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Falsey AR, Maggi S, Biering-Sørensen T. Podcast: Need for Quality Evidence for Decision-Making on Seasonal Influenza Vaccines. Infect Dis Ther 2024; 13:659-666. [PMID: 38485847 PMCID: PMC11058138 DOI: 10.1007/s40121-024-00932-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/26/2024] [Indexed: 04/30/2024] Open
Abstract
Seasonal influenza is usually considered an acute respiratory infection with a full recovery within a week. In addition to the traditional outcomes, there is now evidence of indirect effects in terms of neurological and functional complications. Major organ systems can be affected, underlining the need for preventative measures against infection. The aim of this podcast, featuring Dr. Ann Falsey, Dr. Stefania Maggi, and Dr. Tor Biering-Sørensen, is to outline influenza complications beyond acute respiratory disease, as well as discussing the need for quality of evidence when evaluating influenza vaccines. Assessing the benefits of vaccination can be challenging. To ensure a high quality of evidence, the innovative randomization of patients within the study design to avoid bias and the assessment of additional outcomes beyond immunogenicity as well as the inclusion of a broad population-including frail or vulnerable individuals-are essential. Studies leveraging nationwide registries such as the DANFLU-2 trial in Denmark highlight the advantages of a digitalized healthcare system for conducting large-scale randomized trials. Furthermore, large-scale trials such as the Gravenstein study have supplied a sizable body of evidence supporting the use of high-dose influenza vaccine in older adults. In conclusion, achieving a high quality of evidence is key for decision-making on seasonal influenza vaccines.
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Affiliation(s)
- Ann R Falsey
- Department of Medicine, Infectious Diseases, University of Rochester Medical Center, Rochester, USA.
| | - Stefania Maggi
- Aging Branch, CNR Institute of Neuroscience, Padua, Italy
| | - Tor Biering-Sørensen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, Copenhagen, Denmark
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Correa RA, Arancibia F, De Ávila Kfouri R, Chebabo A, García G, Gutiérrez Robledo LM, Lopardo G, Nemerovsky J, Pérez CM, Rendon A, Ruiz-Palacios GM, Aggarwal B, Berzanskis A, Cintra O. Understanding the Burden of Respiratory Syncytial Virus in Older Adults in Latin America: An Expert Perspective on Knowledge Gaps. Pulm Ther 2024; 10:1-20. [PMID: 38358618 PMCID: PMC10881952 DOI: 10.1007/s41030-024-00253-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 01/12/2024] [Indexed: 02/16/2024] Open
Abstract
Respiratory syncytial virus (RSV) is a significant global health concern and major cause of hospitalization, particularly among infants and older adults. The clinical impact of RSV is well characterized in infants; however, in many countries, the burden and risk of RSV in older populations are overlooked. In Latin America, there are limited data on RSV epidemiology and disease management in older adults. Therefore, the impact of RSV in this region needs to be addressed. Here, current insights on RSV infections in older populations in Latin America, including those with underlying health conditions, are discussed. We also outline the key challenges limiting our understanding of the burden of RSV in Latin America in a worldwide context and propose an expert consensus to improve our understanding of the burden of RSV in the region. By so doing, we aim to ultimately improve disease management and outcomes of those at risk and to alleviate the impact on healthcare systems.A graphical plain language summary is available with this article.
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Affiliation(s)
- Ricardo Amorim Correa
- Medical School, Pulmonology and Thoracic Surgery Department, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Francisco Arancibia
- Pulmonary Department, Instituto Nacional del Tórax and Clínica Santa María, Santiago de Chile, Chile
| | - Renato De Ávila Kfouri
- Pediatric Infectious Disease Specialist, Brazilian Pediatric Society and Brazilian Immunization, São Paulo, Brazil
| | - Alberto Chebabo
- University Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Luis Miguel Gutiérrez Robledo
- National Institute of Medical Sciences and Nutrition "S Zubiran" and National Institute of Geriatric Medicine, Mexico City, Mexico
| | - Gustavo Lopardo
- Infectious Diseases Department, Hospital Bernardo Houssay, Buenos Aires, Argentina
| | - Julio Nemerovsky
- Geriatrician Physician, Argentine Society of Gerontology and Geriatrics, Buenos Aires, Argentina
| | - Carlos M Pérez
- Faculty of Medicine and Science, Universidad San Sebastian, Santiago, Chile
| | - Adrian Rendon
- Universidad Autonoma de Nuevo León, Hospital Universitario "Dr. Jose Eleuterio Gonzalez", Centro de Investigación, Prevención y Tratamiento de Infecciones Respiratorias (CIPTIR), Monterrey, Mexico
| | - Guillermo M Ruiz-Palacios
- Department of Infectious Diseases, National Institute of Medical Sciences and Nutrition, Mexico City, Mexico
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Maggi S, Andrew MK, de Boer A. Podcast: Influenza-Associated Complications and the Impact of Vaccination on Public Health. Infect Dis Ther 2024; 13:413-420. [PMID: 37996695 PMCID: PMC10965885 DOI: 10.1007/s40121-023-00885-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/04/2023] [Indexed: 11/25/2023] Open
Abstract
Influenza is primarily considered an acute respiratory infection but can lead to a myriad of medium and long-term sequelae across every major organ system in the body. Increasing awareness, gaining broader understanding of its mechanistic pathways, identifying at-risk individuals, and determining how to better protect them could help minimize its impact. The aim of this podcast, featuring Dr Stefania Maggi, Dr Annemarijn de Boer, and Dr Melissa K. Andrew, is to outline the main influenza complications and their impact beyond acute respiratory disease, as well as highlighting vaccination as a tool at our disposal. Both physical and cognitive function can be affected as a result of influenza infection, notably in frailer individuals, which in turn may lead to a loss of independence. Observational studies have identified beneficial effects of vaccination for cardioprotection as well as preventing dementia, but more evidence is required. In conclusion, influenza can cause a wide array of complications, which vaccination may help prevent.Podcast available for this article.
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Affiliation(s)
- Stefania Maggi
- Aging Branch, CNR Institute of Neuroscience, Padua, Italy.
| | - Melissa K Andrew
- Department of Medicine, Division of Geriatric Medicine, Dalhousie University, Nova Scotia, Canada
| | - Annemarijn de Boer
- Julius Center for Health Sciences and Primary Care, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands
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Weng B, Jin J, Huang L, Tong X, Jiao W, Wang Y, Fang C, Wang M, Li Y. Risk factors associated with functional decline in older hospital survivors with acute lower respiratory tract infections: a prospective cohort study. BMC Geriatr 2024; 24:208. [PMID: 38424506 PMCID: PMC10902937 DOI: 10.1186/s12877-024-04838-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 02/21/2024] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVE To evaluate the dynamics of basic activity of daily living (BADL) in older patients with acute lower respiratory tract infections (LRTIs) during acute phase and to investigate risk factors associated with decreased physical function at discharge. METHODS We conducted a prospective cohort study of patients aged 65 years and older who were hospitalized for acute LRTIs between April 15, 2020 and January 15, 2023. All patients received geriatric assessment at admission, including emotion, cognition, frailty, physical function status and so on. The BADL was also evaluated by the Barthel Index (BI) at two weeks before admission by recall (baseline status), at admission and at discharge. Based on the BI grades at baseline and at discharge, patients were classified into two groups: ADL decline and no ADL decline. Multivariable adjusted logistic regression models were used to evaluate the risk factors of decreased physical function. RESULTS A total of 364 older survivors with LRTIs were included in the analysis. The median age was 74 years (IQR 61.0-82.0), 231 (62.6%) were male, the median length of stay was 10 days. In the geriatric assessment, 139 patients (38.2%) were classified as frailty, 137 patients (37.6%) experienced insomnia, 60 patients (16.5%) exhibited cognitive impairments, and 37 patients (10.2%) were defined as malnutrition. Additionally, 30 patients (8.2%) dealt with emotional disorders. On average, patients were taking 3 medications, and Charlson Comorbidity Index score was 4. 72 patients (19.8%) had function decline at discharge. In the multivariable analysis, frailty status had an odds ratio of 4.25 (95% CI 1.31-19.26) for decreased physical function and cognitive impairment had an odds ratio of 2.58 (95% CI 1.27-5.19). CONCLUSIONS About 20% older patients with LRTIs experienced functional decline at discharge. Compared to age, severity of diseases and length of stay, frailty and cognitive impairment performed better at predicting the function decline. The apply of geriatric assessment may contribute to enhance the quality of management and treatment for patients with the older with LRTIs.
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Affiliation(s)
- Bingxuan Weng
- Department of Respiratory and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Jin Jin
- Department of Respiratory and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Lixue Huang
- Department of Respiratory and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Xunliang Tong
- Department of Respiratory and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Wenshu Jiao
- Department of Respiratory and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Yuanqi Wang
- Department of Respiratory and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Chuangsen Fang
- Department of Respiratory and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Mengyuan Wang
- Department of Respiratory and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Yanming Li
- Department of Respiratory and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China.
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Tobin R, Pridham G, Rutenberg AD. Modelling lifespan reduction in an exogenous damage model of generic disease. Sci Rep 2023; 13:16304. [PMID: 37770483 PMCID: PMC10539353 DOI: 10.1038/s41598-023-43005-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 09/18/2023] [Indexed: 09/30/2023] Open
Abstract
We model the effects of disease and other exogenous damage during human aging. Even when the exogenous damage is repaired at the end of acute disease, propagated secondary damage remains. We consider both short-term mortality effects due to (acute) exogenous damage and long-term mortality effects due to propagated damage within the context of a generic network model (GNM) of individual aging that simulates a U.S. population. Across a wide range of disease durations and severities we find that while excess short-term mortality is highest for the oldest individuals, the long-term years of life lost are highest for the youngest individuals. These appear to be universal effects of human disease. We support this conclusion with a phenomenological model coupling damage and mortality. Our results are consistent with previous lifetime mortality studies of atom bomb survivors and post-recovery health studies of COVID-19. We suggest that short-term health impact studies could complement lifetime mortality studies to better characterize the lifetime impacts of disease on both individuals and populations.
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Affiliation(s)
- Rebecca Tobin
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, NS, B3H 4R2, Canada
- Data Science, Analytics, and Artificial Intelligence (DSAAI) program, Carlton University, Ottawa, K1S 5B6, Canada
| | - Glen Pridham
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, NS, B3H 4R2, Canada
| | - Andrew D Rutenberg
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, NS, B3H 4R2, Canada.
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Bowdish DM, Rossi L, Loeb M, Johnstone J, Schenck LP, Fontes M, Surette MG, Whelan FJ. The impact of respiratory infections and probiotic use on the nasal microbiota of frail residents in long-term care homes. ERJ Open Res 2023; 9:00212-2023. [PMID: 37753289 PMCID: PMC10518876 DOI: 10.1183/23120541.00212-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/19/2023] [Indexed: 09/28/2023] Open
Abstract
Background Residents in long-term care homes, who tend to be of advanced age and frail, are at increased risk of respiratory infections. The respiratory microbiota is known to change with age, but whether these changes contribute to the risk of infection is not known. Our goal was to determine how the nasal microbiota of frail older adults changes during symptoms of influenza-like illness (ILI) and how this may be impacted by enrolment in a placebo-controlled trial testing the feasibility of administering a Lactobacillus rhamnosus GG probiotic to prevent respiratory infection (2014-2017). Methods The microbiome of the nasal (mid-turbinate) of 150 residents of long-term care homes was interrogated using 16S rRNA gene sequencing. Results We identified a diverse and individualised microbiota which could be separated into nine distinct clusters based on Bray-Curtis distances. Samples collected during symptoms of ILI differed statistically from those collected pre- and post-cold and influenza season, and we observed decreased temporal stability (as measured by movement between clusters) in individuals who experienced ILI compared to those who did not. Conclusions The use of probiotics decreased ILI-induced changes to the microbiota; however, it is not clear whether this decrease is sufficient to prevent respiratory illness.
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Affiliation(s)
- Dawn M.E. Bowdish
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- M.G. DeGroote Institute for Infectious Disease Research, McMaster University, Hamilton, ON, Canada
- Firestone Institute for Respiratory Health, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Laura Rossi
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Mark Loeb
- M.G. DeGroote Institute for Infectious Disease Research, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Jennie Johnstone
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Louis P. Schenck
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada
| | - Michelle Fontes
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Michael G. Surette
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- M.G. DeGroote Institute for Infectious Disease Research, McMaster University, Hamilton, ON, Canada
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada
| | - Fiona J. Whelan
- School of Life Sciences, University of Nottingham, Nottingham, UK
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7
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ElSherif M, Andrew MK, Ye L, Ambrose A, Boivin G, Bowie W, David MP, Gruselle O, Halperin SA, Hatchette TF, Johnstone J, Katz K, Langley JM, Loeb M, MacKinnon-Cameron D, McCarthy A, McElhaney JE, McGeer A, Poirier A, Pirçon JY, Powis J, Richardson D, Semret M, Smith S, Smyth D, Trottier S, Valiquette L, Webster D, McNeil SA, LeBlanc JJ. Leveraging Influenza Virus Surveillance From 2012 to 2015 to Characterize the Burden of Respiratory Syncytial Virus Disease in Canadian Adults ≥50 Years of Age Hospitalized With Acute Respiratory Illness. Open Forum Infect Dis 2023; 10:ofad315. [PMID: 37441353 PMCID: PMC10334379 DOI: 10.1093/ofid/ofad315] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/12/2023] [Indexed: 07/15/2023] Open
Abstract
Background Respiratory syncytial virus (RSV) disease in older adults is undercharacterized. To help inform future immunization policies, this study aimed to describe the disease burden in Canadian adults aged ≥50 years hospitalized with RSV. Methods Using administrative data and nasopharyngeal swabs collected from active surveillance among adults aged ≥50 years hospitalized with an acute respiratory illness (ARI) during the 2012-2013, 2013-2014, and 2014-2015 influenza seasons, RSV was identified using a respiratory virus multiplex polymerase chain reaction test to describe the associated disease burden, incidence, and healthcare costs. Results Of 7797 patients tested, 371 (4.8%) were RSV positive (2.2% RSV-A and 2.6% RSV-B). RSV prevalence varied by season from 4.2% to 6.2%. Respiratory virus coinfection was observed in 11.6% (43/371) of RSV cases, with influenza A being the most common. RSV hospitalization rates varied between seasons and increased with age, from 8-12 per 100 000 population in adults aged 50-59 years to 174-487 per 100 000 in adults aged ≥80 years. The median age of RSV cases was 74.9 years, 63.7% were female, and 98.1% of cases had ≥1 comorbidity. Among RSV cases, the mean length of hospital stay was 10.6 days, 13.7% were admitted to the intensive care unit, 6.4% required mechanical ventilation, and 6.1% died. The mean cost per RSV case was $13 602 (Canadian dollars) but varied by age and Canadian province. Conclusions This study adds to the growing literature on adult RSV burden by showing considerable morbidity, mortality, and healthcare costs in hospitalized adults aged ≥50 years with ARIs such as influenza.
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Affiliation(s)
- May ElSherif
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Melissa K Andrew
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lingyun Ye
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ardith Ambrose
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Guy Boivin
- Centre de Recherche du Centre hospitalier universitaire de Québec-Université Laval, Québec City, Québec, Canada
| | - William Bowie
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Scott A Halperin
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Todd F Hatchette
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Kevin Katz
- North York General Hospital, Toronto, Ontario, Canada
| | - Joanne M Langley
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mark Loeb
- McMaster University, Hamilton, Ontario, Canada
| | - Donna MacKinnon-Cameron
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | | | - Andre Poirier
- Centre intégré universitaire de santé et services sociaux de la Mauricie et du Centre du Québec, Québec City, Québec, Canada
| | | | - Jeff Powis
- Michael Garron Hospital, Toronto, Ontario, Canada
| | | | | | | | - Daniel Smyth
- The Moncton Hospital, Moncton, New Brunswick, Canada
| | - Sylvie Trottier
- Centre de Recherche du Centre hospitalier universitaire de Québec-Université Laval, Québec City, Québec, Canada
| | | | - Duncan Webster
- Saint John Regional Hospital, Saint John, New Brunswick, Canada
| | - Shelly A McNeil
- Correspondence: Jason J. LeBlanc, PhD, FCCM, D(ABMM), Division of Microbiology, Nova Scotia Health, Queen Elizabeth II Health Sciences Centre, Room 404B, Mackenzie Bldg, 5788 University Ave, Halifax, NS B3H 1V8, Canada (); Shelly McNeil, MD, FRCPC, FIDSA, Canadian Center for Vaccinology, IWK Health Centre, 4th Floor Goldbloom Pavilion, 5850/5980 University Ave, Halifax, NS B3K 6R8, Canada ()
| | - Jason J LeBlanc
- Correspondence: Jason J. LeBlanc, PhD, FCCM, D(ABMM), Division of Microbiology, Nova Scotia Health, Queen Elizabeth II Health Sciences Centre, Room 404B, Mackenzie Bldg, 5788 University Ave, Halifax, NS B3H 1V8, Canada (); Shelly McNeil, MD, FRCPC, FIDSA, Canadian Center for Vaccinology, IWK Health Centre, 4th Floor Goldbloom Pavilion, 5850/5980 University Ave, Halifax, NS B3K 6R8, Canada ()
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8
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Iwai-Saito K, Sato K, Kondo K. Associations of influenza and pneumococcal vaccinations with burdens of older family caregivers: The Japan Gerontological Evaluation study (JAGES) cross-sectional study. Vaccine 2023; 41:444-451. [PMID: 36470685 DOI: 10.1016/j.vaccine.2022.11.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/28/2022] [Accepted: 11/20/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Influenza and pneumonia tend to be severe in older adults; thus, vaccination is necessary to prevent these illnesses. Vaccination is especially important for older family caregivers (OFCs) not only to prevent them from becoming ill, but also to prevent secondary infections in the family care receivers (FCRs), who are mostly frail older adults and have a higher risk of severe illness. Thus, we investigated whether caregiving burdens were associated with the vaccinations among older adults. METHODS We used cross-sectional data from the Japan Gerontological Evaluation Study (JAGES), which was conducted in 64 Japanese municipalities from November 2019 to January 2020. The target population consisted of 26,177 individuals aged 65 years or older who were independent and did not need public long-term care. The primary outcome was the uptakes of either or both influenza and pneumococcal vaccinations. Multinomial logistic regressions were performed, setting those who underwent neither vaccinations as the reference group. RESULTS Among the participants, 23.3 %, 25.8 %, 9.4 %, or 41.5 % underwent neither, only influenza, only pneumococcal, or the both vaccinations, respectively. The caregiving frequency, time length in a day, or dementia of FCR were negatively associated with influenza vaccination (caregiving almost every day: relative risk ratio {RRR}: 0.39, 95 % confident interval {95 % CI} [0.24-0.63]; caregiving almost all day: 0.44, 95 % CI: 0.23-0.85; caregiving for FCR: RRR:0.55, 95 % CI: 0.34-0.91). On the other hand, those caregiving burdens were not associated with pneumococcal only or the both vaccinations. Having a family physician mitigated all the negative effect of the caregiving burdens on the vaccinations. CONCLUSION Our results suggest that the caregiving burden is a barrier to influenza vaccination but not to pneumococcal vaccination and that having a physician mitigates the negative effect regardless of the burden kind.
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Affiliation(s)
- Kousuke Iwai-Saito
- Division of International Health, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
| | - Koryu Sato
- Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University, Kyoto, Japan.
| | - Katsunori Kondo
- Department of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba 360-0856, Japan; Department of Gerontological Evaluation, Center for Gerontology and Social Science, Research Institution, National Center for Geriatrics and Gerontology, Aichi, Japan.
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9
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Niebla-Cárdenas A, Bareke H, Juanes-Velasco P, Landeira-Viñuela A, Hernández ÁP, Montalvillo E, Góngora R, Arroyo-Anlló E, Silvia Puente-González A, Méndez-Sánchez R, Fuentes M. Translational research into frailty from bench to bedside: Salivary biomarkers for inflammaging. Exp Gerontol 2023; 171:112040. [PMID: 36455696 DOI: 10.1016/j.exger.2022.112040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 11/22/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022]
Abstract
Frailty is a complex physiological syndrome associated with adverse ageing and decreased physiological reserves. Frailty leads to cognitive and physical disability and is a significant cause of morbidity, mortality and economic costs. The underlying cause of frailty is multifaceted, including immunosenescence and inflammaging, changes in microbiota and metabolic dysfunction. Currently, salivary biomarkers are used as early predictors for some clinical diseases, contributing to the effective prevention and treatment of diseases, including frailty. Sample collection for salivary analysis is non-invasive and simple, which are paramount factors for testing in the vulnerable frail population. The aim of this review is to describe the current knowledge on the association between frailty and the inflammatory process and discuss methods to identify putative biomarkers in salivary fluids to predict this syndrome. This study describes the relationship between i.-inflammatory process and frailty; ii.-infectious, chronic, skeletal, metabolic and cognitive diseases with inflammation and frailty; iii.-inflammatory biomarkers and salivary fluids. There is a limited number of previous studies focusing on the analysis of inflammatory salivary biomarkers and frailty syndrome; hence, the study of salivary fluids as a source for biomarkers is an open area of research with the potential to address the increasing demands for frailty-associated biomarkers.
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Affiliation(s)
- Alfonssina Niebla-Cárdenas
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Salamanca, 37007 Salamanca, Spain
| | - Halin Bareke
- Department of Pharmaceutical Biotechnology, Faculty of Pharmacy, Institute of Health Sciences, Marmara University, Istanbul, Turkey; Department of Medicine and Cytometry General Service-Nucleus, CIBERONC CB16/12/00400, Cancer Research Centre (IBMCC/CSIC/USAL/IBSAL), 37007 Salamanca, Spain
| | - Pablo Juanes-Velasco
- Department of Medicine and Cytometry General Service-Nucleus, CIBERONC CB16/12/00400, Cancer Research Centre (IBMCC/CSIC/USAL/IBSAL), 37007 Salamanca, Spain
| | - Alicia Landeira-Viñuela
- Department of Medicine and Cytometry General Service-Nucleus, CIBERONC CB16/12/00400, Cancer Research Centre (IBMCC/CSIC/USAL/IBSAL), 37007 Salamanca, Spain
| | - Ángela-Patricia Hernández
- Department of Medicine and Cytometry General Service-Nucleus, CIBERONC CB16/12/00400, Cancer Research Centre (IBMCC/CSIC/USAL/IBSAL), 37007 Salamanca, Spain; Department of Pharmaceutical Sciences: Organic Chemistry, Faculty of Pharmacy, University of Salamanca, CIETUS, IBSAL, 37007 Salamanca, Spain
| | - Enrique Montalvillo
- Department of Medicine and Cytometry General Service-Nucleus, CIBERONC CB16/12/00400, Cancer Research Centre (IBMCC/CSIC/USAL/IBSAL), 37007 Salamanca, Spain
| | - Rafael Góngora
- Department of Medicine and Cytometry General Service-Nucleus, CIBERONC CB16/12/00400, Cancer Research Centre (IBMCC/CSIC/USAL/IBSAL), 37007 Salamanca, Spain
| | - Eva Arroyo-Anlló
- Department of Psychobiology, Neuroscience Institute of Castilla-León, Faculty of Psychology, University of Salamanca, 37007 Salamanca, Spain
| | - Ana Silvia Puente-González
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Salamanca, 37007 Salamanca, Spain; Institute of Biomedical Research of Salamanca. Primary Care, Public Health and Pharmacology Area, 37007 Salamanca, Spain.
| | - Roberto Méndez-Sánchez
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Salamanca, 37007 Salamanca, Spain; Institute of Biomedical Research of Salamanca. Primary Care, Public Health and Pharmacology Area, 37007 Salamanca, Spain
| | - Manuel Fuentes
- Department of Medicine and Cytometry General Service-Nucleus, CIBERONC CB16/12/00400, Cancer Research Centre (IBMCC/CSIC/USAL/IBSAL), 37007 Salamanca, Spain; Proteomics Unit, Cancer Research Centre (IBMCC/CSIC/USAL/IBSAL), Salamanca, Spain.
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10
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Barazzoni R, Bischoff SC, Busetto L, Cederholm T, Chourdakis M, Cuerda C, Delzenne N, Genton L, Schneider S, Singer P, Boirie Y. Nutritional management of individuals with obesity and COVID-19: ESPEN expert statements and practical guidance. Clin Nutr 2022; 41:2869-2886. [PMID: 34140163 PMCID: PMC8110326 DOI: 10.1016/j.clnu.2021.05.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 04/29/2021] [Indexed: 01/27/2023]
Abstract
The COVID-19 pandemics has created unprecedented challenges and threats to patients and healthcare systems worldwide. Acute respiratory complications that require intensive care unit (ICU) management are a major cause of morbidity and mortality in COVID-19 patients. Among other important risk factors for severe COVID-19 outcomes, obesity has emerged along with undernutrition-malnutrition as a strong predictor of disease risk and severity. Obesity-related excessive body fat may lead to respiratory, metabolic and immune derangements potentially favoring the onset of COVID-19 complications. In addition, patients with obesity may be at risk for loss of skeletal muscle mass, reflecting a state of hidden malnutrition with a strong negative health impact in all clinical settings. Also importantly, obesity is commonly associated with micronutrient deficiencies that directly influence immune function and infection risk. Finally, the pandemic-related lockdown, deleterious lifestyle changes and other numerous psychosocial consequences may worsen eating behaviors, sedentarity, body weight regulation, ultimately leading to further increments of obesity-associated metabolic complications with loss of skeletal muscle mass and higher non-communicable disease risk. Therefore, prevention, diagnosis and treatment of malnutrition and micronutrient deficiencies should be routinely included in the management of COVID-19 patients in the presence of obesity; lockdown-induced health risks should also be specifically monitored and prevented in this population. In the current document, the European Society for Clinical Nutrition and Metabolism (ESPEN) aims at providing clinical practice guidance for nutritional management of COVID-19 patients with obesity in various clinical settings.
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Affiliation(s)
- Rocco Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Italy,Azienda sanitaria universitaria Giuliano Isontina (ASUGI), Cattinara Hospital, Trieste, Italy,Corresponding author. Department of Medical, Surgical and Health Sciences and Azienda sanitaria universitaria Giuliano Isontina (ASUGI), Cattinara University Hospital, Strada di Fiume 447, Trieste, Italy
| | - Stephan C. Bischoff
- Department of Nutritional Medicine and Prevention, University of Hohenheim, Stuttgart, Germany
| | - Luca Busetto
- Department of Medicine, University of Padova, Italy
| | - Tommy Cederholm
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | - Michael Chourdakis
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Cristina Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Laurence Genton
- Clinical Nutrition, Geneva University Hospitals, Geneva, Switzerland
| | - Stephane Schneider
- Gastroenterology and Nutrition, Nice University Hospital, Université Côte d’Azur, Nice, France
| | - Pierre Singer
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Sackler School of Medicine, Tel Aviv University, Israel
| | - Yves Boirie
- Department of Clinical Nutrition, CHU Clermont-Ferrand, University of Clermont Auvergne, Human Nutrition Unit, CRNH Auvergne, F-63000, Clermont-Ferrand, France
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11
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Lv C, Shi W, Pan T, Li H, Peng W, Xu J, Deng J. Exploration of Aging-Care Parameters to Predict Mortality of Patients Aged 80-Years and Above with Community-Acquired Pneumonia. Clin Interv Aging 2022; 17:1379-1391. [PMID: 36164658 PMCID: PMC9509012 DOI: 10.2147/cia.s382347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 09/12/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose The study explores a clinical model based on aging-care parameters to predict the mortality of hospitalized patients aged 80-year and above with community-acquired pneumonia (CAP). Patients and methods In this study, four hundred and thirty-five CAP patients aged 80-years and above were enrolled in the Central Hospital of Minhang District, Shanghai during 01,01,2018–31,12,2021. The clinical data were collected, including aging-care relevant factors (ALB, FRAIL, Barthel Index and age-adjusted Charlson Comorbidity Index) and other commonly used factors. The prognostic factors were screened by multivariable logistic regression analysis. Receiver operating characteristic (ROC) curves were used to predict the mortality risk. Results Univariate analysis demonstrated that several factors, including gender, platelet distribution width, NLR, ALB, CRP, pct, pre-albumin, CURB-65, low-density, lipoprotein, Barthel Index, FRAIL, leucocyte count, neutrophil count, lymphocyte count and aCCI, were associated with the prognosis of CAP. Multivariate model analyses further identified that CURB-65 (p < 0.0001, OR = 5.44, 95% CI = 3.021–10.700), FRAIL (p < 0.0001, OR = 5.441, 95% CI = 2.611–12.25) and aCCI (p = 0.003, OR = 1.551, 95% CI = 1.165–2.099) were independent risk factors, whereas ALB (p = 0.005, OR = 0.871, 95% CI = 0.788–0.957) and Barthel Index (p = 0.0007, OR = 0.958, 95% CI = 0.933–0.981) were independent protective factors. ROC curves were plotted to further predict the in-hospital mortality and revealed that combination of three parameters (Barthel Index+ FRAI +CURB-65) showed the best performance. Conclusion This study showed that CURB-65, frailty and aCCI were independent risk factors influencing prognosis. In addition, ALB and Barthel Index were protective factors for in CAP patients over 80-years old. AUC was calculated and revealed that combination of three parameters (Barthel Index+ FRAI +CURB-65) showed the best performance.
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Affiliation(s)
- Chunxin Lv
- Oncology Department, Punan Hospital of Pudong New District, Shanghai, People's Republic of China
| | - Wen Shi
- Department of Dermatology, Punan Hospital of Pudong New District, Shanghai, People's Republic of China
| | - Teng Pan
- The 3rd Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, People's Republic of China.,Richard Dimbleby Laboratory of Cancer Research, School of Cancer & Pharmaceutical Sciences, King's College London, London, SE1 1UL, UK
| | - Houshen Li
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care King's College London, London, UK
| | - Weixiong Peng
- Hunan Zixing Artificial Intelligence Technology Group Co, Ltd, Changsha City, Hunan Province, People's Republic of China
| | - Jiayi Xu
- Geriatric Department, Fudan University, Minhang Hospital, Shanghai, People's Republic of China
| | - Jinhai Deng
- Richard Dimbleby Laboratory of Cancer Research, School of Cancer & Pharmaceutical Sciences, King's College London, London, SE1 1UL, UK.,Hunan Zixing Artificial Intelligence Technology Group Co, Ltd, Changsha City, Hunan Province, People's Republic of China
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12
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Branche AR, Saiman L, Walsh EE, Falsey AR, Jia H, Barrett A, Alba L, Phillips M, Finelli L. Change in functional status associated with respiratory syncytial virus infection in hospitalized older adults. Influenza Other Respir Viruses 2022; 16:1151-1160. [PMID: 36069297 DOI: 10.1111/irv.13043] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/11/2022] [Accepted: 08/22/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) causes severe respiratory illnesses in infants and older adults. Older adults are frequently hospitalized with RSV illness and may experience loss of function. This study evaluated longitudinal changes in function associated with RSV hospitalization in older adults. METHODS Adults ≥60 years hospitalized with laboratory-confirmed RSV were enrolled (N = 302). Demographics and comorbidities were collected. Functional status was assessed 2 weeks pre-hospitalization by recall, at enrollment, hospital discharge and 2, 4, and 6 months post-discharge using the Lawton-Brody Instrumental Activities of Daily Living (IADL) (scale 0-8) and Barthel ADL Index (scale 0-100). RESULTS RSV-associated hospitalization resulted in acute functional loss. Median IADL (5 vs. 3, p < 0.0001) and ADL (90 vs. 70, p < 0.0001) scores decreased significantly from pre-hospitalization to admission and remained decreased at discharge. There were no statistically significant differences between pre-hospitalization and 2-, 4-, or 6-month scores. However, 33% and 32% of subjects experienced decreased 6-month IADL and ADL scores, respectively. Additionally, 14% required a higher level of care at discharge. When stratified by pre-hospitalization living situation, 6-month IADL scores declined significantly for those admitted from a skilled nursing facility (3 vs. 1, p = 0.001). In multivariate analysis, male sex and diabetes were associated with a 6-month decline in ADL score of ≥10. CONCLUSIONS Older adults hospitalized with RSV demonstrate acute functional decline that may become prolonged. Pre-hospitalization living situation may predict patient outcomes. Further study is needed with hospitalized age-matched controls and refined measurement tools to better define the specific impact of RSV on function.
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Affiliation(s)
- Angela R Branche
- Department of Medicine, Division of Infectious Diseases, University of Rochester, Rochester, New York, USA
| | - Lisa Saiman
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA.,Department of Infection Prevention & Control, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Edward E Walsh
- Department of Medicine, Division of Infectious Diseases, University of Rochester, Rochester, New York, USA.,Rochester General Hospital, Rochester, New York, USA
| | - Ann R Falsey
- Department of Medicine, Division of Infectious Diseases, University of Rochester, Rochester, New York, USA.,Rochester General Hospital, Rochester, New York, USA
| | - Haomiao Jia
- Department of Biostatistics, Columbia University Irving Medical Center, New York, New York, USA
| | - Angela Barrett
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - Luis Alba
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - Matthew Phillips
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, New Jersey, USA
| | - Lyn Finelli
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, New Jersey, USA
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13
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Goldman CR, Sieling WD, Alba LR, Silverio Francisco RA, Vargas CY, Barrett AE, Phillips M, Finelli L, Saiman L. Severe Clinical Outcomes Among Adults Hospitalized With Respiratory Syncytial Virus Infections, New York City, 2017-2019. Public Health Rep 2022; 137:929-935. [PMID: 34487436 PMCID: PMC9379840 DOI: 10.1177/00333549211041545] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Respiratory syncytial virus (RSV) causes substantial morbidity and mortality in older adults. We assessed severe clinical outcomes among hospitalized adults that were associated with RSV infections. METHODS We performed a nested retrospective study in 3 New York City hospitals during 2 respiratory viral seasons, October 2017-April 2018 and October 2018-April 2019, to determine the proportion of patients with laboratory-confirmed RSV infection who experienced severe outcomes defined as intensive care unit (ICU) admission, mechanical ventilation, and/or death. We assessed factors associated with these severe outcomes and explored the effect of RSV-associated hospitalizations on changes in the living situations of surviving patients. RESULTS Of the 403 patients studied (median age, 69 years), 119 (29.5%) were aged ≥80. Severe outcomes occurred in 19.1% of patients, including ICU admissions (16.4%), mechanical ventilation (12.4%), and/or death (6.7%). Patients admitted from residential living facilities had a 4.43 times higher likelihood of severe RSV infection compared with patients who were living in the community with or without assistance from family or home health aides. At discharge, 56 (15.1%) patients required a higher level of care than at admission. CONCLUSIONS RSV infection was associated with severe outcomes in adults. Living in a residential facility at admission was a risk factor for severe outcomes and could be a proxy for frailty rather than an independent risk factor. Our data support the development of prevention strategies for RSV infection in older populations, especially older adults living in residential living facilities.
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Affiliation(s)
- Connor R. Goldman
- Department of Pediatrics, Columbia University Irving Medical
Center, New York, NY, USA
| | - William D. Sieling
- Department of Pediatrics, Columbia University Irving Medical
Center, New York, NY, USA
| | - Luis R. Alba
- Department of Pediatrics, Columbia University Irving Medical
Center, New York, NY, USA
| | | | - Celibell Y. Vargas
- Department of Pediatrics, Columbia University Irving Medical
Center, New York, NY, USA
| | - Angela E. Barrett
- Department of Pediatrics, Columbia University Irving Medical
Center, New York, NY, USA
| | - Matthew Phillips
- Center for Observational and Real-World Evidence, Merck &
Co, Inc, Kenilworth, NJ, USA
| | - Lyn Finelli
- Center for Observational and Real-World Evidence, Merck &
Co, Inc, Kenilworth, NJ, USA
| | - Lisa Saiman
- Department of Pediatrics, Columbia University Irving Medical
Center, New York, NY, USA
- Department of Infection Prevention & Control, New
York–Presbyterian Hospital, New York, NY, USA
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14
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Damanti S, Cilla M, Cilona M, Fici A, Merolla A, Pacioni G, De Lorenzo R, Martinenghi S, Vitali G, Magnaghi C, Fumagalli A, Gennaro Mazza M, Benedetti F, Tresoldi M, Rovere Querini P. Prevalence of Long COVID-19 Symptoms After Hospital Discharge in Frail and Robust Patients. Front Med (Lausanne) 2022; 9:834887. [PMID: 35911387 PMCID: PMC9329529 DOI: 10.3389/fmed.2022.834887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 06/10/2022] [Indexed: 12/12/2022] Open
Abstract
Background A motley postacute symptomatology may develop after COVID-19, irrespective of the acute disease severity, age, and comorbidities. Frail individuals have reduced physiological reserves and manifested a worse COVID-19 course, during the acute setting. However, it is still unknown, whether frailty may subtend some long COVID-19 manifestations. We explored the prevalence of long COVID-19 disturbs in COVID-19 survivals. Methods This was an observational study. Patients aged 65 years or older were followed-up 1, 3, and 6 months after hospitalization for COVID-19 pneumonia. Results A total of 382 patients were enrolled. Frail patients were more malnourished (median Mini Nutritional Assessment Short Form score 8 vs. 9, p = 0.001), at higher risk of sarcopenia [median Strength, Assistance with walking, Rising from a chair, Climbing stairs, and Falls (SARC-F) score 3 vs. 1.5, p = 0.003], and manifested a worse physical performance [median Short Physical Performance Battery (SPPB) score 10 vs. 11, p = 0.0007] than robust individuals, after hospital discharge following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia. Frailty was significantly associated with: (i) confusion, as a presenting symptom of COVID-19 [odds ratio (OR) 77.84, 95% CI 4.23–1432.49, p = 0.003]; (ii) malnutrition (MNA-SF: adjusted B –5.63, 95% CI –8.39 to –2.87, p < 0.001), risk of sarcopenia (SARC-F: adjusted B 9.11, 95% CI 3.10–15.13, p = 0.003), impaired muscle performance (SPPB: B –3.47, 95% CI –6.33 to –0.61, p = 0.02), complaints in mobility (adjusted OR 1674200.27, 95% CI 4.52–619924741831.25, p = 0.03), in self-care (adjusted OR 553305.56, 95% CI 376.37–813413358.35, p < 0.001), and in performing usual activities of daily living (OR 71.57, 95% CI 2.87–1782.53, p = 0.009) at 1-month follow-up; (iii) dyspnea [modified Medical Research Council (mMRC): B 4.83, 95% CI 1.32–8.33, p = 0.007] and risk of sarcopenia (SARC-F: B 7.12, 95% CI 2.17–12.07, p = 0.005) at 3-month follow-up; and (iv) difficulties in self-care (OR 2746.89, 95% CI 6.44–1172310.83, p = 0.01) at the 6-month follow-up. In a subgroup of patients (78 individuals), the prevalence of frailty increased at the 1-month follow-up compared to baseline (p = 0.009). Conclusion The precocious identification of frail COVID-19 survivors, who manifest more motor and respiratory complaints during the follow-up, could improve the long-term management of these COVID-19 sequelae.
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Affiliation(s)
- Sarah Damanti
- Unit of General Medicine and Advanced Care, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Institute, Milan, Italy
- *Correspondence: Sarah Damanti,
| | - Marta Cilla
- Unit of General Medicine and Advanced Care, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Institute, Milan, Italy
| | - Maria Cilona
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
| | - Aldo Fici
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
| | - Aurora Merolla
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
| | - Giacomo Pacioni
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
| | - Rebecca De Lorenzo
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
| | - Sabina Martinenghi
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giordano Vitali
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Cristiano Magnaghi
- Department of Immunology, Transplantation and Infectious Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Anna Fumagalli
- COVID Trial Unit, Department of Internal Medicine, IRCCS San Raffaele Institute, Milan, Italy
| | - Mario Gennaro Mazza
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, IRCCS Scientific Institute Ospedale San Raffaele, Milan, Italy
| | - Francesco Benedetti
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, IRCCS Scientific Institute Ospedale San Raffaele, Milan, Italy
| | - Moreno Tresoldi
- Unit of General Medicine and Advanced Care, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Institute, Milan, Italy
| | - Patrizia Rovere Querini
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
- Department of Immunology, Transplantation and Infectious Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
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15
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Gärtner BC, Weinke T, Wahle K, Kwetkat A, Beier D, Schmidt KJ, Schwarz TF. Importance and value of adjuvanted influenza vaccine in the care of older adults from a European perspective - A systematic review of recently published literature on real-world data. Vaccine 2022; 40:2999-3008. [PMID: 35459556 DOI: 10.1016/j.vaccine.2022.04.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/21/2022] [Accepted: 04/04/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is an urgent need for improved influenza vaccines especially for older adults due to the presence of immunosenescence. It is therefore highly relevant to compare enhanced influenza vaccines with traditional influenza vaccines with respect to their effectiveness. OBJECTIVE To compare vaccine efficacy and effectiveness of adjuvanted influenza vaccines (aTIV/aQIV) vs. non-adjuvanted standard-dose (TIV/QIV) and high-dose (TIV-HD/QIV-HD) influenza vaccines regarding influenza-related outcomes in older adults, complementing findings from the European Centre for Disease Prevention and Control (ECDC)'s systematic review of enhanced seasonal influenza vaccines from February 2020. METHODS A systematic literature search was conducted in Embase and MEDLINE to identify randomised controlled trials, observational studies and systematic reviews, published since ECDC's systematic review (between 7 February 2020 and 6 September 2021). Included studies were appraised with either the Cochrane Risk of Bias tool, ROBINS-I or AMSTAR 2. RESULTS Eleven analyses from nine real-world evidence (RWE) studies comprising ∼53 million participants and assessing the relative vaccine effectiveness (rVE) of aTIV vs. TIV, QIV and/or TIV-HD in adults aged ≥65 years over the 2006/07-2008/09 and 2011/12-2019/20 influenza seasons were identified. Nine analyses found that aTIV was significantly more effective than TIV and QIV in reducing influenza-related outcomes by clinical setting and suspected influenza outbreaks (rVE ranging from 7.5% to 25.6% for aTIV vs. TIV and 7.1% to 36.3% for aTIV vs. QIV). Seven analyses found similar effectiveness of aTIV vs. TIV-HD in reducing influenza-related medical encounters, inpatient stays and hospitalisations/emergency room visits. In three analyses, aTIV was significantly more effective than TIV-HD in reducing influenza-related medical encounters and office visits (rVE ranging from 6.6% to 16.6%). Risk of bias of identified studies was moderate to high. CONCLUSIONS Our study suggests that both adjuvanted and high-dose vaccines are effective alternatives for vaccination programmes in older adults and preferable over conventional standard-dose vaccines.
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Affiliation(s)
- B C Gärtner
- Institute for Medical Microbiology and Hygiene, Saarland University Hospital and Medical Faculty of Saarland University, Kirrberger Straße, Building 43, 66421 Homburg/Saar, Germany
| | - T Weinke
- Clinic of Gastroenterology and Infectiology, Ernst von Bergmann Klinikum, Charlottenstraße 72, 14467 Potsdam, Germany
| | - K Wahle
- University of Münster, Schlossplatz 2, 48149 Münster, Germany
| | - A Kwetkat
- Department of Geriatrics, Jena University Hospital, Bachstraße 18, 07743 Jena, Germany
| | - D Beier
- Member of Saxon Committee on Vaccinations (SIKO), Elisabeth-Reichelt-Weg 35, 09116 Chemnitz, Germany
| | - K J Schmidt
- Xcenda GmbH, Lange Laube 31, 30159 Hannover, Germany
| | - T F Schwarz
- Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Standort Juliusspital, Salvatorstraße 7, 97074 Würzburg, Germany.
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16
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Who Were Hospitalized Deceased Patients from COVID-19 During the First Year of Pandemic? Retrospective Analysis of 1104 Deceased Patients in South of France. J Epidemiol Glob Health 2022; 12:196-205. [PMID: 35486358 PMCID: PMC9053122 DOI: 10.1007/s44197-022-00039-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 04/05/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Following the first year of the COVID-19 pandemic, a complete analysis of the characteristics of the deceased hospitalized patients was performed, to identify factors related to premature mortality and to compare patient profiles according to the epidemic periods. Methods Retrospective analysis of 1104 deceased patients in two University Hospitals in South-eastern France, between March 1, 2020 and March 12, 2021 from Hospital’s electronic medical records was performed. Results Mean age was 80 years (± 11.1) and 10% of the deceased were younger than 65 years with specific comorbidities, e.g., genetic conditions, metastatic cancer, or massive obesity. Among the three clusters identified, two clusters (75% of deceased patients) include very elderly patients with numerous comorbidities, and differ by their proportion of dependent institutionalized patients. The third cluster is made up of younger patients with fewer but severe comorbidities. Deceased patients’ profiles varied according to the epidemic periods: during the first period (March–June 2020), more patients were institutionalized. The second period (September–December2020) coincided with a higher mortality rate. Conclusions This study confirmed that most patients hospitalized and dying from COVID-19 were frail, i.e., elderly and/or highly comorbid and that the small proportion of young patients had severe comorbidities. Supplementary Information The online version contains supplementary material available at 10.1007/s44197-022-00039-3.
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17
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Seligman B, Charest B, Ho YL, Gerlovin H, Ward RE, Cho K, Driver JA, Gaziano JM, Gagnon DR, Orkaby AR. 30-day Mortality Following COVID-19 and Influenza Hospitalization Among US Veterans Aged 65 and Older. J Am Geriatr Soc 2022; 70:2542-2551. [PMID: 35474510 PMCID: PMC9115089 DOI: 10.1111/jgs.17828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 03/29/2022] [Accepted: 04/09/2022] [Indexed: 11/28/2022]
Abstract
Background COVID‐19 and influenza are important sources of morbidity and mortality among older adults. Understanding how outcomes differ for older adults hospitalized with either infection is important for improving care. We compared outcomes from infection with COVID‐19 and influenza among hospitalized older adults. Methods We conducted a retrospective study of 30‐day mortality among veterans aged 65+ hospitalized with COVID‐19 from March 1, 2020–December 31, 2020 or with influenza A/B from September 1, 2017 to August 31, 2019 in Veterans Affairs Health Care System (VAHCS). COVID‐19 infection was determined by a positive PCR test and influenza by tests used in the VA system. Frailty was defined by the claims‐based Veterans Affairs Frailty Index (VA‐FI). Logistic regressions of mortality on frailty, age, and infection were adjusted for multiple confounders. Results A total of 15,474 veterans were admitted with COVID‐19 and 7867 with influenza. Mean (SD) ages were 76.1 (7.8) and 75.8 (8.3) years, 97.7% and 97.4% were male, and 66.9% and 76.4% were white in the COVID‐19 and influenza cohorts respectively. Crude 30‐day mortality (95% CI) was 18.9% (18.3%–19.5%) for COVID‐19 and 4.3% (3.8%–4.7%) for influenza. Combining cohorts, the odds ratio for 30‐day mortality from COVID‐19 (versus influenza) was 6.61 (5.74–7.65). There was a statistically significant interaction between infection with COVID‐19 and frailty, but there was no significant interaction between COVID‐19 and age. Separating cohorts, greater 30‐day mortality was significantly associated with older age (p: COVID‐19: <0.001, Influenza: <0.001) and for frail compared with robust individuals (p for trend: COVID‐19: <0.001, Influenza: <0.001). Conclusion Mortality from COVID‐19 exceeded that from influenza among hospitalized older adults. However, odds of mortality were higher at every level of frailty among those admitted with influenza compared to COVID‐19. Prevention will remain key to reducing mortality from viral illnesses among older adults.
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Affiliation(s)
- Benjamin Seligman
- New England Geriatrics Research, Education, and Clinical Center, VA Boston Health Care System, Boston, MA.,Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.,Geriatrics Research, Education, and Clinical Center, VA Greater Los Angeles Health Care System, Los Angeles, CA.,Division of Geriatric Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Brian Charest
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Health Care System, Boston, MA
| | - Yuk-Lam Ho
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Health Care System, Boston, MA
| | - Hanna Gerlovin
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Health Care System, Boston, MA
| | - Rachel E Ward
- New England Geriatrics Research, Education, and Clinical Center, VA Boston Health Care System, Boston, MA.,Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Health Care System, Boston, MA.,Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA
| | - Kelly Cho
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Health Care System, Boston, MA.,Division of Aging, Brigham & Women's Hospital, Harvard Medical School, Boston, MA
| | - Jane A Driver
- New England Geriatrics Research, Education, and Clinical Center, VA Boston Health Care System, Boston, MA.,Division of Aging, Brigham & Women's Hospital, Harvard Medical School, Boston, MA
| | - J Michael Gaziano
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Health Care System, Boston, MA.,Division of Aging, Brigham & Women's Hospital, Harvard Medical School, Boston, MA
| | - David R Gagnon
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Health Care System, Boston, MA.,Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Ariela R Orkaby
- New England Geriatrics Research, Education, and Clinical Center, VA Boston Health Care System, Boston, MA.,Division of Aging, Brigham & Women's Hospital, Harvard Medical School, Boston, MA
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18
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Clinical and economic outcomes associated with respiratory syncytial virus vaccination in older adults in the United States. Vaccine 2021; 40:483-493. [PMID: 34933763 DOI: 10.1016/j.vaccine.2021.12.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is an important cause of lower respiratory infections and hospitalizations among older adults. We aimed to estimate the potential clinical benefits and economic value of RSV vaccination of older adults in the United States (US). METHODS We developed an economic model using a decision-tree framework to capture outcomes associated with RSV infections in US adults aged ≥ 60 years occurring during one RSV season for a hypothetical vaccine versus no vaccine. Two co-base-case epidemiology sources were selected from a targeted review of the US literature: a landmark study capturing all RSV infections and a contemporary study reporting medically attended RSV that also distinguishes mild from moderate-to-severe disease. Both base-case analyses used recent data on mortality risk in the year after RSV hospitalizations. Direct medical costs and quality-adjusted life-years (QALYs) lost per case were obtained from the literature and publicly available sources. Model outcomes included the population-level clinical and economic RSV disease burden among older adults, potential vaccine-avoidable disease burden, and the potential value-based price of a vaccine from a third-party payer perspective. RESULTS Our two base-case analyses estimated that a vaccine with 50% efficacy and coverage matching that of influenza vaccination would prevent 43,700-81,500 RSV hospitalizations and 8,000-14,900 RSV-attributable deaths per RSV season, resulting in 1,800-3,900 fewer QALYs lost and avoiding $557-$1,024 million. Value-based prices for the co-base-case analyses were $152-$299 per vaccination at a willingness to pay of $100,000/QALY gained. Sensitivity analyses found that the economic value of vaccination was most sensitive to RSV incidence and increased posthospitalization mortality risks. CONCLUSIONS Despite variability and gaps in the epidemiology literature, this study highlights the potential value of RSV vaccination for older adults in the US. Our analysis provides contemporary estimates of the population-level RSV disease burden and insights into the economic value drivers for RSV vaccination.
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19
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Adams K, Tenforde MW, Chodisetty S, Lee B, Chow EJ, Self WH, Patel MM. A literature review of severity scores for adults with influenza or community-acquired pneumonia - implications for influenza vaccines and therapeutics. Hum Vaccin Immunother 2021; 17:5460-5474. [PMID: 34757894 PMCID: PMC8903905 DOI: 10.1080/21645515.2021.1990649] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/02/2021] [Indexed: 12/11/2022] Open
Abstract
Influenza vaccination and antiviral therapeutics may attenuate disease, decreasing severity of illness in vaccinated and treated persons. Standardized assessment tools, definitions of disease severity, and clinical endpoints would support characterizing the attenuating effects of influenza vaccines and antivirals. We review potential clinical parameters and endpoints that may be useful for ordinal scales evaluating attenuating effects of influenza vaccines and antivirals in hospital-based studies. In studies of influenza and community-acquired pneumonia, common physiologic parameters that predicted outcomes such as mortality, ICU admission, complications, and duration of stay included vital signs (hypotension, tachypnea, fever, hypoxia), laboratory results (blood urea nitrogen, platelets, serum sodium), and radiographic findings of infiltrates or effusions. Ordinal scales based on these parameters may be useful endpoints for evaluating attenuating effects of influenza vaccines and therapeutics. Factors such as clinical and policy relevance, reproducibility, and specificity of measurements should be considered when creating a standardized ordinal scale for assessment.
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Affiliation(s)
- Katherine Adams
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mark W. Tenforde
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shreya Chodisetty
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Benjamin Lee
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Eric J. Chow
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Wesley H. Self
- Department of Emergency Medicine and Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Manish M. Patel
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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20
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Immune-mediated attenuation of influenza illness after infection: opportunities and challenges. THE LANCET MICROBE 2021; 2:e715-e725. [DOI: 10.1016/s2666-5247(21)00180-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 06/01/2021] [Accepted: 07/01/2021] [Indexed: 01/04/2023] Open
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21
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Rhynehart A, Dunlevy C, Hayes K, O'Connell J, O'Shea D, O'Malley E. The Association of Physical Function Measures With Frailty, Falls History, and Metabolic Syndrome in a Population With Complex Obesity. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:716392. [PMID: 36188769 PMCID: PMC9397832 DOI: 10.3389/fresc.2021.716392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/16/2021] [Indexed: 11/19/2022]
Abstract
Background: Frailty, falls and metabolic syndrome are known to be associated with poorer physical function. This study builds on available research by further investigating the relationship between physical function measures, including those comprising frailty, with metabolic syndrome (MetS) and falls, in the context of complex obesity. Methods: Participants were recruited from the national Level 3 weight management service in Ireland. A retrospective audit of data gathered at initial assessment was performed. Data included past medical history, blood tests, blood pressure measurement, anthropometrics, falls history, self-reported physical activity levels (PALs) and physical function measures, including hand grip strength (HGS), “timed up and go” (TUG), functional reach (FR), sit to stand (STS) and gait speed. A modified version of the Fried Frailty Index was employed. Results: Of the 713 participants, 65.1% (n = 464) were female and 34.9% (n = 249) were male with a mean age of 44.2 (±11.7) years and body mass index (BMI) of 50.6 kg/m2 (±8.2). Frailty was identified in 3.4% (n = 24), falls in 28.8% (n = 205) and MetS in 55.1% (n = 393). Frailty was associated with older age (53.8 ± 14.3 vs. 43.9 ± 11.5 years), poorer PALs (27.29 ± 46.3 vs. 101.1 ± 147.4 min/wk), reduced grip strength (17.7 ± 4.6 vs. 34.2 ± 11.0 Kg) longer STS (21.7 ± 6.6 vs. 13.7 ± 5.7 s), shorter functional reach (29.7 ± 7.9 vs. 37.9 ± 8.2 cm) and slower gait speed (0.6 ± 0.2 vs. 1.1 ± 0.5 m/s). Those reporting a falls history had a reduced FR (35.8 ± 8.9 vs. 38.3 ± 7.8 cm) and slower STS (15.4 ± 8.0 vs. 13.3 ± 4.7 s). Participants with MetS had lower PALs (83.2 ± 128.2 vs. 119.2 ± 157.6) and gait speed (1.1 ± 0.3 vs. 1.2 ± 0.7 m/s). There was no difference in BMI between fallers and non-fallers (51.34 ± 8.44 vs. 50.33 ± 8.13 Kg/m2, p = 0.138), nor between those with or without MetS. Significant associations were found between BMI and all physical function measures except the TUAG. Conclusion: The associations between frailty, falls and MetS and their combined impact on physical function in people living with obesity demonstrates the need for appropriate screening. Utilising grip strength and gait speed to identify frailty in those with obesity and metabolic syndrome could help target therapies aimed at improving strength, physical function and ultimately quality of life.
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Affiliation(s)
- Amanda Rhynehart
- Weight Management Service, St Columcille's Hospital, Dublin, Ireland
- *Correspondence: Amanda Rhynehart ;
| | - Colin Dunlevy
- Weight Management Service, St Columcille's Hospital, Dublin, Ireland
| | - Katie Hayes
- Weight Management Service, St Columcille's Hospital, Dublin, Ireland
| | - Jean O'Connell
- Weight Management Service, St Columcille's Hospital, Dublin, Ireland
- Obesity Research Group, St Vincent's University Hospital, Dublin, Ireland
| | - Donal O'Shea
- Weight Management Service, St Columcille's Hospital, Dublin, Ireland
- Obesity Research Group, St Vincent's University Hospital, Dublin, Ireland
| | - Emer O'Malley
- Weight Management Service, St Columcille's Hospital, Dublin, Ireland
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22
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Hussien H, Nastasa A, Apetrii M, Nistor I, Petrovic M, Covic A. Different aspects of frailty and COVID-19: points to consider in the current pandemic and future ones. BMC Geriatr 2021; 21:389. [PMID: 34176479 PMCID: PMC8236311 DOI: 10.1186/s12877-021-02316-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 06/06/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Older adults at a higher risk of adverse outcomes and mortality if they get infected with Severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2). These undesired outcomes are because ageing is associated with other conditions like multimorbidity, frailty and disability. This paper describes the impact of frailty on coronavirus disease 2019 (COVID-19) management and outcomes. We also try to point out the role of inflamm-ageing, immunosenescence and reduced microbiota diversity in developing a severe form of COVID-19 and a different response to COVID-19 vaccination among older frail adults. Additionally, we attempt to highlight the impact of frailty on intensive care unit (ICU) outcomes, and hence, the rationale behind using frailty as an exclusion criterion for critical care admission. Similarly, the importance of using a time-saving, validated, sensitive, and user-friendly tool for frailty screening in an acute setting as COVID-19 triage. We performed a narrative review. Publications from 1990 to March 2021 were identified by searching the electronic databases MEDLINE, CINAHL and SCOPUS. Based on this search, we have found that in older frail adults, many mechanisms contribute to the severity of COVID-19, particularly cytokine storm; those mechanisms include lower immunological capacity and status of ongoing chronic inflammation and reduced gut microbiota diversity. Higher degrees of frailty were associated with poor outcomes and higher mortality rates during and after ICU admission. Also, the response to COVID-19 vaccination among frail older adults might differ from the general population regarding effectiveness and side effects. Researches also had shown that there are many tools for identifying frailty in an acute setting that could be used in COVID-19 triage, and before ICU admission, the clinical frailty scale (CFS) was the most recommended tool. CONCLUSION Older frail adults have a pre-existing immunopathological base that puts them at a higher risk of undesired outcomes and mortality due to COVID-19 and poor response to COVID-19 vaccination. Also, their admission in ICU should depend on their degree of frailty rather than their chronological age, which is better to be screened using the CFS.
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Affiliation(s)
- Hani Hussien
- Dr C I Parhon University Hospital, Department of Nephrology, Iasi, Romania
- Department of Internal Medicine, Nephrology and Geriatrics, Grigore T Popa University of Medicine and Pharmacy, Faculty of Medicine, Bd Carol nr 50, Iasi, Romania
| | - Andra Nastasa
- Department of Internal Medicine, Nephrology and Geriatrics, Grigore T Popa University of Medicine and Pharmacy, Faculty of Medicine, Bd Carol nr 50, Iasi, Romania.
| | - Mugurel Apetrii
- Dr C I Parhon University Hospital, Department of Nephrology, Iasi, Romania
- Department of Internal Medicine, Nephrology and Geriatrics, Grigore T Popa University of Medicine and Pharmacy, Faculty of Medicine, Bd Carol nr 50, Iasi, Romania
| | - Ionut Nistor
- Dr C I Parhon University Hospital, Department of Nephrology, Iasi, Romania
- Department of Internal Medicine, Nephrology and Geriatrics, Grigore T Popa University of Medicine and Pharmacy, Faculty of Medicine, Bd Carol nr 50, Iasi, Romania
| | - Mirko Petrovic
- Section of Geriatrics, Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Adrian Covic
- Dr C I Parhon University Hospital, Department of Nephrology, Iasi, Romania
- Department of Internal Medicine, Nephrology and Geriatrics, Grigore T Popa University of Medicine and Pharmacy, Faculty of Medicine, Bd Carol nr 50, Iasi, Romania
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23
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Swain SL, Kugler-Umana O, Tonkonogy SL. "An Intrinsic Program Determines Key Age-Associated Changes in Adaptive Immunity that Limit Response to Non-Pathogens.". FRONTIERS IN AGING 2021; 2:701900. [PMID: 35382063 PMCID: PMC8979546 DOI: 10.3389/fragi.2021.701900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/09/2021] [Indexed: 01/14/2023]
Abstract
As mice age their adaptive immune system changes dramatically, leading to weakened responses to newly encountered antigens and poor efficacy of vaccines. A shared pattern emerges in the aged, with both CD4 T and B cell responses requiring higher levels of pathogen recognition. Moreover, in aged germ-free mice we find accumulation of the same novel age-associated T and B cell subsets that we and others have previously identified using mice maintained in normal laboratory animal housing conditions, suggesting that their development follows an intrinsic program.
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Affiliation(s)
- Susan L. Swain
- Department of Pathology, University of Massachusetts Medical School, Worcester, MA, United States
| | - Olivia Kugler-Umana
- Department of Pathology, University of Massachusetts Medical School, Worcester, MA, United States
| | - Susan L. Tonkonogy
- College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
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24
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Zucchelli A, Bologna E, Marengoni A. Why data on frailty and SARS-CoV-2 infection are basic to progress. Aging Clin Exp Res 2021; 33:1429-1432. [PMID: 33797742 PMCID: PMC8017512 DOI: 10.1007/s40520-021-01846-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 03/23/2021] [Indexed: 12/12/2022]
Abstract
Several studies showed that frailty was a predictor of in-hospital death in older adults with COVID-19. The mechanisms through which frailty increases the severity of COVID-19 are several, including immunosenescense and dysregulated inflammation. Whether individuals affected by frailty exhibit a higher susceptibility to SARS-CoV-2 infection remains an open question. Here we report the case series of 40 older persons that in February 2020, before the first case of COVID-19 was detected in Italy, went together on a winter holiday. Back home, 7 of them developed influenza-like symptoms and one was hospitalized due to COVID-19 pneumonia. Between May and July, the seniors were offered the possibility to be tested for SARS-CoV-2 antibody positivity. Twenty-seven of them accepted: 13 had a positive serological test whereas no active infection was found. Comparing the characteristics of those who tested positive and the others, we found that the former group was frailer, exhibiting higher Clinical Frailty Scale scores.
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Affiliation(s)
- A Zucchelli
- Department of Information Engineering, Università degli Studi di Brescia, vle Branze 38, 25123, Brescia, Italy.
| | - E Bologna
- Fondazione Piera, Pietro e Giovanni Ferrero, Alba, Italy
| | - A Marengoni
- Department of Clinical and Experimental Sciences, Università degli Studi di Brescia, Brescia, Italy
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25
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Andrew MK, Schmader KE, Rockwood K, Clarke B, McElhaney JE. Considering Frailty in SARS-CoV-2 Vaccine Development: How Geriatricians Can Assist. Clin Interv Aging 2021; 16:731-738. [PMID: 33953551 PMCID: PMC8088982 DOI: 10.2147/cia.s295522] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/02/2021] [Indexed: 12/15/2022] Open
Abstract
The COVID-19 pandemic has disproportionately impacted frail older adults, especially residents of long-term care (LTC) facilities. This has appropriately led to prioritization of frail older adults and LTC residents, and those who care for them, in the vaccination effort against COVID-19. Older adults have distinct immunological, clinical, and practical complexity, which can be understood through a lens of frailty. Even so, frailty has not been considered in studies of COVID-19 vaccines to date, leading to concerns that the vaccines have not been optimally tailored for and evaluated in this population even as vaccination programs are being implemented. This is an example of how vaccines are often not tested in Phase 1/2/3 clinical trials in the people most in need of protection. We argue that geriatricians, as frailty specialists, have much to contribute to the development, testing and implementation of COVID-19 vaccines in older adults. We discuss roles for geriatricians in ten stages of the vaccine development process, covering vaccine design, trial design, trial recruitment, establishment and interpretation of illness definitions, safety monitoring, consideration of relevant health measures such as frailty and function, analysis methods to account for frailty and differential vulnerability, contributions in regulatory and advisory roles, post-marketing surveillance, and program implementation and public health messaging. In presenting key recommendations pertinent to each stage, we hope to contribute to a dialogue on how to push the field of vaccinology to embrace the complexity of frailty. Making vaccines that can benefit frail older adults will benefit everyone in the fight against COVID-19.
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Affiliation(s)
- Melissa K Andrew
- Department of Medicine, Division of Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Canadian Center for Vaccinology, Halifax, Nova Scotia, Canada
| | - Kenneth E Schmader
- Division of Geriatrics, Duke University Medical Center and GRECC, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
| | - Kenneth Rockwood
- Department of Medicine, Division of Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Barry Clarke
- Department of Family Medicine, Dalhousie University, Halifax, Canada
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26
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Iwai-Saito K, Shobugawa Y, Aida J, Kondo K. Frailty is associated with susceptibility and severity of pneumonia in older adults (A JAGES multilevel cross-sectional study). Sci Rep 2021; 11:7966. [PMID: 33846416 PMCID: PMC8041848 DOI: 10.1038/s41598-021-86854-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/19/2021] [Indexed: 12/17/2022] Open
Abstract
Pneumonia is a leading cause of mortality among older adults worldwide. Recently, several studies reported that frailty was associated with mortality among older adults hospitalized due to respiratory infectious diseases, including pneumonia. However, it is unknown whether frailty is associated with susceptibility to and severity of pneumonia in functionally-independent community-dwelling older adults. In this study, we examined whether frailty increased the susceptibility to pneumonia and hospitalization in older adults. We used cross-sectional data from the Japan Gerontological Evaluation Study; the data was collected by using mail-based, self-reported questionnaires from 177,991 functionally-independent community-dwelling older adults aged ≥ 65 years. Our results showed that frailty was significantly associated with both occurrence of and hospitalization due to pneumonia after adjustments with covariates; (Preference ratio {PR} 1.92, 95% confidence interval {95% CI} [1.66-2.22] and PR 1.80, 95% CI [1.42-2.28], respectively, p < 0.001 for the both). Pre-frailty was associated only with the occurrence of pneumonia. Besides, the instrumental activity of daily living, physical strength, nutrition status, oral function, homeboundness, and depression status in frail older adults were associated with either or both occurrence of and hospitalization due to pneumonia. Our results suggest that frailty influenced the susceptibility to and severity of pneumonia in older adults.
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Affiliation(s)
- Kousuke Iwai-Saito
- Division of International Health, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-dori, Chuo Ward, Niigata, 951-8510, Japan.
| | - Yugo Shobugawa
- Department of Active Aging (Donated By Tokamachi City, Niigata Japan), Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Jun Aida
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo City, Tokyo, 113-8549, Japan.,Liaison Center for Innovative Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba Ward, Sendai City, Miyagi, 980-8574, Japan
| | - Katsunori Kondo
- Department of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University, Chuo-ku, Chiba, 260-8670, Japan.,Department of Gerontology and Evaluation Study, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu, Aichi, 474-8511, Japan
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27
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Iwai-Saito K, Shobugawa Y, Aida J, Kondo K. Frailty is associated with susceptibility and severity of pneumonia in older adults (A JAGES multilevel cross-sectional study). Sci Rep 2021. [PMID: 33846416 DOI: 10.1038/s41598-021-86854-3[publishedonlinefirst:2021/04/14]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
Pneumonia is a leading cause of mortality among older adults worldwide. Recently, several studies reported that frailty was associated with mortality among older adults hospitalized due to respiratory infectious diseases, including pneumonia. However, it is unknown whether frailty is associated with susceptibility to and severity of pneumonia in functionally-independent community-dwelling older adults. In this study, we examined whether frailty increased the susceptibility to pneumonia and hospitalization in older adults. We used cross-sectional data from the Japan Gerontological Evaluation Study; the data was collected by using mail-based, self-reported questionnaires from 177,991 functionally-independent community-dwelling older adults aged ≥ 65 years. Our results showed that frailty was significantly associated with both occurrence of and hospitalization due to pneumonia after adjustments with covariates; (Preference ratio {PR} 1.92, 95% confidence interval {95% CI} [1.66-2.22] and PR 1.80, 95% CI [1.42-2.28], respectively, p < 0.001 for the both). Pre-frailty was associated only with the occurrence of pneumonia. Besides, the instrumental activity of daily living, physical strength, nutrition status, oral function, homeboundness, and depression status in frail older adults were associated with either or both occurrence of and hospitalization due to pneumonia. Our results suggest that frailty influenced the susceptibility to and severity of pneumonia in older adults.
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Affiliation(s)
- Kousuke Iwai-Saito
- Division of International Health, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-dori, Chuo Ward, Niigata, 951-8510, Japan.
| | - Yugo Shobugawa
- Department of Active Aging (Donated By Tokamachi City, Niigata Japan), Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Jun Aida
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo City, Tokyo, 113-8549, Japan
- Liaison Center for Innovative Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba Ward, Sendai City, Miyagi, 980-8574, Japan
| | - Katsunori Kondo
- Department of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University, Chuo-ku, Chiba, 260-8670, Japan
- Department of Gerontology and Evaluation Study, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu, Aichi, 474-8511, Japan
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28
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Marengoni A, Zucchelli A, Vetrano DL, Armellini A, Botteri E, Nicosia F, Romanelli G, Beindorf EA, Giansiracusa P, Garrafa E, Ferrucci L, Fratiglioni L, Bernabei R, Onder G. Beyond Chronological Age: Frailty and Multimorbidity Predict In-Hospital Mortality in Patients With Coronavirus Disease 2019. J Gerontol A Biol Sci Med Sci 2021; 76:e38-e45. [PMID: 33216846 PMCID: PMC7717138 DOI: 10.1093/gerona/glaa291] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND We evaluated whether frailty and multimorbidity predict in-hospital mortality in patients with COVID-19 beyond chronological age. METHOD A total of 165 patients admitted from March 8th to April 17th, 2020, with COVID-19 in an acute geriatric ward in Italy were included. Predisease frailty was assessed with the Clinical Frailty Scale (CFS). Multimorbidity was defined as the co-occurrence of ≥2 diseases in the same patient. The hazard ratio (HR) of in-hospital mortality as a function of CFS score and number of chronic diseases in the whole population and in those aged 70+ years were calculated. RESULTS Among the 165 patients, 112 were discharged, 11 were transferred to intensive care units, and 42 died. Patients who died were older (81.0 vs 65.2 years, p < .001), more frequently multimorbid (97.6 vs 52.8%; p < .001), and more likely frail (37.5 vs 4.1%; p < .001). Less than 2.0% of patients without multimorbidity and frailty, 28% of those with multimorbidity only, and 75% of those with both multimorbidity and frailty died. Each unitary increment in the CFS was associated with a higher risk of in-hospital death in the whole sample (HR = 1.3; 95% CI = 1.05-1.62) and in patients aged 70+ years (HR = 1.29; 95% CI = 1.04-1.62), whereas the number of chronic diseases was not significantly associated with higher risk of death. The CFS addition to age and sex increased mortality prediction by 9.4% in those aged 70+ years. CONCLUSIONS Frailty identifies patients with COVID-19 at risk of in-hospital death independently of age. Multimorbidity contributes to prognosis because of the very low probability of death in its absence.
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Affiliation(s)
- Alessandra Marengoni
- Department of Clinical and Experimental Sciences, University of Brescia, Italy.,ASST Spedali Civili di Brescia, Montichiari, Italy.,Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden
| | | | - Davide Liborio Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden.,Department of Geriatrics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | | | - Giuseppe Romanelli
- Department of Clinical and Experimental Sciences, University of Brescia, Italy.,ASST Spedali Civili di Brescia, Montichiari, Italy
| | | | | | - Emirena Garrafa
- Department of Molecular and Translational Medicine, University of Brescia, Italy
| | | | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden
| | - Roberto Bernabei
- Department of Geriatrics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Graziano Onder
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
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Aw D, Woodrow L, Ogliari G, Harwood R. Association of frailty with mortality in older inpatients with Covid-19: a cohort study. Age Ageing 2020; 49:915-922. [PMID: 32778870 PMCID: PMC7454254 DOI: 10.1093/ageing/afaa184] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Indexed: 02/06/2023] Open
Abstract
Background COVID-19 has disproportionately affected older people. Objective to investigate whether frailty is associated with all-cause mortality in older hospital inpatients, with COVID-19. Design cohort study. Setting secondary care acute hospital. Participants six hundred and seventy-seven consecutive inpatients aged 65 years and over. Methods Cox proportional hazards models were used to examine the association of frailty with mortality. Frailty was assessed at baseline, according to the Clinical Frailty Scale (CFS), where higher categories indicate worse frailty. Analyses were adjusted for age, sex, deprivation, ethnicity, previous admissions and acute illness severity. Results six hundred and sixty-four patients were classified according to CFS. Two hundred and seventy-one died, during a mean follow-up of 34.3 days. Worse frailty at baseline was associated with increased mortality risk, even after full adjustment (p = 0.004). Patients with CFS 4 and CFS 5 had non-significant increased mortality risks, compared to those with CFS 1–3. Patients with CFS 6 had a 2.13-fold (95% CI 1.34–3.38) and those with CFS 7–9 had a 1.79-fold (95% CI 1.12–2.88) increased mortality risk, compared to those with CFS 1–3 (p = 0.001 and 0.016, respectively). Older age, male sex and acute illness severity were also associated with increased mortality risk. Conclusions frailty is associated with all-cause mortality risk in older inpatients with COVID-19.
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Affiliation(s)
- Darren Aw
- Health Care of the Older Person, Nottingham University Hospitals NHS Trust, Queen’s Medical Centre, Derby Road, Nottingham, NG7 2UH
- Corresponding Author: Dr Darren Aw, Address: HCOP Secretaries, Nottingham University Hospitals NHS Trust, Queen’s Medical Centre, Derby Road, Nottingham, NG7 2UH,
| | - Lauren Woodrow
- Health Care of the Older Person, Nottingham University Hospitals NHS Trust, Queen’s Medical Centre, Derby Road, Nottingham, NG7 2UH
| | - Giulia Ogliari
- Health Care of the Older Person, Nottingham University Hospitals NHS Trust, Queen’s Medical Centre, Derby Road, Nottingham, NG7 2UH
| | - Rowan Harwood
- Health Care of the Older Person, Nottingham University Hospitals NHS Trust, Queen’s Medical Centre, Derby Road, Nottingham, NG7 2UH
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Andrew MK, McNeil SA. Influenza vaccination and the evolution of evidence-based recommendations for older adults: A Canadian perspective. Vaccine 2020; 39 Suppl 1:A36-A41. [PMID: 32958335 DOI: 10.1016/j.vaccine.2020.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/16/2020] [Accepted: 09/01/2020] [Indexed: 01/08/2023]
Abstract
Older adults are at high risk from influenza and its complications, and are therefore an important population for prevention efforts. In Canada, public health efforts targeting influenza are multi-pronged and include vaccination programs as well as surveillance which informs the national surveillance reporting platform FluWatch run by the Public Health Agency of Canada. Recommendations regarding use of vaccines are made nationally by the National Advisory Committee on Immunization (NACI) and by the Comité sur l'immunisation du Québec in Quebec, while vaccination programs are planned and delivered at the provincial/territorial level as opposed to as a harmonized national immunization program. NACI performs rigorous targeted literature reviews to inform their statements, and recommendations also vary by whether they apply on Individual (pertaining to decisions for individual patients) vs. Programmatic (informing policy decisions for implementation of publicly funded vaccination programs) levels. This unique context results in inter-provincial variation in vaccine schedules and funded vaccine products. In this paper, the importance of influenza vaccination for older adults is discussed; to provide insights from the Canadian context, the evolution of NACI evidence reviews and recommendations on influenza vaccination is presented.
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Affiliation(s)
- Melissa K Andrew
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, NS, Canada.
| | - Shelly A McNeil
- Division of Infectious Diseases, Department of Medicine, Dalhousie University, Halifax, NS, Canada
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