in the elderly, there is an urgent need to raise awareness of this still little-known problem of potentially great public health importance and to find appropriate prevention and treatment measures.

Long COVID and hypertension-related disorders: a report from the Japanese Society of Hypertension Project Team on COVID-19

The coronavirus disease 2019 (COVID-19) affects infected patients even after the acute phase and impairs their health and quality of life by causing a wide variety of symptoms, referred to as long COVID. Although the evidence is still insufficient, hypertension is suspected to be a potential risk factor for long COVID, and the occurrence of cardiovascular diseases seems to be a key facet of multiple conditions observed in long COVID. Nonetheless, there are few reports that comprehensively review the impacts of long COVID on hypertension and related disorders. As a sequel to our previous report in 2020 which reviewed the association of COVID-19 and hypertension, we summarize the possible influences of long COVID on hypertension-related organs, including the cardiovascular system, kidney, and endocrine system, as well as the pathophysiological mechanisms associated with the disorders in this review. Given that the clinical course of COVID-19 is highly affected by age and sex, we also review the impacts of these factors on long COVID. Lastly, we discuss areas of uncertainty and future directions, which may lead to better understanding and improved prognosis of clinical problems associated with COVID-19.

Cognitive Deficits in the Acute Phase of COVID-19: A Review and Meta-Analysis

This meta-analysis was conducted to quantify the risk of patients exhibiting cognitive deficits in the acute phase of COVID-19 at the time of the first variants (i.e., before the vaccine) and quantify the potential vulnerability of older patients and those who experienced more severe respiratory symptoms. To this end, we searched the LitCovid and EMBASE platforms for articles, including preprints, and included all studies (n = 48) that featured a measurement of cognition, which encompassed 2233 cases of COVID-19. Of these, 28 studies reported scores on global cognitive efficiency scales administered in the acute phase of COVID-19 (up to 3 months after infection). We were able to perform a meta-analysis of proportions on 24 articles (N_patients = 943), and a logistic regression on 18 articles (N_patients = 518). The meta-analysis for proportion indicated that 52.31% of patients with COVID-19 exhibited cognitive deficits in the acute phase. This high percentage, however, has to be interpreted taking in consideration the fact that the majority of patients were hospitalized, and some presented neurological complications, such as encephalopathy. A bootstrap procedure with random resampling revealed that an age of 59 was the threshold at which one would be more prone to present cognitive deficits. However, the severity of respiratory symptoms did not influence the scores on a global cognitive efficiency scale. Overall, our results indicated that neuropsychological deficits were a major consequence of the acute phase of the first forms of COVID-19.

Risk Factors of Severe COVID-19: A Review of Host, Viral and Environmental Factors

The clinical course and outcome of COVID-19 are highly variable, ranging from asymptomatic infections to severe disease and death. Understanding the risk factors of severe COVID-19 is relevant both in the clinical setting and at the epidemiological level. Here, we provide an overview of host, viral and environmental factors that have been shown or (in some cases) hypothesized to be associated with severe clinical outcomes. The factors considered in detail include the age and frailty, genetic polymorphisms, biological sex (and pregnancy), co- and superinfections, non-communicable comorbidities, immunological history, microbiota, and lifestyle of the patient; viral genetic variation and infecting dose; socioeconomic factors; and air pollution. For each category, we compile (sometimes conflicting) evidence for the association of the factor with COVID-19 outcomes (including the strength of the effect) and outline possible action mechanisms. We also discuss the complex interactions between the various risk factors.

Older Women Who Practiced Physical Exercises before the COVID-19 Pandemic Present Metabolic Alterations and Worsened Functional Physical Capacity after One Year of Social Isolation

Background: Because the consequences of the lifestyle changes in older adults associated with the social isolation imposed in response to the COVID-19 pandemic are not fully understood, here, we investigated the effects of one year of social isolation imposed by COVID-19 on the metabolic parameters and functional physical capacity of older women who regularly practiced physical exercises before the pandemic. Methods: Systemic lipid and protein profiles, estimated creatinine clearance (ECC), and functional physical capacity (FPC) were assessed before (January-February 2020) and 12 months after social isolation in 30 older women (mean age 73.77 ± 6.22) who were engaged in a combined-exercise training program for at least 3 years before the COVID-19 pandemic. Results: In this group, we observed increased plasma levels of triglycerides and creatinine, an increase in the time necessary to perform gait speed and time-up-and-go tests, and reduced muscle strength assessed by the handgrip test and ECC post-COVID-19 pandemic relative to values recorded pre-pandemic. In addition, we observed significant correlations (both negative and positive) between anthropometric, some metabolic parameters, and physical tests. Conclusion: One year of interruption of physical exercise practice imposed in response to the COVID-19 pandemic significantly altered some systemic metabolic parameters and worsened ECC and FPC in older women.

COVID-19 Vaccination Delivery in Long-Term-Care using the CARD (Comfort Ask Relax Distract) System: Mixed Methods study of Implementation Drivers

Objectives

Methods

Results

Discussion

Trajectories of cognitive and physical performance after accidental falls in nursing home residents: A prospective study

This prospective study evaluated cognitive and physical trajectories of nursing home (NH) residents after fall occurrence and their predictors. In 167 residents aged ≥60, we considered the closest pre-fall assessment and up to the first three post-fall assessments of cognitive and physical functions performed through Mini-Mental State Examination (MMSE) and Tinetti tests. Mixture models identified three post-fall cognitive and physical trajectories: stability, slow decline, and rapid decline. At logistic regression, older age, fewer informal visits, and falls within one month from institutionalization increased the probability of experiencing a decline in MMSE and Tinetti scores. Worse pre-fall cognitive function increased the likelihood of cognitive and physical decline, while worse pre-fall Tinetti score negatively impacted only physical decline. In conclusion, the impact of falls on the cognitive and physical health of NH residents may be modulated by their pre-fall cognitive function and some modifiable factors, such as social interactions and physical function.

Effects of a Multicomponent Exercise Program on Improving Frailty in Post-COVID-19 Older Adults after Intensive Care Units: A Single-Group Retrospective Cohort Study

Background: Older adult patients with post-COVID-19 syndrome present greater physical impairment accompanied by frailty than younger patients, which is why multicomponent exercise programs (MEP) are recommended for their positive effects on improving frailty and physical capacity. The aim of this study was to evaluate the effects of a short MEP (Vivifrail; <4 weeks) on improving frailty in post-COVID-19 older adults after intensive care units. Methods: To develop a retrospective cohort study, data were collected from the functional gait training program based on selected Vivifrail MEP in a single-group and applied to patients admitted with a diagnosis of post-COVID-19 functional impairment. The MEP was carried out for 3 weeks, with daily sessions lasting 40 min. Patients included were assessed at the beginning and at the end of the protocol by using the Short Performance Physical Battery (SPPB), the number of falls in the last year, the number of falls with medical attention, the Timed Up and Go (TUG) test, the presence of dementia, the Trunk Control Test (TCT), the Tinetti balance and gait test, Barthel Index, Medical Research Council Sum Score (MRCSS) and handgrip strength dynamometry. Results: The results of this study show statistically significant improvements in physical fitness and frailty with increases in the Short Physical Performance Battery (Z = 9.12, p < 0.001) by means of the MET applied in its short version (<4 weeks) showing even clinically relevant improvements (>2.5 points). Statistically significant improvements were also found in Medical Research Council Sum Score (Z = 12.345, p < 0.001), Barthel Index Score (Z = 12.272, p < 0.001), Trunk Control Test (Z = 12. 36, p < 0.001), Tinetti−POMA (Z = 12.293, p < 0.001) including the balance (Z = 12.11, p < 0.001), gait (Z = 12.164, p < 0.001) subscales and in the hand dynamometry (Z = 12.172, p < 0.001). Conclusions: The selected Vivifrail MEP is effective and safe for improving frailty in post-COVID-19 older adult’s patients.

Postural balance and its association with functionality and quality of life in non-hospitalized patients with post-acute COVID-19 syndrome

Background and Objectives

The neuromuscular system is responsible for performing adequate muscle activities to maintain postural balance. Since COVID‐19 can cause damage to this system, long‐term sequelae might alter control of postural stability. This study aimed to evaluate the postural balance of patients with post‐acute COVID‐19 syndrome (PCS) who were not hospitalized and to evaluate the correlations of changes in postural balance with general fatigue, muscle strength, and quality of life (QoL).

Methods

This was a cross‐sectional study in which 40 patients with PCS and 40 controls underwent balance assessment through the Berg Balance Scale (BBS) and Tinetti Balance Scale (TBS). They were evaluated for general fatigue by the Functional Assessment of Chronic Illness Therapy‐Fatigue (FACIT‐F) scale, handgrip strength (HGS), and quality of life (QoL) by the Short Form‐36 (SF‐36).

Results

When compared to controls, patients with PCS had lower BBS and TBS scores (p = 0.001 for both). The FACIT‐F score was lower in PCS patients (p = 0.0001). HGS was slightly lower in the PCS patients, but not statistically significant (p = 0.09). Regarding QoL, PCS patients showed worse evaluations in five dimensions of the SF‐36 (physical functioning, physical role limitations, bodily pain, general health perceptions, and mental health). Both the BBS and TBS scores had statistically significant positive correlations with the FACIT‐F score, HGS, and two SF‐36 dimensions (physical role limitations and emotional role limitations).

Conclusions

Patients with PCS show worse postural balance than controls, which is associated with general fatigue, lower HGS, and poor QoL. Postural balance assessment should be considered in the follow‐up and rehabilitation of PCS.

Poor Nutritional Status and Dynapenia Are Highly Prevalent in Post-Acute COVID-19

Poor nutritional status is common (estimated prevalence 5–69%) in acute coronavirus disease-2019 (COVID-19), and has been associated with hospitalization, the need for intensive care, and mortality. Body composition (BC) and muscle function have also been related in such patients to poor disease outcomes.

As the evidence in the literature is limited, a cross-sectional study was carried out to determine the frequency of malnutrition in a cohort of post-acute COVID-19 patients referred to a rehabilitation center after hospital discharge. BC and muscle strength were assessed and the differences between bedridden and not bedridden patients were specifically evaluated.

The study sample was composed of 144 post-acute COVID-19 patients (mean age 64.8 years; males = 95), 37% of whom were bedridden (males = 60%). Nutritional status was evaluated with Mini-Nutritional Assessment (MNA) and Controlling Nutritional status (CONUT). Fat-free mass (FFM) and skeletal muscle mass (SM) were estimated using bioelectrical impedance analysis (BIA). Raw BIA variables (phase angle = PhA and impedance ratios = IRs) were also determined and handgrip strength (HGS) was measured. Dynapenia was identified according to the 2019 EWGSOP criteria.

According to MNA, 18% (n. 26) of patients were malnourished and 62% (n. 89) were at risk of malnutrition. As for CONUT, 21% (n. 31) of cases had moderate–severe malnutrition and 58% (n. 83) had light malnutrition. Abnormalities of raw BIA variables (low PhA and high IRs) and low HGS were more common in bedridden patients, in those who were malnourished, or had low FFM or SM. Dynapenic patients were 65% men and 47% women.

In conclusion, malnutrition, BC alterations, and low HGS occur in post-acute COVID-19 patients and are more common in bedridden patients. Further studies are needed to identify reliable algorithms for assessing nutritional status in post-acute COVID-19 patients undergoing rehabilitation.

Association of frailty and cognitive function disorders in old patients with COVID-19: a protocol of systematic review and meta-analysis

INTRODUCTION

COVID-19 infections have become an urgent worldwide public health concern. Although it is primarily a respiratory disease, up to two-thirds of hospitalised COVID-19 patients exhibit nervous system damage and an increased risk of frailty. In this study,we aim to investigate the relationship between frailty and cognitive function disorders in patients with COVID-19 with a systematic review and meta-analysis approach.

METHODS AND ANALYSIS

This meta-analysis has been registered by the International Prospective Register of Systematic Reviews. We will search for relevant studies from PubMed, Embase, Chinese Biological Medical Database, China National Knowledge Infrastructure, Wanfang Database, the Cochrane Central Register of Controlled Trials databases, from their inception to 5 July 2021. We will also search reference lists of selected articles for additional studies. Our search strategy will have no language restrictions. We will employ a fixed or random-effects model to calculate OR and 95% CIs for pooled data, and assess heterogeneity using Cochrane's Q and I² tests. The primary outcome will be the rate of cognitive disorders related to frailty in old patients with COVID-19.

ETHICS AND DISSEMINATION

Ethical approval is not essential since data will be extracted from previously published studies. The results of this meta-analysis will be published in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42021257148.

Role of senescence in the chronic health consequences of COVID-19

While the full impact of COVID-19 is not yet clear, early studies have indicated that upwards of 10% of patients experience COVID-19 symptoms longer than 3 weeks, known as Long-Hauler's Syndrome or PACS (postacute sequelae of SARS-CoV-2 infection). There is little known about risk factors or predictors of susceptibility for Long-Hauler's Syndrome, but older adults are at greater risk for severe outcomes and mortality from COVID-19. The pillars of aging (including cellular senescence, telomere dysfunction, impaired proteostasis, mitochondrial dysfunction, deregulated nutrient sensing, genomic instability, progenitor cell exhaustion, altered intercellular communication, and epigenetic alterations) that contribute to age-related dysfunction and chronic diseases (the "Geroscience Hypothesis") may interfere with defenses against viral infection and consequences of these infections. Heightening of the low-grade inflammation that is associated with aging may generate an exaggerated response to an acute COVID-19 infection. Innate immune system dysfunction that leads to decreased senescent cell removal and/or increased senescent cell formation could contribute to accumulation of senescent cells with both aging and viral infections. These processes may contribute to increased risk for long-term COVID-19 sequelae in older or chronically ill patients. Hence, senolytics and other geroscience interventions that may prolong healthspan and alleviate chronic diseases and multimorbidity linked to fundamental aging processes might be an option for delaying, preventing, or alleviating Long-Hauler's Syndrome.

A Typology of COVID-19 Data Gaps and Noise From Long-Term Care Facilities: Approximating the True Numbers

Although there is agreement that COVID-19 has had devastating impacts in long-term care facilities (LTCFs), estimates of cases and deaths have varied widely with little attention to the causes of this variation. We developed a typology of data vulnerabilities and a strategy for approximating the true total of COVID-19 cases and deaths in LTCFs. Based on iterative qualitative consensus, we categorized LTCF reporting vulnerabilities and their potential impacts on accuracy. Concurrently, we compiled one dataset based on LTCF self-reports and one based on confirmatory matching with California’s COVID-19 databases, including death certificates. Through March 2021, Alameda County LTCFs reported 6663 COVID-19 cases and 481 deaths. In contrast, our confirmatory matching file includes 5010 cases and 594 deaths, corresponding to 25% fewer cases but 23% more deaths. We argue that the higher (self-report) case total approximates the lower bound of true COVID-19 cases, and the higher (confirmed match) death total approximates the lower bound of true COVID-19 deaths, both of which are higher than state and federal counts. LTCFs other than nursing facilities accounted for 35% of cases and 29% of deaths. Improving the accuracy of COVID-19 figures, particularly across types of LTCFs, would better inform interventions for these vulnerable populations.

Immunogenicity of the BNT162b2 mRNA COVID-19 vaccine in older residents of a long-term care facility: relation with age, frailty and prior infection status

Clinical and biological assessment of the COVID-19 vaccine efficacy in the frail population is of crucial importance. The study focuses on measuring the levels of anti-SARS-CoV-2 IgG antibodies before and after BNT162b2 mRNA COVID-19 vaccination among long-term care facility (LTCF) elderly residents. We conducted a prospective, single-center, observational study among LTCF residents. The study protocol was based on three blood sample acquisitions: first taken at baseline-5 days before the first dose of the vaccine, second-20 days after the first dose, and third-12 days after the second shot of the vaccine. The comparison was made for two cohorts: patients with and without prior COVID-19 infection. The data was collected from January to March 2021. A total number of 78 LTCF residents (55 women and 23 men) aged 62-104, 85.72 ± 7.59 years (mean ± SD), were enrolled in the study. All study participants were investigated for the presence of SARS-CoV-2 anti-spike (S) protein IgG, using a chemiluminescent immunoassay. Frailty was assessed with the Clinical Frailty Scale. Among elderly COVID-19 survivors in LTCF, a single dose of vaccine significantly increased anti-SARS-CoV-2 IgG antibody levels. IgG concentration after a single and double dose was comparable, which may suggest that elderly COVID-19 survivors do not require a second dose of vaccine. For residents without a previous history of COVID-19, two doses are needed to achieve an effective serological response. The level of anti-SARS-CoV-2 IgG antibodies after vaccination with BNT162b2 mRNA COVID-19 did not correlate with the frailty and age of the studied individuals.

Monitoring COVID-19 vaccine use in Italian Long Term Care Centers: the GeroCovid VAX Study

The COVID-19 pandemic has changed routine care practice for older persons, especially in those with frailty living in long term care (LTC) facilities. Due to the high mortality rates of Nursing home (NH) residents during the first wave of the COVID-19 pandemic, priority for COVID-19 vaccinations was given to this vulnerable population. However, the safety and efficacy of such vaccines in older frail elders remains questionable due to the fact that initial randomized clinical trials (RCTs) for such vaccines did not include this population. This type of discrimination in patient participation in RCTs continues and has been recognized in the literature. Nevertheless, in the context of a worldwide emergency, COVID-19 vaccination in older persons living in LTC facilities may provide a solid basis to protect against negative outcomes, such as COVID-19 infection and death. In this report, we present the protocol of the GeroCovid Vax study, an Italian study that began in February 2021 which is aimed at investigating the safety and efficacy of the anti-SARS-CoV-2 vaccinations in older persons living in LTCs. This protocol specially aims to continuously and closely monitor events related to- and following- the anti-SARS-CoV-2 vaccination in elderly living in LTC facilities. In this report, we will provide information related to the study protocol and describe baseline characteristics of the sample.

Internet-based cognitive behavioral therapy for psychological distress in older adults without cognitive impairment living in nursing homes during the COVID-19 pandemic: A feasibility study

BACKGROUND

The COVID-19 pandemic has had a detrimental effect on the mental health of older adults living in nursing homes. Very few studies have examined the effects of Internet-based Cognitive Behavioral Therapy (ICBT) on older adults living in nursing homes during the pandemic. We conducted a feasibility study using a single-group design, to explore the effectiveness of ICBT on psychological distress in 137 older adults (without cognitive impairment) from 8 nursing homes in 4 southeast cities in China, between January and March 2020.

METHODS

Symptoms of depression, anxiety, general psychological distress, and functional disability were measured at baseline, post-treatment (5 weeks) and at a 1-month follow-up. Mixed-effects model was used to assess the effects of ICBT.

RESULTS

Statistically significant changes with large effect sizes were observed from pre- to post-treatment on the PHQ-9 (p < .001, Cohen's d = 1.74), GAD-7 (p < .001, d = 1.71), GDS (p < .001, d = 1.30), K-10 (p < .001, d = 1.93), and SDS (p < .001, d = 2.03). Furthermore, improvements in treatment outcomes were sustained at 1-month follow-up, and high levels of adherence and satisfaction were indicated.

CONCLUSION

ICBT was effective in reducing psychological distress in older adults without cognitive impairments living in nursing homes during the COVID-19 pandemic. Thus, it could be applied in improving the mental health of this vulnerable group during the pandemic.

SARS-CoV-2 causes senescence in human cells and exacerbates the senescence-associated secretory phenotype through TLR-3

Senescent cells, which arise due to damage-associated signals, are apoptosis-resistant and can express a pro-inflammatory, tissue-destructive senescence-associated secretory phenotype (SASP). We recently reported that a component of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) surface protein, S1, can amplify the SASP of senescent cultured human cells and that a related mouse β-coronavirus, mouse hepatitis virus (MHV), increases SASP factors and senescent cell burden in infected mice. Here, we show that SARS-CoV-2 induces senescence in human non-senescent cells and exacerbates the SASP in human senescent cells through Toll-like receptor-3 (TLR-3). TLR-3, which senses viral RNA, was increased in human senescent compared to non-senescent cells. Notably, genetically or pharmacologically inhibiting TLR-3 prevented senescence induction and SASP amplification by SARS-CoV-2 or Spike pseudotyped virus. While an artificial TLR-3 agonist alone was not sufficient to induce senescence, it amplified the SASP in senescent human cells. Consistent with these findings, lung p16INK4a+ senescent cell burden was higher in patients who died from acute SARS-CoV-2 infection than other causes. Our results suggest that induction of cellular senescence and SASP amplification through TLR-3 contribute to SARS-CoV-2 morbidity, indicating that clinical trials of senolytics and/or SASP/TLR-3 inhibitors for alleviating acute and long-term SARS-CoV-2 sequelae are warranted.

Concurrent and Predictive Validity of FRAIL-NH in Hospitalized Older Persons: An Exploratory Study

OBJECTIVES

The FRAIL-NH was originally developed for frailty assessment of nursing home (NH) residents. We aimed to compare concurrent, predictive, and known-groups validity between FRAIL-NH and FRAIL, using the Frailty Index (FI) as gold standard reference. We also examined for ceiling effect of both measures in the detection of severe frailty.

DESIGN

A secondary analysis of a prospective cohort study.

SETTING & PARTICIPANTS

Older adults (mean age 89.4 years) hospitalized for an acute medical illness in a 1300-bed tertiary hospital.

MEASUREMENTS

Baseline data on demographics, comorbidities, severity of illness, functional status, and cognitive status were gathered. We also captured outcomes of mortality, length of stay (LOS), institutionalization, and functional decline. For concurrent validity, we compared areas under the operating characteristic curves (AUCs) for both measures against the FI. For predictive validity, univariate analyses and multiple logistic regression were used to compare both measures against the adverse outcomes of interest. For known-groups validity, we compared both measures against comorbidities and functional status via 1-way analysis of variance, and dementia diagnosis via independent t test. Box plots were also derived to investigate for possible ceiling effect.

RESULTS

Both measures had good concurrent validity (both AUC > 0.8 and P < .001), with FRAIL-NH detecting more frailty cases (79.5% vs 50.0%). Although FRAIL-frail was superior for in-hospital mortality [6.7% vs 1.0%, P = .031, odds ratio (OR) 9.29, 95% confidence interval (CI) 1.09-79.20, P < .042] and LOS (10 vs 8 days, P = .043), FRAIL-NH-frail better predicted mortality (OR 6.62, 95% CI 1.91-22.94, P = .003) and institutionalization (OR 6.03, 95% CI 2.01-18.09, P = .001) up to 12 months postenrollment. Known-groups validity was good for both measures with FRAIL-NH yielding greater F values for functional status and dementia. Lastly, box plots revealed a ceiling effect for FRAIL in the severely frail group.

CONCLUSIONS AND IMPLICATIONS

This exploratory study highlights the potential for expanding the role of FRAIL-NH beyond NH to acute care settings. Contrasted to FRAIL, FRAIL-NH had better overall validity with less ceiling effect in discrimination of severe frailty.

The FRAIL-NH Scale: Systematic Review of the Use, Validity and Adaptations for Frailty Screening in Nursing Homes

OBJECTIVES

To investigate frailty prevalence, cross-sectional associations, predictive validity, concurrent validity, and cross-cultural adaptations of the FRAIL-NH scale.

DESIGN

Systematic review.

SETTING AND PARTICIPANTS

Frail residents living in nursing homes.

METHODS

MEDLINE, EMBASE, CINAHL, and Cochrane Library were searched from January 2015 to June 2021 for primary studies that used the FRAIL-NH scale, irrespective of study designs and publication language.

RESULTS

Overall, 40 studies conducted across 20 countries utilized the FRAIL-NH scale; majority in Australia (n=14), followed by China (n=6), United States (n=3), and Spain (n=3). The scale has been translated and back-translated into Brazilian Portuguese, Chinese, and Japanese. Various cut-offs have been used, with ≥2 and ≥6 being the most common cut-offs for frail and most frail, respectively. When defined using these cut-offs, frailty prevalence varied from 15.1-79.5% (frail) to 28.5-75.0% (most frail). FRAIL-NH predicted falls (n=2), hospitalization or length of stay (n=4), functional or cognitive decline (n=4), and mortality (n=9) over a median follow-up of 12 months. FRAIL-NH has been compared to 16 other scales, and was correlated with Fried's phenotype (FP), Frailty Index (FI), and FI-Lab. Four studies reported fair-to-moderate agreements between FRAIL-NH and FI, FP, and the Comprehensive Geriatric Assessment. Ten studies assessed the sensitivity and specificity of different FRAIL-NH cut-offs, with ≥8 having the highest sensitivity (94.1%) and specificity (82.8%) for classifying residents as frail based on FI, while two studies reported an optimal cut-off of ≥2 based on FI and FP, respectively.

CONCLUSION

In seven years, the FRAIL-NH scale has been applied in 20 countries and adapted into three languages. Despite being applied with a range of cut-offs, FRAIL-NH was associated with higher care needs and demonstrated good agreement with other well-established but more complex scales. FRAIL-NH was predictive of adverse outcomes across different settings, highlighting its value in guiding care for frail residents in nursing homes.