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Shinohara T, Saida K, Tanaka S, Murayama A, Higuchi D. Changes in frailty and lifestyle among community-dwelling older adults: A two-point cross-sectional study during and after the COVID-19 pandemic in Japan. Geriatr Nurs 2024; 58:208-214. [PMID: 38833813 DOI: 10.1016/j.gerinurse.2024.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 05/04/2024] [Accepted: 05/13/2024] [Indexed: 06/06/2024]
Abstract
We aimed to verify the characteristics of lifestyles and frailty among older adults during and after the COVID-19 pandemic. This two-point cross-sectional study conducted a baseline survey (BL) in 2020 and a follow-up survey (FU) in 2023 with community-dwelling individuals aged ≥65 years in Japan. The 700 and 572 participants in the BL and FU were analyzed. We compared frailty occurrence and lifestyle characteristics between both surveys. In the BL and FU, 38.3 %, 52.4 %, and 9.3 % and 29.4 %, 59.4 %, and 11.2 % of the individuals were classified as robust, pre-frail, and frail, respectively, showing a significant decrease in the number of robust, and an increase in the number of pre-frail. A significant decrease in dietary intake was observed among robust individuals in the FU, with an overall significant decrease in communication opportunities in the BL. Therefore, lifestyle changes due to infection control measures may have a delayed impact on frailty.
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Affiliation(s)
- Tomoyuki Shinohara
- Department of Physical Therapy, Faculty of Health Care, Takasaki University of Health and Welfare, 501 Naka Orui-machi, Takasaki-shi, Gunma 370-0033, Japan.
| | - Kosuke Saida
- Department of Physical Therapy, Faculty of Health Care, Takasaki University of Health and Welfare, 501 Naka Orui-machi, Takasaki-shi, Gunma 370-0033, Japan
| | - Shigeya Tanaka
- Department of Physical Therapy, Faculty of Health Care, Takasaki University of Health and Welfare, 501 Naka Orui-machi, Takasaki-shi, Gunma 370-0033, Japan
| | - Akihiko Murayama
- Department of Physical Therapy, Faculty of Rehabilitation, Gunma University of Health and Welfare, Maebashi Plaza Genki21 Maebashi 6-7F, 2-12-1 Hon-machi, Maebashi-shi, Gunma 371-0023, Japan
| | - Daisuke Higuchi
- Department of Physical Therapy, Faculty of Health Care, Takasaki University of Health and Welfare, 501 Naka Orui-machi, Takasaki-shi, Gunma 370-0033, Japan
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Ruiz JG, Muscedere J. The ethics of frailty: a need for consensus guidelines. J Nutr Health Aging 2024; 28:100265. [PMID: 38823305 DOI: 10.1016/j.jnha.2024.100265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 05/13/2024] [Indexed: 06/03/2024]
Affiliation(s)
| | - John Muscedere
- Faculty of Health Sciences at Queen's University, Ontario, Canada
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Hou T. Depressive Symptoms, Sleep Quality, and Pain Are Associated With Frailty in Nursing Home Residents During the COVID-19 Pandemic. Pain Manag Nurs 2024; 25:241-248. [PMID: 38413256 DOI: 10.1016/j.pmn.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 01/30/2024] [Accepted: 02/03/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND The COVID-19 pandemic has caused severe effects on older adults. Depressive symptoms, poor sleep quality, and pain are common in older adults with frailty. However, it is unknown the relationship between these symptoms and frailty in nursing home residents and the difference of importance between pain intensity and pain impact on frailty during the COVID-19 Pandemic. Therefore, this study aims to explore the associations between depressive symptoms, poor sleep quality, pain intensity, and pain impact with frailty in older adults living in nursing homes. METHODS In this cross-sectional population-based study, 172 older adults living in nursing homes from Changsha in China were included. We collected data on depressive symptoms, sleep quality, pain, and frailty using the Patient Health Questionnaire, the Pittsburgh Sleep Quality, the Brief Pain Inventory-short form, and the FRAIL-NH Scale. Generalized linear regression models were used to explore the interaction association between these symptoms with frailty. RESULTS Most older adults were between 80 and 90 years old. Approximately 11.6% of older adults experienced one of the following symptoms: depressive symptoms, poor sleep quality, pain intensity, or pain impact. Moreover, 76.7% of older adults experienced at least two of these symptoms. The most common overlapping symptoms were depressive symptoms and poor sleep quality (14.5%). Among nursing home residents, the most common sites of pain were the lower limbs, followed by the back. There was a strong correlation between depressive symptoms, sleep quality, pain intensity, pain impact, and frailty. After adjusting for covariates, the interaction term between any two or three symptoms of depressive symptoms, poor sleep quality, pain intensity, and pain impact was found to be associated with a higher likelihood of frailty in older adults residing in nursing homes (p< .05). CONCLUSIONS Depressive symptoms, poor sleep quality, pain intensity, and pain impact are common among nursing home residents. Furthermore, these symptoms interacted with each other. In future studies, multidisciplinary interventions aimed at releasing these symptoms and reducing the adverse outcome of frailty are needed.
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Affiliation(s)
- Tianxue Hou
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
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Martín-Martínez A, Viñas P, Carrillo I, Martos J, Clavé P, Ortega O. The Impact of Frailty, Oropharyngeal Dysphagia and Malnutrition on Mortality in Older Patients Hospitalized for Covid-19. Aging Dis 2024; 15:927-938. [PMID: 37548930 PMCID: PMC10917529 DOI: 10.14336/ad.2023.0425-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 04/25/2023] [Indexed: 08/08/2023] Open
Abstract
COVID-19 hospital mortality is higher among older patients through as yet little-known factors. We aimed to assess the effect of frailty (FR), oropharyngeal dysphagia (OD) and malnutrition (MN) on mortality in hospitalized COVID-19 older patients. Prospective cohort study of older patients (>70 years) with COVID-19 admitted to a general hospital from April 2020 to January 2021. Patients were evaluated on admission, discharge and at 1- and 3-months follow up. FR was assessed with FRAIL-VIG, OD with Volume-Viscosity Swallowing Test and MN with GLIM criteria. Clinical characteristics and outcomes, including intra-hospital, 1- and 3-month mortality, were analyzed. 258 patients were included (82.5±7.6 years; 58.9% women); 66.7% had FR (mild 28.7%, moderate 27.1% and severe 10.9%); 65.4%, OD and 50.6%, MN. OD prevalence increased from non-FR patients through the severity levels of FR: mild, moderate and severe (29.8%, 71.6%, 90.0%, 96.2%; p<0.0001, respectively), but not that of MN (50.6%, 47.1%, 52.5%, 56.0%). Mortality over the whole study significantly increased across FR categories (9.3% non-FR; 23.0% mild; 35.7% moderate; 75.0% severe; p<.001). Functionality (Barthel pre-admission, HR=0.983, CI-95%:0.973-0.993; p=0.001), OD (HR=2.953, CI-95%:0.970-8.989; p=0.057) and MN (HR=4.279, CI-95%:1.658-11.049; p=0.003) were independent risk factors for intra-hospital mortality. FR, OD and MN are highly prevalent conditions in older patients hospitalized with COVID-19. Functionality, OD and MN were independent risk factors for intra-hospital mortality.
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Affiliation(s)
- Alberto Martín-Martínez
- Gastrointestinal Physiology Laboratory CIBERehd CSdM-UAB, Hospital de Mataró, Consorci Sanitari del Maresme, Universitat Autònoma de Barcelona, 08304 Mataró, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain.
| | - Paula Viñas
- Gastrointestinal Physiology Laboratory CIBERehd CSdM-UAB, Hospital de Mataró, Consorci Sanitari del Maresme, Universitat Autònoma de Barcelona, 08304 Mataró, Spain.
| | - Irene Carrillo
- Department of Geriatrics, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Mataró, Spain.
| | - Josep Martos
- Department of Geriatrics, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Mataró, Spain.
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory CIBERehd CSdM-UAB, Hospital de Mataró, Consorci Sanitari del Maresme, Universitat Autònoma de Barcelona, 08304 Mataró, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain.
| | - Omar Ortega
- Gastrointestinal Physiology Laboratory CIBERehd CSdM-UAB, Hospital de Mataró, Consorci Sanitari del Maresme, Universitat Autònoma de Barcelona, 08304 Mataró, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain.
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Sciacchitano S, Carola V, Nicolais G, Sciacchitano S, Napoli C, Mancini R, Rocco M, Coluzzi F. To Be Frail or Not to Be Frail: This Is the Question-A Critical Narrative Review of Frailty. J Clin Med 2024; 13:721. [PMID: 38337415 PMCID: PMC10856357 DOI: 10.3390/jcm13030721] [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: 11/15/2023] [Revised: 01/07/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
Many factors have contributed to rendering frailty an emerging, relevant, and very popular concept. First, many pandemics that have affected humanity in history, including COVID-19, most recently, have had more severe effects on frail people compared to non-frail ones. Second, the increase in human life expectancy observed in many developed countries, including Italy has led to a rise in the percentage of the older population that is more likely to be frail, which is why frailty is much a more common concern among geriatricians compared to other the various health-care professionals. Third, the stratification of people according to the occurrence and the degree of frailty allows healthcare decision makers to adequately plan for the allocation of available human professional and economic resources. Since frailty is considered to be fully preventable, there are relevant consequences in terms of potential benefits both in terms of the clinical outcome and healthcare costs. Frailty is becoming a popular, pervasive, and almost omnipresent concept in many different contexts, including clinical medicine, physical health, lifestyle behavior, mental health, health policy, and socio-economic planning sciences. The emergence of the new "science of frailty" has been recently acknowledged. However, there is still debate on the exact definition of frailty, the pathogenic mechanisms involved, the most appropriate method to assess frailty, and consequently, who should be considered frail. This narrative review aims to analyze frailty from many different aspects and points of view, with a special focus on the proposed pathogenic mechanisms, the various factors that have been considered in the assessment of frailty, and the emerging role of biomarkers in the early recognition of frailty, particularly on the role of mitochondria. According to the extensive literature on this topic, it is clear that frailty is a very complex syndrome, involving many different domains and affecting multiple physiological systems. Therefore, its management should be directed towards a comprehensive and multifaceted holistic approach and a personalized intervention strategy to slow down its progression or even to completely reverse the course of this condition.
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Affiliation(s)
- Salvatore Sciacchitano
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy;
- Unit of Anaesthesia, Intensive Care and Pain Medicine, Sant’Andrea University Hospital, 00189 Rome, Italy; (M.R.); (F.C.)
- Department of Life Sciences, Health and Health Professions, Link Campus University, 00165 Rome, Italy
| | - Valeria Carola
- Department of Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome, 00189 Rome, Italy; (V.C.); (G.N.)
| | - Giampaolo Nicolais
- Department of Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome, 00189 Rome, Italy; (V.C.); (G.N.)
| | - Simona Sciacchitano
- Department of Psychiatry, La Princesa University Hospital, 28006 Madrid, Spain;
| | - Christian Napoli
- Department of Surgical and Medical Science and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy;
| | - Rita Mancini
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy;
| | - Monica Rocco
- Unit of Anaesthesia, Intensive Care and Pain Medicine, Sant’Andrea University Hospital, 00189 Rome, Italy; (M.R.); (F.C.)
- Department of Surgical and Medical Science and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy;
| | - Flaminia Coluzzi
- Unit of Anaesthesia, Intensive Care and Pain Medicine, Sant’Andrea University Hospital, 00189 Rome, Italy; (M.R.); (F.C.)
- Department Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, 04100 Latina, Italy
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Dengler J, Gheewala H, Kraft CN, Hegewald AA, Dörre R, Heese O, Gerlach R, Rosahl S, Maier B, Burger R, Wutzler S, Carl B, Ryang YM, Hau KT, Stein G, Gulow J, Allam A, Abduljawwad N, Rico Gonzalez G, Kuhlen R, Hohenstein S, Bollmann A, Stoffel M. Changes in frailty among patients hospitalized for spine pathologies during the COVID-19 pandemic in Germany-a nationwide observational study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:19-30. [PMID: 37971536 DOI: 10.1007/s00586-023-08014-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 10/11/2023] [Accepted: 10/18/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE In spine care, frailty is associated with poor outcomes. The aim of this study was to describe changes in frailty in spine care during the coronavirus disease 2019 (COVID-19) pandemic and their relation to surgical management and outcomes. METHODS Patients hospitalized for spine pathologies between January 1, 2019, and May 17, 2022, within a nationwide network of 76 hospitals in Germany were retrospectively included. Patient frailty, types of surgery, and in-hospital mortality rates were compared between pandemic and pre-pandemic periods. RESULTS Of the 223,418 included patients with spine pathologies, 151,766 were admitted during the pandemic and 71,652 during corresponding pre-pandemic periods in 2019. During the pandemic, the proportion of high-frailty patients increased from a range of 5.1-6.1% to 6.5-8.8% (p < 0.01), while the proportion of low frailty patients decreased from a range of 70.5-71.4% to 65.5-70.1% (p < 0.01). In most phases of the pandemic, the Elixhauser comorbidity index (ECI) showed larger increases among high compared to low frailty patients (by 0.2-1.8 vs. 0.2-0.8 [p < 0.01]). Changes in rates of spine surgery were associated with frailty, most clearly in rates of spine fusion, showing consistent increases among low frailty patients (by 2.2-2.5%) versus decreases (by 0.3-0.8%) among high-frailty patients (p < 0.02). Changes in rates of in-hospital mortality were not associated with frailty. CONCLUSIONS During the COVID-19 pandemic, the proportion of high-frailty patients increased among those hospitalized for spine pathologies in Germany. Low frailty was associated with a rise in rates of spine surgery and high frailty with comparably larger increases in rates of comorbidities.
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Affiliation(s)
- Julius Dengler
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Campus Bad Saarow, Bad Saarow, Germany.
- Department of Neurosurgery, HELIOS Hospital Bad Saarow, Bad Saarow, Germany.
| | - Hussain Gheewala
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Campus Bad Saarow, Bad Saarow, Germany
- Department of Neurosurgery, HELIOS Hospital Bad Saarow, Bad Saarow, Germany
| | - Clayton N Kraft
- Department of Orthopedics, Trauma Surgery and Hand Unit, HELIOS Klinikum Krefeld, Krefeld, Germany
| | - Aldemar A Hegewald
- Department of Neurosurgery, VAMED Ostsee Hospital Damp, Ostseebad Damp, Germany
| | - Ralf Dörre
- Department of Neurosurgery, HELIOS Hospital St. Marienberg, Helmstedt, Germany
| | - Oliver Heese
- Department of Neurosurgery and Spinal Surgery, HELIOS Hospital Schwerin - University Campus of MSH Medical School Hamburg, Schwerin, Germany
| | - Rüdiger Gerlach
- Department of Neurosurgery, HELIOS Hospital Erfurt, Erfurt, Germany
| | - Steffen Rosahl
- Department of Neurosurgery, HELIOS Hospital Erfurt, Erfurt, Germany
| | - Bernd Maier
- Department of Trauma and Orthopedic Surgery, HELIOS Hospital Pforzheim, Pforzheim, Germany
| | - Ralf Burger
- Department of Neurosurgery, HELIOS Hospital Uelzen, Uelzen, Germany
| | - Sebastian Wutzler
- Department of Trauma, Hand and Orthopedic Surgery, HELIOS Dr. Horst Schmidt Kliniken Wiesbaden, Wiesbaden, Germany
| | - Barbara Carl
- Department of Neurosurgery, University of Marburg, Marburg, Germany
- Marburg Center for Mind, Brain and Behavior (MCMBB), Marburg, Germany
- Department of Neurosurgery, HELIOS Dr. Horst Schmidt Kliniken, Wiesbaden, Germany
| | - Yu-Mi Ryang
- Department of Neurosurgery and Spine Center, HELIOS Hospital Berlin Buch, Berlin, Germany
- Department of Neurosurgery, Klinikum Rechts Der Isar, Technical University Munich, Munich, Germany
| | - Khanh Toan Hau
- Department of Spine Surgery, HELIOS Hospital Duisburg, Duisburg, Germany
| | - Gregor Stein
- Department of Orthopaedic, Trauma and Spine Surgery, HELIOS Hospital Siegburg, Siegburg, Germany
| | - Jens Gulow
- Department of Spine Surgery, HELIOS Park-Klinikum Leipzig, Leipzig, Germany
| | - Ali Allam
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Campus Bad Saarow, Bad Saarow, Germany
- Department of Anesthesiology and Intensive Care Medicine, HELIOS Hospital Bad Saarow, Bad Saarow, Germany
| | - Nehad Abduljawwad
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Campus Bad Saarow, Bad Saarow, Germany
- Department of Neurosurgery, HELIOS Hospital Bad Saarow, Bad Saarow, Germany
| | - Gerardo Rico Gonzalez
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Campus Bad Saarow, Bad Saarow, Germany
- Department of Neurosurgery, HELIOS Hospital Bad Saarow, Bad Saarow, Germany
| | | | - Sven Hohenstein
- Real World Evidence and Health Technology Assessment, Helios Health Institute, Berlin, Germany
| | - Andreas Bollmann
- Real World Evidence and Health Technology Assessment, Helios Health Institute, Berlin, Germany
- Department of Electrophysiology, Heart Center Leipzig at Leipzig University, Leipzig, Germany
| | - Michael Stoffel
- Department of Neurosurgery, HELIOS Hospital Krefeld, Krefeld, Germany
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7
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Dash D, Mowbray FI, Poss JW, Aryal K, Stall NM, Hirdes JP, Hillmer MP, Heckman GA, Bowdish DME, Costa AP, Jones A. The association between frailty, long-term care home characteristics and COVID-19 mortality before and after SARS-CoV-2 vaccination: a retrospective cohort study. Age Ageing 2023; 52:afad229. [PMID: 38163287 DOI: 10.1093/ageing/afad229] [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: 07/06/2023] [Revised: 09/19/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND The relative contributions of long-term care (LTC) resident frailty and home-level characteristics on COVID-19 mortality has not been well studied. We examined the association between resident frailty and home-level characteristics with 30-day COVID-19 mortality before and after the availability of SARS-CoV-2 vaccination in LTC. METHODS We conducted a population-based retrospective cohort study of LTC residents with confirmed SARS-CoV-2 infection in Ontario, Canada. We used multi-level multivariable logistic regression to examine associations between 30-day COVID-19 mortality, the Hubbard Frailty Index (FI), and resident and home-level characteristics. We compared explanatory models before and after vaccine availability. RESULTS There were 11,179 and 3,655 COVID-19 cases in the pre- and post-vaccine period, respectively. The 30-day COVID-19 mortality was 25.9 and 20.0% during the same periods. The median odds ratios for 30-day COVID-19 mortality between LTC homes were 1.50 (95% credible interval [CrI]: 1.41-1.65) and 1.62 (95% CrI: 1.46-1.96), respectively. In the pre-vaccine period, 30-day COVID-19 mortality was higher for males and those of greater age. For every 0.1 increase in the Hubbard FI, the odds of death were 1.49 (95% CI: 1.42-1.56) times higher. The association between frailty and mortality remained consistent in the post-vaccine period, but sex and age were partly attenuated. Despite the substantial home-level variation, no home-level characteristic examined was significantly associated with 30-day COVID-19 mortality during either period. INTERPRETATION Frailty is consistently associated with COVID-19 mortality before and after the availability of SARS-CoV-2 vaccination. Home-level characteristics previously attributed to COVID-19 outcomes do not explain significant home-to-home variation in COVID-19 mortality.
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Affiliation(s)
- Darly Dash
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Fabrice I Mowbray
- College of Nursing, Michigan State University, East Lansing, MI, USA
| | - Jeffrey W Poss
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Komal Aryal
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Nathan M Stall
- Division of General Internal Medicine and Geriatrics, Sinai Health System, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - John P Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Michael P Hillmer
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - George A Heckman
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Dawn M E Bowdish
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Firestone Institute for Respiratory Health, St. Joseph's Health Care Hamilton, Hamilton, ON, Canada
| | - Andrew P Costa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Aaron Jones
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
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Deore HS, Taranikanti M, Gaur A, Varatharajan S, John NA, Katta R, Taranikanti SS, Umesh M, Ganji V, Medala K. Comprehensive, continuous, and compulsory monitoring of frailty in elderly. J Family Med Prim Care 2023; 12:3194-3199. [PMID: 38361887 PMCID: PMC10866276 DOI: 10.4103/jfmpc.jfmpc_233_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 06/21/2023] [Accepted: 07/03/2023] [Indexed: 02/17/2024] Open
Abstract
Background The increasing elderly population makes frailty an increasing concern in society with vulnerability to stress and functional decline. Unrecognised comorbidities are common among the elderly due to lack of mention by the patients. Physicians should be equipped with effective interviewing skills along with the use of screening tools to assess any impairments in activities of daily living, cognition and signs of depression. Objectives To measure the degree of independence or dependence using scales and stratify patients based on Clinical Frailty Scale (CFS) so as to recommend it as a routinely usable tool. Materials and Methods In total, 191 elderly subjects above the age of 65 years were recruited for geriatric assessment. Tools that assess performance in daily living activities and cognition were used. The prevalidated CFS was used to score frailty to stratify patients into frail and non-frail groups, and the parameters were compared. Results Mean age of the study population was 69.54 years with 53.4% males and 46.6% females. Mean Katz index and mean Lawton score were >5. The mean Global Deterioration Scale (GDS) score was 1.5, and the mean clinical frailty score was 3.55. Significantly high number of male individuals were found in the frailty group. Hypertension was significantly higher in the frail group. The mean Katz scores were significantly lower, and mean GDS scores were significantly higher in the frailty group. Multivariable logistic regression has shown gender to be an important determinant of frailty with an odds ratio of 0.05 (CI-0.01-0.20). The higher Lawton score and GDS scores were significantly associated with frailty with an odds ratio of 0.33 (CI: 0.21-0.52) and 2.62 (CI: 1.14-6.02), respectively. Conclusion Men are more frail than women and co-morbidities like hypertension and coronary artery disease contribute to frailty with cognitive decline and decreased autonomy. A comprehensive assessment to identify frailty will provide a holistic view of well being among the elderly.
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Affiliation(s)
- Hiranya S. Deore
- Department of Physiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Madhuri Taranikanti
- Department of Physiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Archana Gaur
- Department of Physiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Sakthivadivel Varatharajan
- Department of General Medicine, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Nitin A. John
- Department of Physiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Roja Katta
- Department of Physiology, ESIC Medical College and Hospital, Hyderabad, Telangana, India
| | - Sai Shriya Taranikanti
- Department of General Medicine, Agartala Government Medical College and GB Pant Hospital, Agartala, Tripura, India
| | - Madhusudhan Umesh
- Department of Physiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Vidya Ganji
- Department of Physiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Kalpana Medala
- Department of Physiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
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9
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Roncati L, Bartolacelli G, Galeazzi C, Caramaschi S. Trends in the COVID-19 Pandemic in Italy during the Summers of 2020 (before Mass Vaccination), 2021 (after Primary Mass Vaccination) and 2022 (after Booster Mass Vaccination): A Real-World Nationwide Study Based on a Population of 58.85 Million People. Pathogens 2023; 12:1376. [PMID: 38133261 PMCID: PMC10747560 DOI: 10.3390/pathogens12121376] [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: 10/18/2023] [Revised: 11/15/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Like all RNA viruses, SARS-CoV-2 shows a high mutation rate, which has led to the emergence of new variants. Among them, Gamma and Delta developed at the turn of 2020-2021 in Amazonas and India, two ecoregions characterized by hot-humid weather, very similar to that of the summer season in Italy due to climate change, the first Western country to be hit hard by COVID-19 and to experience lockdown restrictions in a democratic framework of 58.85 million people. The aim of our research has been to evaluate the impact of climate on the COVID-19 pandemic in Italy during the summers of 2020 (before mass vaccination), 2021 (after primary mass vaccination) and 2022 (after booster mass vaccination), also taking into account the emergence of these two variants. METHODS During the state of national health emergency and the Draghi government, the Civil Defense Department released the aggregate data coming from the Ministry of Health, the Higher Institute of Health, the Independent Provinces and the Italian Regions daily, in order to inform about the pandemic situation in Italy. Among these data there were the number of deaths, hospitalizations in intensive care units (ICU), non-ICU patients, contagions and performed swabs. By means of a team effort, we have collected and elaborated all these data, comparing the COVID-19 pandemic in Italy during the summers of 2020 (following the nationwide lockdown), 2021 and 2022. RESULTS from the summer of 2020 to the summers of 2021 and 2022 all pandemic trend indicators have shown a sharp worsening in Italy. COVID-19 deaths increased by ≈298% and ≈834%, ICU hospitalizations by ≈386% and ≈310%, non-ICU hospitalizations by ≈224% and ≈600%, contagions by ≈627% and ≈6850% (i.e., ≈68.50 times), swabs by ≈354% and ≈370%, and the mean positivity rate passed from ≈1% to ≈2% and ≈20%, respectively. CONCLUSIONS SARS-CoV-2 can be transmitted in any climate, including areas with hot and humid weather, and the emergence of variants adapted to hot-humid climates may result in summer COVID-19 outbreaks, even in neither tropical nor subtropical countries. Although COVID-19 vaccines can confer cross-protection against newly emerging variants, this cross-immunity is naturally not absolute but limited, considering that vaccine protection wanes significantly after 6 months. It follows that a subject vaccinated at the beginning of the winter will not be completely covered in the height of the summer, and we should not forget the unvaccinated. As a final remark, the long and strict nationwide lockdown made it possible to flatten SARS-CoV-2 circulation and, therefore, its negative impact on Italy during the summer of 2020.
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Affiliation(s)
- Luca Roncati
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Interest in Transplantation, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Giulia Bartolacelli
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Interest in Transplantation, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Carlo Galeazzi
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Interest in Transplantation, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Stefania Caramaschi
- Department of Maternal, Infant and Adult Medical and Surgical Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy
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10
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Kananen L, Molnár C, Ansker F, Kozlowska DJ, Hägg S, Jylhävä J, Religa D, Raaschou P. Anticoagulant treatment and COVID-19 mortality among older adults living in nursing homes in Sweden. Health Sci Rep 2023; 6:e1692. [PMID: 38028709 PMCID: PMC10644256 DOI: 10.1002/hsr2.1692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Background Anticoagulants (AC) were introduced in March 2020 as standard of care in nursing home (NH) residents affected with COVID-19 in the Stockholm region, Sweden. ACs are proven to reduce the risk of complications and mortality from COVID-19 among patients of other ages and settings, but there is limited scientific evidence underpinning this practice in the NH setting. Methods This matched cohort study included 182 NH residents in the Stockholm Region diagnosed with COVID-19 in March-May 2020. The main exposure was any AC treatment. Exposed (n = 91), 49% prevalent (pre-COVID-19 diagnosis) AC and 51% incident AC were compared with unexposed controls (n = 91). The outcome was 28-days all-cause mortality after COVID-19 infection. The mortality odds ratios (OR) were assessed using logistic regression, adjusted for age, sex, multimorbidity, and mobility, also stratified by incident or prevalent AC-type, age group, and sex. Results Of the 182 individuals diagnosed with COVID-19 (median age 88 years, 68% women), 39% died within 28 days after diagnosis. Use of either incident or prevalent AC was associated with a reduced, adjusted 28-day mortality (OR[95% CI]: 0.31[0.16-0.62]). In stratified analyses, the association was significant in both age groups: 70-89 (OR: 0.37 [0.15-0.89]) and 90-99 years of age (OR: 0.22 [0.07-0.65]. In sex-stratified analysis, the AC-lowering effect was significant in women only (OR: 0.28[0.11-0.67]). In the analyses stratified by AC type, the mortality-lowering effect was observed for both prevalent AC (OR: 0.35[0.12-0.99]) and incident AC (OR: 0.29[0.11-0.76]). Conclusions Both prevalent and incident use of ACs in prophylactic dosing was associated with reduced 28-day mortality among older individuals with COVID-19 in a NH setting. The effect was seen across age-strata and in women. The findings present new insight in best practice for individuals diagnosed with COVID-19 in the NH setting.
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Affiliation(s)
- Laura Kananen
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetSolnaStockholmSweden
- Faculty of Social Sciences (Health Sciences), and Gerontology Research CenterTampere UniversityTampereFinland
- Faculty of Medicine and Health Technology, and Gerontology Research CenterTampere UniversityTampereFinland
| | - Christian Molnár
- Department of Neurobiology, Care Sciences and Society (NVS)Karolinska InstitutetStockholmSweden
- Familjeläkarna SÄBOFamiljeläkarna i SaltsjöbadenStockholmSweden
| | - Fredrik Ansker
- Familjeläkarna SÄBOFamiljeläkarna i SaltsjöbadenStockholmSweden
| | | | - Sara Hägg
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetSolnaStockholmSweden
| | - Juulia Jylhävä
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetSolnaStockholmSweden
- Faculty of Social Sciences (Health Sciences), and Gerontology Research CenterTampere UniversityTampereFinland
| | - Dorota Religa
- Department of Neurobiology, Care Sciences and Society (NVS)Karolinska InstitutetStockholmSweden
| | - Pauline Raaschou
- Department of Medicine Solna, Clinical Epidemiology Section & Clinical Pharmacology UnitKarolinska InstitutetSolnaStockholmSweden
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11
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Demonceau C, Buckinx F, Reginster JY, Bruyère O. Investigation of the relationships between frailty, nutritional status and muscle strength and the incidence and severity of Covid-19 among the residents of nursing homes. Results from the SENIOR cohort. Maturitas 2023; 177:107800. [PMID: 37506561 DOI: 10.1016/j.maturitas.2023.107800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/26/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023]
Abstract
Few studies have investigated the factors associated with the incidence of Covid-19 in nursing homes. The aim of this study was to investigate the relationships between frailty, nutritional status, muscle strength and the Covid-19 incidence and severity in nursing home residents. Data from the last two years of follow-up of the SENIOR (Sample of Elderly Nursing homes individuals: an Observational Research) cohort were used. A total of 75 participants of the cohort were included, 56 % of whom had Covid-19. After adjustment for covariates, no association was found between frailty, nutritional status or grip strength and the incidence and severity of Covid-19.
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Affiliation(s)
- Céline Demonceau
- WHO Collaborating Center for Epidemiologic aspects of musculo-skeletal health and ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Avenue Hippocrate 13, CHU Bât B23, 4000 Liège, Belgium.
| | - Fanny Buckinx
- WHO Collaborating Center for Epidemiologic aspects of musculo-skeletal health and ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Avenue Hippocrate 13, CHU Bât B23, 4000 Liège, Belgium
| | - Jean-Yves Reginster
- WHO Collaborating Center for Epidemiologic aspects of musculo-skeletal health and ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Avenue Hippocrate 13, CHU Bât B23, 4000 Liège, Belgium
| | - Olivier Bruyère
- WHO Collaborating Center for Epidemiologic aspects of musculo-skeletal health and ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Avenue Hippocrate 13, CHU Bât B23, 4000 Liège, Belgium
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12
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Calder PC. Nutrition and immunity: lessons from coronavirus disease-2019. Proc Nutr Soc 2023:1-16. [PMID: 37886807 DOI: 10.1017/s0029665123004792] [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] [Indexed: 10/28/2023]
Abstract
This review will provide an overview of the immune system and then describe the effects of frailty, obesity, specific micronutrients and the gut microbiota on immunity and susceptibility to infection including data from the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic where relevant. A key role for the immune system is providing host defence against pathogens. Impaired immunity predisposes to infections and to more severe infections and weakens the response to vaccination. A range of nutrients, including many micronutrients, play important roles in supporting the immune system to function. The immune system can decline in later life and this is exaggerated by frailty. The immune system is also weakened with obesity, generalised undernutrition and micronutrient deficiencies, which all result in increased susceptibility to infection. Findings obtained during the SARS-CoV-2 pandemic support what was already known about the effects of ageing, frailty and obesity on immunity and susceptibility to infection. Observational studies conducted during the pandemic also support previous findings that multiple micronutrients including vitamins C, D and E, zinc and selenium and long-chain n-3 fatty acids are important for immune health, but whether these nutrients can be used to treat those already with coronavirus disease discovered in 2019 (COVID-19), particularly if already hospitalised, is uncertain from current inconsistent or scant evidence. There is gut dysbiosis in patients with COVID-19 and studies with probiotics report clinical improvements in such patients. There is an inverse association between adherence to a healthy diet and risk of SARS-CoV-2 infection and hospitalisation with COVID-19 which is consistent with the effects of individual nutrients and other dietary components. Addressing frailty, obesity and micronutrient insufficiency will be important to reduce the burden of future pandemics and nutritional considerations need to be a central part of the approach to preventing infections, optimising vaccine responses and promoting recovery from infection.
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Affiliation(s)
- Philip C Calder
- School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton SO16 6YD, UK
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13
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Xing Y, Sun Y, Tang M, Huang W, Luo J, Ma Q. Variables Associated with 30-Day Mortality in Very Elderly COVID-19 Patients. Clin Interv Aging 2023; 18:1155-1162. [PMID: 37522071 PMCID: PMC10386830 DOI: 10.2147/cia.s417282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/11/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND Advanced age increases the risk for severe COVID-19. However, the risk factors for mortality from COVID-19 in very elderly patients (≥80-years-old) are unknown. OBJECTIVE Investigate the relationship of mortality with the clinical characteristics of very elderly COVID-19 patients. MATERIALS AND METHODS Very elderly patients who were hospitalized with COVID-19 from December 3, 2022 to January 1, 2023 were retrospectively examined. Sociodemographic and clinical variables were recorded and survival was recorded after 30 days. RESULTS We examined 181 patients (median age: 90.84 years; 114 older than 90 years). The median Barthel index was 30.69, and 55.8% of patients had severe or critical COVID-19 pneumonia. Forty-two patients (33.2%) received a high-flow nasal cannula or non-invasive ventilation, and only 4.4% received mechanical ventilation. The overall mortality was 35.9%, and there was no significant difference in mortality for the 80 to 90-year-old group and the over 90-year-old group (37.7% vs 32.8%, P=0.508). A multivariate analysis showed that the Barthel index (OR, 0.975; 95% CI, 0.962-0.989), serum creatinine (SCr) level (OR, 1.003; 95% CI, 1.000-1.006), white blood cell (WBC) count (OR, 1.160; 95% CI, 1.056-1.276), D-dimer level (OR, 1.060; 95% CI, 1.009-1.113), and corticosteroid use (OR, 0.268; 95% CI, 0.124-0.582) were significantly and independently related to 30-day mortality. A binary classification model based on the multivariate analysis had good predictive value (area under the curve, 0.794). CONCLUSION Very elderly COVID-19 patients have a high risk for mortality. The Barthel index, SCr, WBC count, D-dimer level, and corticosteroid use were independently associated with mortality.
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Affiliation(s)
- Yunli Xing
- Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Ying Sun
- Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Mei Tang
- Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Wei Huang
- Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Jia Luo
- Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Qing Ma
- Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
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14
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Wehrfritz A, Schmidt J, Bremer F, Lang A, Welzer J, Castellanos I. Ethical conflicts associated with COVID-19 pandemic, triage and frailty-unexpected positive disease progression in a 90-year-old patient: A case report. Clin Case Rep 2023; 11:e7710. [PMID: 37476601 PMCID: PMC10354352 DOI: 10.1002/ccr3.7710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 07/02/2023] [Accepted: 07/04/2023] [Indexed: 07/22/2023] Open
Abstract
During the COVID 19 pandemic, advanced age, scoring systems, and a shortage of ICU beds were used as cut-offs for ICU admission. This case report describes the epicrisis of an elderly patient who was almost mistakenly not treated in an ICU.
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Affiliation(s)
- Andreas Wehrfritz
- Department of AnaesthesiologyUniversity hospital of Erlangen, Faculty of Medicine, Friedrich‐Alexander‐University ErlangenErlangenGermany
| | - Joachim Schmidt
- Department of AnaesthesiologyUniversity hospital of Erlangen, Faculty of Medicine, Friedrich‐Alexander‐University ErlangenErlangenGermany
| | - Frank Bremer
- Department of AnaesthesiologyUniversity hospital of Erlangen, Faculty of Medicine, Friedrich‐Alexander‐University ErlangenErlangenGermany
| | - Anne‐Katharina Lang
- Department of AnaesthesiologyUniversity hospital of Erlangen, Faculty of Medicine, Friedrich‐Alexander‐University ErlangenErlangenGermany
| | - Jacob Welzer
- Department of AnaesthesiologyKlinikum FuerthFuerthGermany
| | - Ixchel Castellanos
- Department of AnaesthesiologyUniversity hospital of Erlangen, Faculty of Medicine, Friedrich‐Alexander‐University ErlangenErlangenGermany
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15
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Bruno RR, Wernly B, Bagshaw SM, van den Boogaard M, Darvall JN, De Geer L, de Gopegui Miguelena PR, Heyland DK, Hewitt D, Hope AA, Langlais E, Le Maguet P, Montgomery CL, Papageorgiou D, Seguin P, Geense WW, Silva-Obregón JA, Wolff G, Polzin A, Dannenberg L, Kelm M, Flaatten H, Beil M, Franz M, Sviri S, Leaver S, Guidet B, Boumendil A, Jung C. The Clinical Frailty Scale for mortality prediction of old acutely admitted intensive care patients: a meta-analysis of individual patient-level data. Ann Intensive Care 2023; 13:37. [PMID: 37133796 PMCID: PMC10155148 DOI: 10.1186/s13613-023-01132-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 04/20/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND This large-scale analysis pools individual data about the Clinical Frailty Scale (CFS) to predict outcome in the intensive care unit (ICU). METHODS A systematic search identified all clinical trials that used the CFS in the ICU (PubMed searched until 24th June 2020). All patients who were electively admitted were excluded. The primary outcome was ICU mortality. Regression models were estimated on the complete data set, and for missing data, multiple imputations were utilised. Cox models were adjusted for age, sex, and illness acuity score (SOFA, SAPS II or APACHE II). RESULTS 12 studies from 30 countries with anonymised individualised patient data were included (n = 23,989 patients). In the univariate analysis for all patients, being frail (CFS ≥ 5) was associated with an increased risk of ICU mortality, but not after adjustment. In older patients (≥ 65 years) there was an independent association with ICU mortality both in the complete case analysis (HR 1.34 (95% CI 1.25-1.44), p < 0.0001) and in the multiple imputation analysis (HR 1.35 (95% CI 1.26-1.45), p < 0.0001, adjusted for SOFA). In older patients, being vulnerable (CFS 4) alone did not significantly differ from being frail. After adjustment, a CFS of 4-5, 6, and ≥ 7 was associated with a significantly worse outcome compared to CFS of 1-3. CONCLUSIONS Being frail is associated with a significantly increased risk for ICU mortality in older patients, while being vulnerable alone did not significantly differ. New Frailty categories might reflect its "continuum" better and predict ICU outcome more accurately. TRIAL REGISTRATION Open Science Framework (OSF: https://osf.io/8buwk/ ).
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Affiliation(s)
- Raphael Romano Bruno
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Bernhard Wernly
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical Private University, Paracelsusstraße 37, 5110, Oberndorf, Austria
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria
| | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, 2-124 Clinical Sciences Building, 8440 112Th ST, Edmonton, AB, T6G 2B7, Canada
| | - Mark van den Boogaard
- Department of Intensive Care Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jai N Darvall
- Intensive Care Unit and Department of Anaesthesia & Pain Management, The Royal Melbourne Hospital, Grattan Street, Parkville, VIC, 3050, Australia
| | - Lina De Geer
- Department of Anaesthesiology and Intensive Care, Linköping University Hospital, Linköping, Sweden
| | | | - Daren K Heyland
- Clinical Evaluation Research Unit, and Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada
| | - David Hewitt
- Glasgow Royal Infirmary Intensive Care Unit, Glasgow, Scotland
| | - Aluko A Hope
- Division of Pulmonary, Allergy, and Critical Care Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Emilie Langlais
- Réanimation Chirurgicale, CHU Rennes, Université Rennes 1, Rennes, France
| | - Pascale Le Maguet
- Département d'Anesthésie Réanimation, CHU Rennes, Rennes, France
- Service d'Anesthésie, CH Quimper, Quimper, France
| | - Carmel L Montgomery
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, 2-124 Clinical Sciences Building, 8440 112Th ST, Edmonton, AB, T6G 2B7, Canada
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 3-171, Edmonton, AB, T6G 1C9, Canada
| | - Dimitrios Papageorgiou
- Faculty of Health and Caring Sciences Department of Nursing, University of West Attica (UWA) Athens, Egaleo, Greece
| | - Philippe Seguin
- Réanimation Chirurgicale, CHU Rennes, Université Rennes 1, Rennes, France
| | - Wytske W Geense
- Department of Intensive Care Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Alberto Silva-Obregón
- Department of Intensive Care Medicine, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - Georg Wolff
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Amin Polzin
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Lisa Dannenberg
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Malte Kelm
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
- CARID (Cardiovascular Research Institute Düsseldorf), University Hospital of Düsseldorf, Germany, Düsseldorf, Germany
| | - Hans Flaatten
- Department of Clinical Medicine, Department of Anaesthesia and Intensive Care, University of Bergen, Haukeland University Hospital, Bergen, Norway
| | - Michael Beil
- Dept. of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Marcus Franz
- Clinic of Internal Medicine I, Department of Cardiology, Friedrich Schiller University, 07737, Jena, Germany
| | - Sigal Sviri
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Susannah Leaver
- General Intensive Care, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Bertrand Guidet
- Equipe: Épidémiologie Hospitalière Qualité Et Organisation Des Soins, Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie Et de Santé Publique, 75012, Paris, France
- Service de Réanimation Médicale, Hôpitaux de Paris, Hôpital Saint-Antoine, 75012, Paris, France
| | - Ariane Boumendil
- Equipe: Épidémiologie Hospitalière Qualité Et Organisation Des Soins, Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie Et de Santé Publique, 75012, Paris, France
- Service de Réanimation Médicale, Hôpitaux de Paris, Hôpital Saint-Antoine, 75012, Paris, France
| | - Christian Jung
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany.
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McGovern J, Wadsworth J, Catchpole A, Richards C, McMillan DC, Kelliher T, Goodall E, Murray E, Melaugh T, McPhillips S, Brice K, Barbour K, Robinson S, Moffitt P, Kemp O, Talwar D, Maguire D. The relationship between micronutrient status, frailty, systemic inflammation, and clinical outcomes in patients admitted to hospital with COVID-19. J Transl Med 2023; 21:284. [PMID: 37118813 PMCID: PMC10139911 DOI: 10.1186/s12967-023-04138-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/16/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Micronutrients have been associated with disease severity and poorer clinical outcomes in patients with COVID-19. However, there is a paucity of studies examining if the relationship with micronutrient status and clinical outcomes is independent of recognised prognostic factors, specifically frailty and the systemic inflammatory response (SIR). The aim of the present study was to examine the relationship between micronutrient status, frailty, systemic inflammation, and clinical outcomes in patients admitted with COVID-19. METHODS Retrospective analysis of prospectively collected data was performed on patients with confirmed COVID-19, admitted to hospital between the 1st April 2020-6th July 2020. Clinicopathological characteristics, frailty assessment, biochemical and micronutrient laboratory results were recorded. Frailty status was determined using the Clinical Frailty scale. SIR was determined using serum CRP. Clinical outcomes of interest were oxygen requirement, ITU admission and 30-day mortality. Categorical variables were analysed using chi-square test and binary logistics regression analysis. Continuous variables were analysed using the Mann-Whitney U or Kruskal Wallis tests. RESULTS 281 patients were included. 55% (n = 155) were aged ≥ 70 years and 39% (n = 109) were male. 49% (n = 138) of patients were frail (CFS > 3). 86% (n = 242) of patients had a serum CRP > 10 mg/L. On univariate analysis, frailty was significantly associated with thirty-day mortality (p < 0.001). On univariate analysis, serum CRP was found to be significantly associated with an oxygen requirement on admission in non-frail patients (p = 0.004). Over a third (36%) of non-frail patients had a low vitamin B1, despite having normal reference range values of red cell B2, B6 and selenium. Furthermore, serum CRP was found to be significantly associated with a lower median red cell vitamin B1 (p = 0.029). CONCLUSION Vitamin B1 stores may be depleted in COVID-19 patients experiencing a significant SIR and providing rationale for thiamine supplementation. Further longitudinal studies are warranted to delineate the trend in thiamine status following COVID-19.
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Affiliation(s)
- Josh McGovern
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Level 2, New Lister Building, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK.
| | - John Wadsworth
- Clinical Biochemistry Department, Glasgow Royal Infirmary, Glasgow, G4 0SF, UK
| | - Anthony Catchpole
- Clinical Biochemistry Department, Glasgow Royal Infirmary, Glasgow, G4 0SF, UK
| | - Conor Richards
- Emergency Department, Glasgow Royal Infirmary, Glasgow, G4 0SF, UK
| | - Donald C McMillan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Level 2, New Lister Building, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK
| | - Tadhg Kelliher
- Emergency Department, Glasgow Royal Infirmary, Glasgow, G4 0SF, UK
| | - Emma Goodall
- Emergency Department, Glasgow Royal Infirmary, Glasgow, G4 0SF, UK
| | - Ellie Murray
- Emergency Department, Glasgow Royal Infirmary, Glasgow, G4 0SF, UK
| | - Terry Melaugh
- Emergency Department, Glasgow Royal Infirmary, Glasgow, G4 0SF, UK
| | | | - Kathryn Brice
- Emergency Department, Glasgow Royal Infirmary, Glasgow, G4 0SF, UK
| | - Katie Barbour
- Emergency Department, Glasgow Royal Infirmary, Glasgow, G4 0SF, UK
| | - Sophie Robinson
- Emergency Department, Glasgow Royal Infirmary, Glasgow, G4 0SF, UK
| | - Peter Moffitt
- Emergency Department, Glasgow Royal Infirmary, Glasgow, G4 0SF, UK
| | - Olivia Kemp
- Emergency Department, Glasgow Royal Infirmary, Glasgow, G4 0SF, UK
| | - Dinesh Talwar
- Clinical Biochemistry Department, Glasgow Royal Infirmary, Glasgow, G4 0SF, UK
| | - Donogh Maguire
- Emergency Department, Glasgow Royal Infirmary, Glasgow, G4 0SF, UK
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Clinical progression, disease severity, and mortality among adults hospitalized with COVID-19 caused by the Omicron and Delta SARS-CoV-2 variants: A population-based, matched cohort study. PLoS One 2023; 18:e0282806. [PMID: 37104488 PMCID: PMC10138229 DOI: 10.1371/journal.pone.0282806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 02/23/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND To compare the intrinsic virulence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) omicron variant with the delta variant in hospitalized adults with coronavirus disease 2019 (COVID-19). METHODS All adults hospitalized in the Capital Region of Copenhagen with a positive reverse transcription polymerase chain reaction test for SARS-CoV-2 and an available variant determination from 1 September 2021 to 11 February 2022. Data from health registries and patient files were used. Omicron and Delta patients were matched (1:1) by age, sex, comorbidities, and vaccination status. We calculated crude and adjusted hazard ratios (aHRs) for severe hypoxemia and mortality at 30 and 60 days. RESULTS 1,043 patients were included. Patients with Omicron were older, had more comorbidities, were frailer, and more often had three vaccine doses than those with Delta. Fewer patients with Omicron developed severe hypoxemia than those with Delta (aHR, 0.55; 95% confidence interval, 0.38-0.78). Omicron patients exhibited decreased aHR for 30-day mortality compared to Delta (aHR, 0.61; 0.39-0.95). Omicron patients who had received three vaccine doses had lower mortality compared to Delta patients who received three doses (aHR, 0.31;0.16-0.59), but not among those who received two or 0-1 doses (aHR, 0.86; 0.41-1.84 and 0.94; 0.49-1.81 respectively). Similar findings were observed for mortality at 60 days. Similar outcomes were obtained in the analyses of 316 individually matched patients. CONCLUSIONS Among adults hospitalized with COVID-19, those with Omicron had less severe hypoxemia and nearly 40% higher 30- and 60-day survival, as compared with those with Delta, mainly driven by a larger proportion of Omicron patients vaccinated with three doses of an mRNA vaccine.
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Leece P, Whelan M, Costa AP, Daneman N, Johnstone J, McGeer A, Rochon P, Schwartz KL, Brown KA. Nursing home crowding and its association with outbreak-associated respiratory infection in Ontario, Canada before the COVID-19 pandemic (2014-19): a retrospective cohort study. THE LANCET. HEALTHY LONGEVITY 2023; 4:e107-e114. [PMID: 36870336 PMCID: PMC9989831 DOI: 10.1016/s2666-7568(23)00018-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND Studies conducted during the COVID-19 pandemic have shown that crowding in nursing homes is associated with high incidence of SARS-CoV-2 infections, but this effect has not been shown for other respiratory pathogens. We aimed to measure the association between crowding in nursing homes and outbreak-associated respiratory infection incidence and related mortality before the COVID-19 pandemic. METHODS We conducted a retrospective cohort study of nursing homes in Ontario, Canada. We identified, characterised, and selected nursing homes through the Ontario Ministry of Long-Term Care datasets. Nursing homes that were not funded by the Ontario Ministry of Long-Term Care and homes that closed before January, 2020 were excluded. Outcomes consisting of respiratory infection outbreaks were obtained from the Integrated Public Health Information System of Ontario. The crowding index equalled the mean number of residents per bedroom and bathroom. The primary outcomes were the incidence of outbreak-associated infections and mortality per 100 nursing home residents per year. We examined the incidence of infections and deaths as a function of the crowding index by use of negative binomial regression with adjustment for three home characteristics (ie, ownership, number of beds, and region) and nine mean resident characteristics (ie, age, female sex, dementia, diabetes, chronic heart failure, renal failure, cancer, chronic obstructive pulmonary disease, and activities of daily living score). FINDINGS Between Sept 1, 2014, and Aug 31, 2019, 5107 respiratory infection outbreaks in 588 nursing homes were recorded, of which 4921 (96·4%), involving 64 829 cases of respiratory infection and 1969 deaths, were included in this analysis. Nursing homes with a high crowding index had higher incidences of respiratory infection (26·4% vs 13·8%; adjusted rate ratio per one resident per room increase in crowding 1·89 [95% CI 1·64-2·17]) and mortality (0·8% vs 0·4%; 2·34 [1·88-2·92]) than did homes with a low crowding index. INTERPRETATION Respiratory infection and mortality rates were higher in nursing homes with high crowding index than in homes with low crowding index, and the association was consistent across various respiratory pathogens. Decreasing crowding is an important safety target beyond the COVID-19 pandemic to help to promote resident wellbeing and decrease the transmission of prevalent respiratory pathogens. FUNDING None.
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Affiliation(s)
| | | | | | - Nick Daneman
- Public Health Ontario, Toronto, ON, Canada; Division of Infectious Diseases, Sunnybrook Research Institute, Toronto, ON, Canada
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Tomidokoro D, Asai Y, Hayakawa K, Kutsuna S, Terada M, Sugiura W, Ohmagari N, Hiroi Y. Comparison of the clinical characteristics and outcomes of Japanese patients with COVID-19 treated in primary, secondary, and tertiary care facilities. J Infect Chemother 2023; 29:302-308. [PMID: 36526254 PMCID: PMC9745966 DOI: 10.1016/j.jiac.2022.12.003] [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: 10/23/2022] [Revised: 11/25/2022] [Accepted: 12/07/2022] [Indexed: 12/15/2022]
Abstract
AIM To compare the characteristics and clinical course of patients with coronavirus disease (COVID-19) according to the healthcare level of the admitted hospital, to provide an insight into determining the appropriate level of care for each patient. METHODS This retrospective, observational study utilized data from the COVID-19 Registry Japan (COVIREGI-JP), the largest Japanese registry of hospitalized patients with COVID-19. Datasets were obtained from reports filed as of May 31, 2022. RESULTS A total of 59,707 patients (2004 in the primary care group, 41,420 in the secondary care group, and 16,283 in the tertiary care group) from 585 facilities were included in the analysis. Patients with established risk factors for severe disease, such as old age and the presence of comorbidities, were treated at higher care facilities and had poorer initial conditions and in-hospital clinical course, as well as higher mortality. Analysis of the fatality rates for each complication suggested that patients with complications requiring procedures (e.g. pleural effusions, myocardial ischemia, and arrhythmia) may have better survival rates in facilities with specialist availability. The number of deaths and severe COVID-19 cases in this study were notably less than those reported overseas. CONCLUSION Our results showed that more difficult COVID-19 cases with poor outcomes were treated at higher care level facilities in Japan. Attending to possible complications may be useful for selecting an appropriate treatment hospital. Healthcare providers need to maintain a broad perspective on the distribution of medical resources.
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Affiliation(s)
- Daiki Tomidokoro
- Department of Cardiology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yusuke Asai
- AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kayoko Hayakawa
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Satoshi Kutsuna
- Department of Infection Control and Prevention, Graduate School of Medicine, Faculty of Medicine, Osaka University, Osaka, Japan
| | - Mari Terada
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan; Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Wataru Sugiura
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yukio Hiroi
- Department of Cardiology, National Center for Global Health and Medicine, Tokyo, Japan.
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Mesic E, Aleckovic-Halilovic M, Paunovic K, Woywodt A, Pjanic M, Paunovic G. COVID - 19 in two dialysis centers situated in two neighbouring states of the Western Balkans. BMC Nephrol 2023; 24:40. [PMID: 36803693 PMCID: PMC9938731 DOI: 10.1186/s12882-023-03080-x] [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: 09/08/2022] [Accepted: 02/06/2023] [Indexed: 02/20/2023] Open
Abstract
BACKGROUND Bosnia and Herzegovina (BiH) and Serbia are countries in the Western Balkans that share parts of their social and political legacy from the former Yugoslavia, such as their health care system and the fact that they are not members of European Union. There are very scarce data on COVID - 19 pandemic from this region when compared to other parts of the world and even less is known about its impact on the provision of renal care or differences between countries in the Western Balkans. MATERIALS AND METHODS This observational prospective study was conducted in two regional renal centres in BiH and Serbia, during the COVID - 19 pandemic. We obtained demographic and epidemiological data, clinical course and outcomes of dialysis and transplant patients with COVID - 19 in both units. Data were collected a via questionnaire for two consecutive time periods: February - June 2020 with a total number of 767 dialysis and transplant patients in the two centres, and July - December 2020 with a total number of 749 studied patients, corresponding to two of the largest waves of the pandemic in our region. Departmental policies and infection control measures in both units were also recorded and compared. RESULTS For a period of 11 months, from February to December 2020, 82 patients on in-centre haemodialysis (ICHD), 11 peritoneal dialysis patients and 25 transplant patients who tested positive for COVID-19. In the first study period, the incidence of COVID - 19 positive in Tuzla was 1.3% among ICHD patients, and there were no positive peritoneal dialysis patients, or any transplant patients who tested positive. The incidence of COVID-19 was significantly higher in both centres in the second time period, which corresponds to the incidence in general population. Total deaths of COVID-19 positive patients was 0% in Tuzla and 45.5% in Niš during first, and 16.7% in Tuzla and 23.4% in Niš during the second period. There were notable differences in the national and local/departmental approach to the pandemic between the two centres. CONCLUSION There was poor survival overall when compared to other regions of Europe. We suggest that this reflects the lack of preparedness of both of our medical systems for such situations. In addition, we describe important differences in outcome between the two centres. We emphasize the importance of preventative measures and infection control and highlight the importance of preparedness.
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Affiliation(s)
- Enisa Mesic
- Department of Nephrology, Dialysis and Transplantation, University Hospital Tuzla, Ulica Prof. Dr. Ibre Pašića, 75000 Tuzla, Bosnia and Herzegovina
| | - Mirna Aleckovic-Halilovic
- Department of Nephrology, Dialysis and Transplantation, University Hospital Tuzla, Ulica Prof. Dr. Ibre Pašića, 75000 Tuzla, Bosnia and Herzegovina
| | - Karolina Paunovic
- grid.418653.d0000 0004 0517 2741Nephrology Department, Niš Clinical Centre, Niš, Serbia
| | - Alexander Woywodt
- grid.440181.80000 0004 0456 4815Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire UK
| | - Mirha Pjanic
- Department of Nephrology, Dialysis and Transplantation, University Hospital Tuzla, Ulica Prof. Dr. Ibre Pašića, 75000, Tuzla, Bosnia and Herzegovina.
| | - Goran Paunovic
- grid.418653.d0000 0004 0517 2741Nephrology Department, Niš Clinical Centre, Niš, Serbia
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21
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Song HJJMD, Chia AZQ, Tan BKJ, Teo CB, Lim V, Chua HR, Samuel M, Kee A. Electrolyte imbalances as poor prognostic markers in COVID-19: a systemic review and meta-analysis. J Endocrinol Invest 2023; 46:235-259. [PMID: 36070177 PMCID: PMC9449297 DOI: 10.1007/s40618-022-01877-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/19/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE Serum electrolyte imbalances are highly prevalent in COVID-19 patients. However, their associations with COVID-19 outcomes are inconsistent, and of unknown prognostic value. We aim to systematically clarify the associations and prognostic accuracy of electrolyte imbalances (sodium, calcium, potassium, magnesium, chloride and phosphate) in predicting poor COVID-19 clinical outcome. METHODS PubMed, Embase and Cochrane Library were searched. Odds of poor clinical outcome (a composite of mortality, intensive-care unit (ICU) admission, need for respiratory support and acute respiratory distress syndrome) were pooled using mixed-effects models. The associated prognostic sensitivity, positive and negative likelihood ratios (LR + , LR-) and predictive values (PPV, NPV; assuming 25% pre-test probability), and area under the curve (AUC) were computed. RESULTS We included 28 observational studies from 953 records with low to moderate risk-of-bias. Hyponatremia (OR = 2.08, 95% CI = 1.48-2.94, I2 = 93%, N = 8), hypernatremia (OR = 4.32, 95% CI = 3.17-5.88, I2 = 45%, N = 7) and hypocalcemia (OR = 3.31, 95% CI = 2.24-4.88, I2 = 25%, N = 6) were associated with poor COVID-19 outcome. These associations remained significant on adjustment for covariates such as demographics and comorbidities. Hypernatremia was 97% specific in predicting poor outcome (LR + 4.0, PPV = 55%, AUC = 0.80) despite no differences in CRP and IL-6 levels between hypernatremic and normonatremic patients. Hypocalcemia was 76% sensitive in predicting poor outcome (LR- 0.44, NPV = 87%, AUC = 0.71). Overall quality of evidence ranged from very low to moderate. CONCLUSION Hyponatremia, hypernatremia and hypocalcemia are associated with poor COVID-19 clinical outcome. Hypernatremia is 97% specific for a poor outcome, and the association is independent of inflammatory marker levels. Further studies should evaluate if correcting these imbalances help improve clinical outcome.
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Affiliation(s)
- H J J M D Song
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - A Z Q Chia
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - B K J Tan
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - C B Teo
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - V Lim
- Department of Medicine, National University Hospital (NUH), Singapore, Singapore
| | - H R Chua
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
- Department of Medicine, National University Hospital (NUH), Singapore, Singapore
| | - M Samuel
- Systematic Review Unit, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - A Kee
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore.
- Department of Medicine, National University Hospital (NUH), Singapore, Singapore.
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22
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Eysenbach G, Leung T, Plourde KV, Gadio S, Elf M, Jones CA, Meijering L, Giguère A, Légaré F. Canadian Older Adults' Intention to Use an Electronic Decision Aid for Housing Decisions: Cross-sectional Web-Based Survey. JMIR Aging 2023; 6:e43106. [PMID: 36566499 PMCID: PMC9947828 DOI: 10.2196/43106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/05/2022] [Accepted: 12/25/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Older adults with disabilities such as loss of autonomy face the decision of whether to stay at home or move to a health care facility such as a nursing home. Therefore, they may need support for this difficult decision. OBJECTIVE We assessed the intention of Canadian older adults to use an electronic decision aid (eDA) to make housing decisions and identified the factors that influenced their intention. METHODS We conducted a cross-sectional study using a web-based survey targeting older adults across 10 Canadian provinces and 3 territories. We included respondents from a web-based panel who were aged ≥65 years, understood English or French, had access to an electronic device with an internet connection, and had made a housing decision over the past few months or were planning to make a decision in the coming year. We based the web-based survey on the Unified Theory of Acceptance and Use of Technology (UTAUT). We adapted 17 UTAUT items to measure respondents' intention to use the eDA for housing decisions, as well as items measuring 4 intention constructs (performance expectancy, effort expectancy, social influence, and facilitating conditions). We also assessed eHealth literacy using both subjective and objective scales. We used descriptive statistics and multivariable linear regression analyses to identify the factors influencing the intention to use the eDA. RESULTS Of the 11,972 invited panelists, 1176 (9.82%) met the eligibility criteria, and 1000 (85.03%) respondents completed the survey. The mean age was 72.5 (SD 5.59) years. Most respondents were male (548/1000, 54.8%), White (906/1000, 90.6%), English speakers (629/1000, 62.9%), and lived in Ontario or Quebec (628/1000, 62.8%) and in urban areas (850/1000, 85%). The mean scores were 27.8 (SD 5.88) out of 40 for subjective eHealth literacy and 3.00 (SD 0.97) out of 5 for objective eHealth literacy. In our sample, the intention score was 4.74 (SD 1.7) out of 7. The mean scores of intention constructs out of 7 were 5.63 (SD 1.28) for facilitating conditions, 4.94 (SD 1.48) for performance expectancy, 5.61 (SD 1.35) for effort expectancy, and 4.76 (SD 1.59) for social influence. In the final model, the factors associated with intention included mother tongue (β=.30; P<.001), objective eHealth literacy (β=-.06; P=.03), performance expectancy (β=.55; P<.001), social influence (β=.37; P<.001), and facilitating conditions (β=.15; P<.001). CONCLUSIONS Findings from this pan-Canadian web-based survey on Canadian older adults suggest that their intention to use the eDA to make housing decisions is similar to the findings in other studies using UTAUT. The factors identified as influencing intention were mother tongue, objective eHealth literacy, performance expectancy, social influence, and facilitating conditions. These will guide future strategies for the implementation of the eDA.
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Affiliation(s)
| | | | - Karine V Plourde
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec City, QC, Canada
| | - Souleymane Gadio
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec City, QC, Canada
| | - Marie Elf
- School of Health and Welfare, Dalarna University, Falun, Dalarna, Sweden
| | - C Allyson Jones
- Faculty of Rehabilitation Medicine, University of Alberta, Edmondon, AB, Canada
| | - Louise Meijering
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Groningen, Netherlands
| | - Anik Giguère
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec City, QC, Canada.,Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC, Canada
| | - France Légaré
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec City, QC, Canada.,Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC, Canada
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Sohal A, Chaudhry H, Kohli I, Gupta G, Singla P, Sharma R, Dukovic D, Prajapati D. Hospital frailty risk score predicts worse outcomes in patients with chronic pancreatitis. Ann Gastroenterol 2023; 36:73-80. [PMID: 36593805 PMCID: PMC9756028 DOI: 10.20524/aog.2022.0765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 11/03/2022] [Indexed: 12/12/2022] Open
Abstract
Background Chronic pancreatitis (CP) is a pathological fibroinflammatory response to persistent inflammation or stress to the pancreas. The effect of frailty on outcomes in patients with CP has not been previously examined. In this study, we examined the effect of frailty on outcomes in hospitalized patients with CP. Methods Records of patients with a primary or secondary discharge diagnosis of CP (ICD10-CM codes K86.0, K86.1) between January 2016 and December 2019 were obtained from the National Inpatient Sample database. Data were collected on patient demographics, hospital characteristics, comorbidities, and etiology of CP. The relationship between frailty and outcomes, including mortality, intensive care unit (ICU) admission, sepsis, shock, length of stay (LOS), and total hospitalization charges (THC), were analyzed using multivariate analysis. Results 722,160 patients were included in the analysis. Patients with a high hospital frailty risk score had a higher mortality risk (adjusted odds ratio [aOR] 12.57, 95% confidence interval [CI] 10.42-15.16; P<0.001) compared to patients with low frailty scores. Patients with high frailty scores also had a higher risk of sepsis (aOR 5.75, 95%CI 4.97-6.66; P<0.001), shock (aOR- 26.25, 95%CI-22.83-30.19; P<0.001), ICU admission (aOR 25.86, 95% CI-22.58-29.62; P<0.001), and acute kidney injury (aOR 24.4, 95%CI 22.39-26.66; P<0.001). They also had a longer LOS (7.04 days, 95%CI 6.57-7.52; P<0.001) and higher THC ($72,200, 95%CI 65,904.52-78,496.66; P<0.001). Conclusions Frail patients, as determined by their hospital frailty risk score, are at high risk of worse outcomes. This data suggests opportunities for physicians to risk-stratify patients and predict outcomes.
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Affiliation(s)
- Aalam Sohal
- Liver Institute Northwest, Seattle, WA (Aalam Sohal)
| | - Hunza Chaudhry
- Department of Internal Medicine, University of California, San Francisco, Fresno, CA, USA (Hunza Chaudhry)
| | - Isha Kohli
- Department of Public Health, Icahn School of Medicine, Mount Sinai, New York, NY, USA (Isha Kohli)
| | - Gagan Gupta
- Dayanand Medical College and Hospital, Punjab, India (Gagan Gupta, Piyush Singla)
| | - Piyush Singla
- Dayanand Medical College and Hospital, Punjab, India (Gagan Gupta, Piyush Singla)
| | - Raghav Sharma
- Punjab Institute of Medical Sciences, Punjab, India (Raghav Sharma)
| | - Dino Dukovic
- Ross University School of Medicine, Bridgetown, Barbados (Dino Dukovic)
| | - Devang Prajapati
- Department of Gastroenterology and Hepatology, University of California, San Francisco, Fresno, CA, USA (Devang Prajapati)
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24
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Mavragani A, Hardy F, Tucker K, Hopper A, Marchã MJM, Navaratnam AV, Briggs TWR, Yates J, Day J, Wheeler A, Eve-Jones S, Gray WK. Frailty, Comorbidity, and Associations With In-Hospital Mortality in Older COVID-19 Patients: Exploratory Study of Administrative Data. Interact J Med Res 2022; 11:e41520. [PMID: 36423306 PMCID: PMC9746678 DOI: 10.2196/41520] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Older adults have worse outcomes following hospitalization with COVID-19, but within this group there is substantial variation. Although frailty and comorbidity are key determinants of mortality, it is less clear which specific manifestations of frailty and comorbidity are associated with the worst outcomes. OBJECTIVE We aimed to identify the key comorbidities and domains of frailty that were associated with in-hospital mortality in older patients with COVID-19 using models developed for machine learning algorithms. METHODS This was a retrospective study that used the Hospital Episode Statistics administrative data set from March 1, 2020, to February 28, 2021, for hospitalized patients in England aged 65 years or older. The data set was split into separate training (70%), test (15%), and validation (15%) data sets during model development. Global frailty was assessed using the Hospital Frailty Risk Score (HFRS) and specific domains of frailty were identified using the Global Frailty Scale (GFS). Comorbidity was assessed using the Charlson Comorbidity Index (CCI). Additional features employed in the random forest algorithms included age, sex, deprivation, ethnicity, discharge month and year, geographical region, hospital trust, disease severity, and International Statistical Classification of Disease, 10th Edition codes recorded during the admission. Features were selected, preprocessed, and input into a series of random forest classification algorithms developed to identify factors strongly associated with in-hospital mortality. Two models were developed; the first model included the demographic, hospital-related, and disease-related items described above, as well as individual GFS domains and CCI items. The second model was similar to the first but replaced the GFS domains and CCI items with the HFRS as a global measure of frailty. Model performance was assessed using the area under the receiver operating characteristic (AUROC) curve and measures of model accuracy. RESULTS In total, 215,831 patients were included. The model using the individual GFS domains and CCI items had an AUROC curve for in-hospital mortality of 90% and a predictive accuracy of 83%. The model using the HFRS had similar performance (AUROC curve 90%, predictive accuracy 82%). The most important frailty items in the GFS were dementia/delirium, falls/fractures, and pressure ulcers/weight loss. The most important comorbidity items in the CCI were cancer, heart failure, and renal disease. CONCLUSIONS The physical manifestations of frailty and comorbidity, particularly a history of cognitive impairment and falls, may be useful in identification of patients who need additional support during hospitalization with COVID-19.
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Affiliation(s)
| | - Flavien Hardy
- Getting It Right First Time programme, National Health Service England and National Health Service Improvement, London, United Kingdom
| | - Katie Tucker
- Innovation and Intelligent Automation Unit, Royal Free London National Health Service Foundation Trust, London, United Kingdom
| | - Adrian Hopper
- Getting It Right First Time programme, National Health Service England and National Health Service Improvement, London, United Kingdom.,Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Maria J M Marchã
- Science and Technology Facilities Council Distributed Research Utilising Advanced Computing High Performance Computing Facility, University College London, London, United Kingdom
| | - Annakan V Navaratnam
- University College London Hospitals National Health Service Foundation Trust, London, United Kingdom
| | - Tim W R Briggs
- Getting It Right First Time programme, National Health Service England and National Health Service Improvement, London, United Kingdom.,Royal National Orthopaedic Hospital National Health Service Trust, London, United Kingdom
| | - Jeremy Yates
- Department of Computer Science, University College London, London, United Kingdom
| | - Jamie Day
- Getting It Right First Time programme, National Health Service England and National Health Service Improvement, London, United Kingdom
| | - Andrew Wheeler
- Getting It Right First Time programme, National Health Service England and National Health Service Improvement, London, United Kingdom
| | - Sue Eve-Jones
- Getting It Right First Time programme, National Health Service England and National Health Service Improvement, London, United Kingdom
| | - William K Gray
- Getting It Right First Time programme, National Health Service England and National Health Service Improvement, London, United Kingdom
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Makovski TT, Ghattas J, Monnier Besnard S, Ambrozova M, Vasinova B, Feteira-Santos R, Bezzegh P, Ponce Bollmann F, Cottam J, Haneef R, Devleesschauwer B, Speybroeck N, Nogueira P, Forjaz MJ, Coste J, Carcaillon-Bentata L. Aetiological and prognostic roles of frailty, multimorbidity and socioeconomic characteristics in the development of SARS-CoV-2 health outcomes: protocol for systematic reviews of population-based studies. BMJ Open 2022; 12:e063573. [PMID: 36414309 PMCID: PMC9684277 DOI: 10.1136/bmjopen-2022-063573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 10/27/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION There is growing evidence that the impact of COVID-19 crisis may be stronger for individuals with multimorbidity, frailty and lower socioeconomic status. Existing reviews focus on few, mainly short-term effects of COVID-19 illness and patients with single chronic disease. Information is also largely missing for population representative samples.Applying population-based approach, the systematic reviews will have two objectives: (1) to evaluate the aetiological roles of frailty, multimorbidity and socioeconomic status on SARS-CoV-2 infection probability, hospitalisation, intensive care unit (ICU) admission, mechanical ventilation and COVID-19 related mortality among general population and (2) to investigate the prognostic roles of frailty, multimorbidity and socioeconomic characteristics on the risk of hospitalisation, ICU admission, mechanical ventilation, COVID-19 mortality, functioning, quality of life, disability, mental health and work absence. METHODS AND ANALYSIS For this ongoing work, four databases were searched: PubMed, Embase, WHO COVID-19 Global literature on coronavirus disease and PsycINFO, for the period between January 2020 and April 7 2021. Peer-reviewed published literature in English and all types of population-based studies will be considered. Studies using standard tools to assess multimorbidity such as disease count, comorbidity indices or disease combinations will be retained, as well as studies with standard scales and scores for frailty or measurement of a socioeconomic gradient. Initial search included 10 139 articles, 411 for full-text reading. Results will be summarised by risk factor, objective and outcome. The feasibility of meta-analysis will be determined by the findings and will aim to better understand uncertainties of the results. Quality of studies will be assessed using standardised scales. ETHICS AND DISSEMINATION The study will be based on published evidence, and it is exempt from the ethical approval. This work is part of the Population Health Information Research Infrastructure (PHIRI) project. Dissemination of the results will imply conference presentation, submission for scientific publication and PHIRI project report. PROSPERO REGISTRATION NUMBER CRD42021249444.
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Affiliation(s)
- Tatjana T Makovski
- Department of non-communicable diseases and injuries, Santé publique France, Saint-Maurice, Île-de-France, France
| | - Jinane Ghattas
- Institut de recherche santé et société (IRSS), Université catholique de Louvain, Woluwe-Saint-Lambert, Brussels, Belgium
| | - Stephanie Monnier Besnard
- Department of non-communicable diseases and injuries, Santé publique France, Saint-Maurice, Île-de-France, France
| | - Monika Ambrozova
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Barbora Vasinova
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Rodrigo Feteira-Santos
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Área Disciplinar Autónoma de Bioestatística, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Peter Bezzegh
- Directorate for Project Management, National Directorate General for Hospitals, Budapest, Hungary
| | | | - James Cottam
- Department of Epidemiology and Public Health, Sciensano, Brussel, Belgium
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Romana Haneef
- Department of non-communicable diseases and injuries, Santé publique France, Saint-Maurice, Île-de-France, France
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussel, Belgium
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
| | - Niko Speybroeck
- Institut de recherche santé et société (IRSS), Université catholique de Louvain, Woluwe-Saint-Lambert, Brussels, Belgium
| | - Paulo Nogueira
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Área Disciplinar Autónoma de Bioestatística, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Maria João Forjaz
- National Center of Epidemiology, Instituto de Salud Carlos III, REDISSEC and RICAPPS, Madrid, Spain
| | - Joel Coste
- Department of non-communicable diseases and injuries, Santé publique France, Saint-Maurice, Île-de-France, France
| | - Laure Carcaillon-Bentata
- Department of non-communicable diseases and injuries, Santé publique France, Saint-Maurice, Île-de-France, France
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Schmid S, Schlosser S, Müller-Schilling M. Geriatrische Syndrome mit intensivmedizinischer Relevanz. ANÄSTHESIE NACHRICHTEN 2022. [PMCID: PMC9589759 DOI: 10.1007/s44179-022-00093-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Stephan Schmid
- Klinik und Poliklinik für Innere Medizin I, Gastroenterologie, Hepatologie, Endokrinologie, Rheumatologie und Infektiologie, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Sophie Schlosser
- Klinik und Poliklinik für Innere Medizin I, Gastroenterologie, Hepatologie, Endokrinologie, Rheumatologie und Infektiologie, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Martina Müller-Schilling
- Klinik und Poliklinik für Innere Medizin I, Gastroenterologie, Hepatologie, Endokrinologie, Rheumatologie und Infektiologie, Universitätsklinikum Regensburg, Regensburg, Deutschland
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Kambayashi D, Manabe T, Hirohara M, Akatsu H. Knowledge, Attitudes, and Practices Survey among Nursing Care Workers Involved in Caring for Older Adults during the Early Stage of the COVID-19 Pandemic in Japan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12993. [PMID: 36293574 PMCID: PMC9602712 DOI: 10.3390/ijerph192012993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/27/2022] [Accepted: 10/08/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND As Japan undergoes population aging, nursing care workers play an important role in supporting older adults in the community, which has been particularly critical during COVID-19 pandemic. However, the knowledge, attitudes, and practices (KAP) among nursing care workers regarding COVID-19 have not been fully elucidated. METHODS A self-administered questionnaire survey was conducted in June 2020 among 481 nursing care workers in the nursing care facilities in Aichi, Japan. We assessed COVID-19-related KAP scores of nursing care workers, and compared them by age, sex, and years of experience. RESULTS A total of 481 nursing care workers responded to the survey. Out of a maximum of 10 points, the mean (standard deviations) knowledge, attitude, and practice scores were 6.86 (1.45), 7.11 (1.42), and 7.40 (1.89), respectively. Comparisons between the KAP scores revealed significantly higher knowledge scores among older workers (p < 0.001) and significantly higher knowledge scores (p = 0.002) and practice scores (p = 0.033) among workers with more than 20 years of working experience. CONCLUSIONS The findings revealed that older age and a longer duration of experience were associated with higher COVID-19-related knowledge and practice scores. To better support older adults, it is essential to improve the education system for care workers and to provide environments for delivering necessary information rapidly.
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Affiliation(s)
- Dan Kambayashi
- Laboratory of Pharmacy Practice, Center for Education and Research on Clinical Pharmacy, Showa Pharmaceutical University, Tokyo 194-8543, Japan
- Department of Medical Innovation, Nagoya City University Graduate School of Medicine, Nagoya 467-8601, Japan
| | - Toshie Manabe
- Department of Medical Innovation, Nagoya City University Graduate School of Medicine, Nagoya 467-8601, Japan
- Center for Clinical Research, Nagoya City University West Medical Center, Nagoya 462-8508, Japan
| | - Masayoshi Hirohara
- Laboratory of Pharmacy Practice, Center for Education and Research on Clinical Pharmacy, Showa Pharmaceutical University, Tokyo 194-8543, Japan
| | - Hiroyasu Akatsu
- Department of Community-Based Medical Education, Nagoya City University Graduate School of Medicine, Nagoya 467-8601, Japan
- Fukushimura Hospital, Toyohashi 441-8124, Japan
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Ioannou P, Spentzouri D, Konidaki M, Papapanagiotou M, Tzalis S, Akoumianakis I, Filippatos TD, Panagiotakis S, Kofteridis DP. COVID-19 in Older Individuals Requiring Hospitalization. Infect Dis Rep 2022; 14:686-693. [PMID: 36136824 PMCID: PMC9498435 DOI: 10.3390/idr14050074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/04/2022] [Accepted: 09/08/2022] [Indexed: 01/08/2023] Open
Abstract
Older individuals have an increased risk for severe coronavirus disease 2019 (COVID-19) and a higher risk for complications and death. The aim of this study was to investigate the clinical characteristics of older patients admitted with COVID-19 and describe their outcomes. This was a retrospective cohort study of patients older than 65 years admitted to the COVID-19 Department of the University Hospital of Heraklion. Data recorded and evaluated included age, gender, Infectious Diseases Society of America (IDSA) severity score, Charlson comorbidity index (CCI), high-flow nasal oxygen (HFNO) use, admission to the Intensive Care Unit (ICU), laboratory exams, treatment administered, and outcome. In total, 224 patients were evaluated in the present study. The median age was 75 years and 105 (46.9%) were female. In 50 patients (22.7%), HFNO was used and 23 (10.3%) were admitted to the ICU. Mortality was 13.4% (30 patients). Patients that died had higher age, were more likely to be male, had an IDSA severity score of 3, had prior HFNO use, had been admitted to the ICU, and were also more likely to have a higher white blood cell (WBC) count, CRP, ferritin, procalcitonin, d-dimers, and troponin. A multivariate logistic regression analysis identified age and the need for HFNO use to be independently positively associated with mortality. To conclude, COVID-19 carries significant mortality in hospitalized older patients, which increases with age, while the need for HFNO also increased the likelihood of worse outcomes. Clinicians caring for patients with COVID-19 should bear in mind these two factors. Future studies could elaborate on the effect of new variants on the dynamics of mortality in older patients.
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Gustafsson PE, Schröders J, Nilsson I, San Sebastián M. Surviving Through Solitude: A Prospective National Study of the Impact of the Early COVID-19 Pandemic and a Visiting Ban on Loneliness Among Nursing Home Residents in Sweden. J Gerontol B Psychol Sci Soc Sci 2022; 77:2286-2295. [PMID: 36055339 PMCID: PMC9494329 DOI: 10.1093/geronb/gbac126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES Targeted social distancing measures were widely implemented for nursing home residents when the extremely high coronavirus disease 2019 mortality in this setting became apparent. However, there is still scarce rigorous research examining how the pandemic and accompanying social distancing measures affected loneliness in this group. This prospective nationwide Swedish study of nursing home residents aimed to examine the impact on loneliness of the early phase of the pandemic and of a national visiting ban at nursing homes. METHODS A panel was selected from a total population survey of all nursing home residents in Sweden March-May 2019 and 2020 (N = 11,782; age range 70-110 years; mean age 88.2 years; 71% women). Prospective pretest-posttest and controlled interrupted time series (ITS) designs were employed, with time trends estimated by date of returned questionnaire. Generalized linear models were used for estimation of effects, adjusting for demographic-, survey-, and health-related covariates. RESULTS Loneliness prevalence increased from 17% to 19% from 2019 to 2020 (risk ratio, RR (95% confidence interval, CI) = 1.104 (1.060; 1.150)), but which was explained by self-reported health (RR (95% CI) = 1.023 (0.982; 1.066)). No additional impact of the visiting ban on loneliness trends was found in the ITS analyses (RR (95% CI) = 0.984 (0.961; 1.008)). DISCUSSION The moderate but health-dependent increased risk of loneliness, and the lack of impact of the nationwide visiting ban at nursing homes, suggests that this ostensibly vulnerable group of nursing home residents also shows signs of resilience, at least during the early phase of the pandemic.
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Affiliation(s)
- Per E Gustafsson
- Address correspondence to: Per E. Gustafsson, PhD, Department of Epidemiology and Global Health, Umeå University, 901 87 Umeå, Sweden. E-mail:
| | - Julia Schröders
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden,Department of Sociology, Umeå University, Umeå, Sweden
| | - Ingeborg Nilsson
- Department of Community Medicine and Rehabilitation, Unit of Occupational Therapy, Umeå University, Umeå, Sweden
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Frailty and risks of all-cause and cause-specific death in community-dwelling adults: a systematic review and meta-analysis. BMC Geriatr 2022; 22:725. [PMID: 36056319 PMCID: PMC9437382 DOI: 10.1186/s12877-022-03404-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 08/22/2022] [Indexed: 12/12/2022] Open
Abstract
Background The associations of frailty with all-cause and cause-specific mortality remain unclear. Therefore, we performed this meta-analysis to fill this gap. Methods We searched the PubMed and Embase databases through June 2022. Prospective cohort studies or clinical trials examining frailty were evaluated, and the multiple adjusted risk estimates of all-cause and cause-specific mortality, such as death from cardiovascular disease (CVD), cancer, respiratory illness, dementia, infection, and coronavirus disease 2019 (COVID-19), were included. A random effects model was used to calculate the summary hazard ratio (HR). Results Fifty-eight studies were included for the qualitative systematic review, of which fifty-six studies were eligible for the quantitative meta-analysis, and the studies included a total of 1,852,951 individuals and more than 145,276 deaths. Compared with healthy adults, frail adults had a significantly higher risk of mortality from all causes (HR 2.40; 95% CI 2.17–2.65), CVD (HR 2.64; 95% CI 2.20–3.17), respiratory illness (HR 4.91; 95% CI 2.97–8.12), and cancer (HR 1.97; 95% CI 1.50–2.57). Similar results were found for the association between prefrail adults and mortality risk. In addition, based on the studies that have reported the HRs of the mortality risk per 0.1 and per 0.01 increase in the frailty index, we obtained consistent results. Conclusions The present study demonstrated that frailty was not only significantly related to an increased risk of all-cause mortality but was also a strong predictor of cause-specific mortality from CVD, cancer, and respiratory illness in community-dwelling adults. More studies are warranted to clarify the relationship between frailty and cause-specific mortality from dementia, infection, and COVID-19. Trial registration PROSPERO (CRD42021276021). Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03404-w.
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Fernandes AL, Pereira RMR. Frailty in the context of COVID-19 pandemic: A life-threatening condition. Front Med (Lausanne) 2022; 9:965562. [PMID: 36091682 PMCID: PMC9451136 DOI: 10.3389/fmed.2022.965562] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/02/2022] [Indexed: 11/16/2022] Open
Abstract
The pandemic outbreak of coronavirus disease 2019 (COVID-19) has caused emerging challenges for healthcare systems regarding the assistance to the older adult population which, added to the increased life expectancy, may be exposing frail older adults to an increased risk of unfavorable health outcomes. Frailty has a pathogenesis of multifactorial etiology and is defined as a condition characterized by progressive decline in physiological function, weakness, decreased strength, and reduced resilience to stressors, leading to vulnerability and an increased risk of fractures, falls, institutionalization, and death. In the context of COVID-19, frail older adults accounted for approximately 51% of hospitalized patients with confirmed cases and elevated risk of mortality in-hospital. In addition, frailty may be associated with recent “excess mortality” reported by the World Health Organization (WHO) in terms of the full death toll associated directly (due to the disease) or indirectly (due to the pandemic's impact on health systems and society) to COVID-19. Therefore, this mini review aimed to provide a summarized discussion from meta-analyses data regarding the impact of frailty in community-dwelling older adults hospitalized with COVID-19 on short-term mortality risk.
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van der Valk AM, Theou O, Wallace LM, Andrew MK, Godin J. Physical demands at work and physical activity are associated with frailty in retirement. Work 2022; 73:695-705. [DOI: 10.3233/wor-210859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: The relationship between occupational physical activity and frailty is complex and understudied. OBJECTIVE: We explore whether moderate-vigorous physical activity (MVPA) in retirement and main lifetime occupation physical demands (OPD) are associated with frailty in retirement. METHODS: Retired adults aged 50 + who participated in waves 3-4 of the Survey of Health, Ageing and Retirement in Europe were included. We constructed a 65-item frailty index (FI; Wave 4). Linear regressions tested the independent associations between OPD (Wave 3) and retirement MVPA (Wave 4) with FI (B: 95% CI) controlling for occupation characteristics (Wave 3) and demographics (Wave 4). These models were repeated across country groups (Nordic; Mediterranean; Continental) and sexes. RESULTS: We included 8,411 adults (51.1% male) aged 72.4 years (SD 8.0). Frequent MVPA was consistently associated with lower FI (-0.09 : 0.10–-0.08, p < .001) while OPD was associated with higher FI (0.02 : 0.01-0.03, p < .001). The MVPA*OPD interaction (-0.02: -0.04–-0.00, p = .043) was weakly associated with FI, but did not explain additional model variance or was significant among any country group or sex. CONCLUSIONS: For a sample of European community-dwelling retirees, a physically demanding main lifetime occupation independently predicts worse frailty, even in individuals who are physically active in retirement.
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Affiliation(s)
| | - Olga Theou
- Geriatric Medicine Research, Nova Scotia Health Authority, Halifax, NS, Canada
- Department of Medicine (Geriatrics), Dalhousie University, Halifax, NS, Canada
- Physiotherapy, Dalhousie University, Halifax, NS, Canada
| | - Lindsay M.K. Wallace
- Geriatric Medicine Research, Nova Scotia Health Authority, Halifax, NS, Canada
- Department of Medicine (Geriatrics), Dalhousie University, Halifax, NS, Canada
| | - Melissa K. Andrew
- Geriatric Medicine Research, Nova Scotia Health Authority, Halifax, NS, Canada
- Department of Medicine (Geriatrics), Dalhousie University, Halifax, NS, Canada
| | - Judith Godin
- Geriatric Medicine Research, Nova Scotia Health Authority, Halifax, NS, Canada
- Department of Medicine (Geriatrics), Dalhousie University, Halifax, NS, Canada
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Continuous Positive Airway Pressure in Elderly Patients with Severe COVID-19 Related Respiratory Failure. J Clin Med 2022; 11:jcm11154454. [PMID: 35956070 PMCID: PMC9369612 DOI: 10.3390/jcm11154454] [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: 06/16/2022] [Revised: 07/26/2022] [Accepted: 07/29/2022] [Indexed: 01/08/2023] Open
Abstract
The elderly population represents a high percentage of patients hospitalized for COVID-19 pneumonia and severe respiratory failure, for whom CPAP may be a treatment option. The aim of this study was to describe the CPAP support modalities and to explore factors associated with CPAP failure. In this retrospective study, 110 consecutive patients aged ≥ 75 years were enrolled. Median frailty score, baseline partial arterial pressure of oxygen to fraction of inspired oxygen ratio (P/F), and respiratory rate (RR) were 5, 108, and 30 cycles/min, respectively. Of the 110 patients that began CPAP treatment, 17 patients died within 72 h from baseline, while in 2 patients, CPAP was withdrawn for clinical improvement. Thus, of the 91 patients still on CPAP at day 3, 67% of them needed continuous CPAP delivery. Patients with RR ≥ 30 and with frailty score ≥ 5 had an odds ratio of continuous CPAP needing of 3 and 4, respectively. Patients unable to tolerate CPAP-free periods demonstrated higher mortality risk as compared to those able to tolerate intermittent CPAP (OR: 6.04, 95% CI 2.38−16.46, p < 0.001). The overall in-hospital mortality was 63.6%. Delirium occurred in 59.1%, with a mortality rate in this subgroup of 83.1%. In a time-varying Cox model, the hazard ratio of death was 2.9 in patients with baseline RR ≥ 30 cycle/min, 2.4 in those with baseline P/F < 100. In the same model, the hazard ratio of death was 20 in patients with delirium and a frailty score < 5 and 8.8 in those without delirium and with frailty ≥ 5, indicating a competitive effect between these two variables on the death risk. Conclusions: Respiratory impairment, frailty, and delirium predict treatment failure, with the latter two factors demonstrating a competitive effect on mortality risk. CPAP support may represent a feasible therapeutic option in elderly patients, although chances of a therapeutic benefit are markedly reduced in case of severe respiratory impairment, very frail baseline condition or delirium occurrence.
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Wasserman M, Konetzka RT. Beyond Compliance: A More Integrated Public Health Approach To Outbreaks In Nursing Homes And Other Disasters. Health Aff (Millwood) 2022; 41:831-837. [PMID: 35666972 DOI: 10.1377/hlthaff.2021.01839] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Nursing home residents are vulnerable to disproportionate harm during disasters and health emergencies, as evidenced by the recent impact of COVID-19 and extreme weather events. Evaluation of these disasters shows that the nursing homes in question were often in compliance with relevant regulations around emergency planning. However, advance planning for disasters cannot anticipate every contingency, leading to the need for flexibility and quick adaptation on the part of nursing home leaders. In addition, disasters often involve larger, regional problems and situations that individual providers cannot solve. We suggest that policy makers need to prioritize development and expectations around leadership skills in nursing home management and better integrate the long-term care sector into local, state, and federal public health planning for future pandemics and other disasters.
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Vlachogiannis NI, Baker KF, Georgiopoulos G, Lazaridis C, van der Loeff IS, Hanrath AT, Sopova K, Tual‐Chalot S, Gatsiou A, Spyridopoulos I, Stamatelopoulos K, Duncan CJ, Stellos K. Clinical frailty, and not features of acute infection, is associated with late mortality in COVID-19: a retrospective cohort study. J Cachexia Sarcopenia Muscle 2022; 13:1502-1513. [PMID: 35257497 PMCID: PMC9088314 DOI: 10.1002/jcsm.12966] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 01/12/2022] [Accepted: 02/03/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is associated with excess mortality after hospital discharge. Identification of patients at increased risk of death following hospital discharge is needed to guide clinical monitoring and early intervention. Herein, we aimed to identify predictors of early vs. late mortality in COVID-19 patients. METHODS A total of 471 patients with polymerase chain reaction-confirmed COVID-19 were followed up for 9 months [median (inter-quartile range) of follow-up time: 271 (14) days] after hospital admission. COVID-19-related signs and symptoms, laboratory features, co-morbidities, Coronavirus Clinical Characterisation Consortium (4C) mortality and Clinical Frailty Scale (CFS) scores were analysed by logistic regression for association with early (28 day) vs. late mortality. Receiver operating characteristic (ROC) analysis was used to determine the discriminative value of 4C and CFS scores for early vs. late mortality. RESULTS A total of 120 patients died within 28 days from hospital admission. Of the remaining 351 patients, 41 died within the next 8 months. Respiratory failure, systemic inflammation, and renal impairment were associated with early mortality, while active cancer and dementia were associated with late mortality, after adjustment for age and sex. 4C mortality score and CFS were associated with both early [odds ratio (OR) (95% confidence interval-CI): 4C: 1.34 (1.25-1.45); CFS: 1.49 (1.33-1.66)] and late [OR (95% CI): 4C: 1.23 (1.12-1.36); CFS: 2.04 (1.62-2.56)] mortality. After adjustment for CFS, the association between 4C and late mortality was lost. By ROC analysis, 4C mortality score was superior to CFS for 28 day mortality [area under the curve (AUC) (95% CI): 0.779 (0.732-0.825) vs. 0.723 (0.673-0.773), respectively; P = 0.039]. In contrast, CFS had higher predictive value for late mortality compared with 4C mortality score [AUC (95% CI): 0.830 (0.776-0.883) vs. 0.724 (0.650-0.798), respectively; P = 0.007]. CONCLUSIONS In our cohort, late mortality in COVID-19 patients is more strongly associated with premorbid clinical frailty than with severity of the acute infection phase.
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Affiliation(s)
- Nikolaos I. Vlachogiannis
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical SciencesNewcastle UniversityNewcastle Upon TyneUK
- RVI and Freeman HospitalsNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle Upon TyneUK
| | - Kenneth F. Baker
- RVI and Freeman HospitalsNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle Upon TyneUK
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle Upon TyneUK
- NIHR Newcastle Biomedical Research CentreNewcastle University and Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle Upon TyneUK
| | - Georgios Georgiopoulos
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical SciencesNewcastle UniversityNewcastle Upon TyneUK
- Department of Clinical TherapeuticsNational and Kapodistrian University of Athens Medical SchoolAthensGreece
| | - Charalampos Lazaridis
- RVI and Freeman HospitalsNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle Upon TyneUK
| | | | - Aidan T. Hanrath
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle Upon TyneUK
| | - Kateryna Sopova
- RVI and Freeman HospitalsNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle Upon TyneUK
| | - Simon Tual‐Chalot
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical SciencesNewcastle UniversityNewcastle Upon TyneUK
| | - Aikaterini Gatsiou
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical SciencesNewcastle UniversityNewcastle Upon TyneUK
| | - Ioakim Spyridopoulos
- RVI and Freeman HospitalsNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle Upon TyneUK
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle Upon TyneUK
- NIHR Newcastle Biomedical Research CentreNewcastle University and Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle Upon TyneUK
| | - Kimon Stamatelopoulos
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical SciencesNewcastle UniversityNewcastle Upon TyneUK
- Department of Clinical TherapeuticsNational and Kapodistrian University of Athens Medical SchoolAthensGreece
| | - Christopher J.A. Duncan
- RVI and Freeman HospitalsNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle Upon TyneUK
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle Upon TyneUK
- NIHR Newcastle Biomedical Research CentreNewcastle University and Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle Upon TyneUK
| | - Konstantinos Stellos
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical SciencesNewcastle UniversityNewcastle Upon TyneUK
- RVI and Freeman HospitalsNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle Upon TyneUK
- NIHR Newcastle Biomedical Research CentreNewcastle University and Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle Upon TyneUK
- Department of Cardiovascular Research, European Center for Angioscience (ECAS)Heidelberg UniversityMannheimGermany
- German Centre for Cardiovascular Research (DZHK), partner site Heidelberg/MannheimMannheimGermany
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Frailty as a Predictor of Poor Rehabilitation Outcomes among Older Patients Attending a Geriatric Day Hospital Program: An Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106276. [PMID: 35627813 PMCID: PMC9140338 DOI: 10.3390/ijerph19106276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/29/2022] [Accepted: 05/19/2022] [Indexed: 02/05/2023]
Abstract
Background: The Geriatric Day Hospital (GDH) is an important outpatient geriatric service, but there are few data on the role of frailty as a potential predictor of poor outcomes in this setting. Methods: Data were analyzed from 499 patients aged ≥ 60 years attending a 12-week GDH program between 2018 and 2021. Frailty status was defined as non-frail (68, 13.6%), mild/moderate frailty (351, 70.3%), and severe frailty (80, 16.0%) based on the Clinical Frailty Scale (CFS). Outcomes were defined as (1) poor outcome (hospital readmission, death, or medical deterioration) during the program and (2) admission to permanent nursing home care upon completion of the program. Multivariate logistic models were used for predictive analyses. Results: The mean age was 80.3 (standard deviation 7.0); 58.3% were women. Overall, 77 patients (15.4%) had a poor outcome, and 48 (9.6%) were admitted to permanent nursing home care. Poor outcome was experienced by none of the non-frail patients (0%), by 49 (14.0%) patients with mild/moderate frailty, and 22 (27.5%) patients with severe frailty (adjusted OR, 2.0; 95% CI 1.3, 3.2; p < 0.01). Admission to a permanent nursing home care was experienced by none of the non-frail patients (0%), 20 (5.7%) of those with mild/moderate frailty, and 28 (35.0%) with severe frailty (adjusted OR, 2.9; 95% CI 1.3, 6.3; p < 0.01). Conclusions: The CFS is a promising risk predictor of poor outcome and admission to permanent nursing home discharge among older patients attending a GDH program.
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COVID-19 prevalence and mortality in longer-term care facilities. Eur J Epidemiol 2022; 37:227-234. [PMID: 35397704 PMCID: PMC8994824 DOI: 10.1007/s10654-022-00861-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/04/2022] [Indexed: 12/11/2022]
Abstract
This essay considers the factors that have contributed to very high COVID-19 mortality in longer-term care facilities (LTCFs). We compare the demographic characteristics of LTCF residents with those of community-dwelling older adults, and then we review the evidence regarding prevalence and infection fatality rates (IFRs), including links to frailty and some comorbidities. Finally, we discuss policy measures that could foster the physical and mental health and well-being of LTCF residents in the present context and in potential future pandemics.
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Olivieri F, Sabbatinelli J, Bonfigli AR, Sarzani R, Giordano P, Cherubini A, Antonicelli R, Rosati Y, Del Prete S, Di Rosa M, Corsonello A, Galeazzi R, Domenico Procopio A, Lattanzio F. Routine laboratory parameters, including complete blood count, predict COVID-19 in-hospital mortality in geriatric patients. Mech Ageing Dev 2022; 204:111674. [PMID: 35421418 PMCID: PMC8996472 DOI: 10.1016/j.mad.2022.111674] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 04/04/2022] [Accepted: 04/07/2022] [Indexed: 12/15/2022]
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Stefan MS, Eltanbedawi A, Devoe NC, Khan S, Zhou Y, Latef T, Esposito A, Fatima A, Knee AB, Lagu TC. Death among patients hospitalized with symptomatic COVID-19: Implications for high-risk patients. J Hosp Med 2022; 17:252-258. [PMID: 35535924 PMCID: PMC9088345 DOI: 10.1002/jhm.12805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND We aimed to examine the role played by the COVID-19 infection in patients' death and to determine the proportion of patients for whom it was a major contributor to death. METHODS We included patients ≥50 years old who were hospitalized with COVID-19 infection and died between March 1, 2020 and September 30, 2020 in a tertiary medical center. We considered COVID-19 infection to be a major cause for death if the patient had well-controlled medical conditions and death was improbable without coronavirus infection, and a minor cause for death if the patient had serious illnesses and had an indication for palliative care. RESULTS Among 243 patients, median age was 80 (interquartile intervals: 72-86) and 40% were female. One in two had moderate or severe frailty and 41% had dementia. Nearly 60% of the patients were classified as having advanced, serious illnesses present prior to the hospitalization, with death being expected within 12 months, and among this group 39% were full code at admission. In the remaining 40% of patients, deaths were classified as unexpected based on patients' prior conditions, suggesting that COVID-19 infection complications were the primary contributor to death. CONCLUSIONS For slightly less than half (40%) of patients who died of complications of COVID-19, death was an unexpected event. Among the 60% of patients for whom death was not a surprise, our findings identify opportunities to improve end-of-life discussions and implement shared decision-making in high-risk patients early on or prior to hospitalization.
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Affiliation(s)
- Mihaela S. Stefan
- Institute for Healthcare Delivery and Population ScienceUniversity of Massachusetts Medical School‐BaystateSpringfieldMassachusettsUSA
- Department of MedicineUniversity of Massachusetts Chan Medical School‐BaystateSpringfieldMassachusettsUSA
| | - Ahmed Eltanbedawi
- Department of MedicineUniversity of Massachusetts Chan Medical School‐BaystateSpringfieldMassachusettsUSA
- Department of Medicine, Internal Medicine Residency ProgramUniversity of Massachusetts Chan Medical School‐BaystateSpringfieldMassachusettsUSA
| | - Neil C. Devoe
- Department of MedicineUniversity of Massachusetts Chan Medical School‐BaystateSpringfieldMassachusettsUSA
- Department of Medicine, Internal Medicine Residency ProgramUniversity of Massachusetts Chan Medical School‐BaystateSpringfieldMassachusettsUSA
| | - Sabiha Khan
- Department of MedicineUniversity of Massachusetts Chan Medical School‐BaystateSpringfieldMassachusettsUSA
- Department of Medicine, Internal Medicine Residency ProgramUniversity of Massachusetts Chan Medical School‐BaystateSpringfieldMassachusettsUSA
| | - Ya Zhou
- Department of MedicineUniversity of Massachusetts Chan Medical School‐BaystateSpringfieldMassachusettsUSA
- Department of Medicine, Internal Medicine Residency ProgramUniversity of Massachusetts Chan Medical School‐BaystateSpringfieldMassachusettsUSA
| | - Taroob Latef
- Department of MedicineUniversity of Massachusetts Chan Medical School‐BaystateSpringfieldMassachusettsUSA
- Department of Medicine, Internal Medicine Residency ProgramUniversity of Massachusetts Chan Medical School‐BaystateSpringfieldMassachusettsUSA
| | - Anthony Esposito
- Department of MedicineUniversity of Massachusetts Chan Medical School‐BaystateSpringfieldMassachusettsUSA
- Department of Medicine, Internal Medicine Residency ProgramUniversity of Massachusetts Chan Medical School‐BaystateSpringfieldMassachusettsUSA
| | - Anum Fatima
- Department of MedicineUniversity of Massachusetts Chan Medical School‐BaystateSpringfieldMassachusettsUSA
- Department of Medicine, Internal Medicine Residency ProgramUniversity of Massachusetts Chan Medical School‐BaystateSpringfieldMassachusettsUSA
| | - Alexander B. Knee
- Department of MedicineUniversity of Massachusetts Chan Medical School‐BaystateSpringfieldMassachusettsUSA
- Department of Academic Affairs, Epidemiology/Biostatistics Research CoreOffice of Research, Baystate Medical CenterSpringfieldMassachusettsUSA
| | - Tara C. Lagu
- Center for Health Services and Outcomes Research, Institute of Public Health and MedicineNorthwestern Feinberg School of MedicineChicagoIllinoisUSA
- Department of Medicine, Division of Hospital MedicineNorthwestern Feinberg School of MedicineChicagoIllinoisUSA
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Salini S, Russo A, De Matteis G, Piccioni A, Della Polla D, Carbone L, Barillaro C, Landi F, Franceschi F, Covino M. Frailty in Elderly Patients with Covid-19: A Narrative Review. Gerontol Geriatr Med 2022; 8:23337214221079956. [PMID: 35274027 PMCID: PMC8902186 DOI: 10.1177/23337214221079956] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/12/2022] [Accepted: 01/24/2022] [Indexed: 01/08/2023] Open
Abstract
Introduction The SARS CoV-2 pandemic still generates a very high number of affected patients and a
significant mortality rate. It is essential to establish objective criteria to stratify
COVID-19 death risk. Frailty has been identified as a potential determinant of increased
vulnerability in older adults affected by COVID-19, because it may suggest alterations
of physical performance and functional autonomy. Methods We have conducted a narrative review of the literature on the evidences regarding
COVID-19 and the frailty condition. Thirteen observational studies were included. Conclusion Data emerging from the studies indicate that older COVID-19 patients with a frailty
condition have an increased risk of mortality compared with non-frail patients, and this
association is independent of other clinical and demographic factors. A frailty
evaluation is required to help clinicians to better stratify the overall risk of death
for older patients with COVID-19.
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Affiliation(s)
- Sara Salini
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Andrea Russo
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Giuseppe De Matteis
- Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Andrea Piccioni
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Davide Della Polla
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Luigi Carbone
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Christian Barillaro
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Francesco Landi
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Francesco Franceschi
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Marcello Covino
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
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Elkrief A, Hennessy C, Kuderer NM, Rubinstein SM, Wulff-Burchfield E, Rosovsky RP, Vega-Luna K, Thompson MA, Panagiotou OA, Desai A, Rivera DR, Khaki AR, Tachiki L, Lynch RC, Stratton C, Elias R, Batist G, Kasi A, Shah DP, Bakouny Z, Cabal A, Clement J, Crowell J, Dixon B, Friese CR, Fry SL, Grover P, Gulati S, Gupta S, Hwang C, Khan H, Kim SJ, Klein EJ, Labaki C, McKay RR, Nizam A, Pennell NA, Puc M, Schmidt AL, Shahrokni A, Shaya JA, Su CT, Wall S, Williams N, Wise-Draper TM, Mishra S, Grivas P, French B, Warner JL, Wildes TM. Geriatric risk factors for serious COVID-19 outcomes among older adults with cancer: a cohort study from the COVID-19 and Cancer Consortium. THE LANCET. HEALTHY LONGEVITY 2022; 3:e143-e152. [PMID: 35187516 PMCID: PMC8843069 DOI: 10.1016/s2666-7568(22)00009-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Older age is associated with poorer outcomes of SARS-CoV-2 infection, although the heterogeneity of ageing results in some older adults being at greater risk than others. The objective of this study was to quantify the association of a novel geriatric risk index, comprising age, modified Charlson comorbidity index, and Eastern Cooperative Oncology Group performance status, with COVID-19 severity and 30-day mortality among older adults with cancer. METHODS In this cohort study, we enrolled patients aged 60 years and older with a current or previous cancer diagnosis (excluding those with non-invasive cancers and premalignant or non-malignant conditions) and a current or previous laboratory-confirmed COVID-19 diagnosis who reported to the COVID-19 and Cancer Consortium (CCC19) multinational, multicentre, registry between March 17, 2020, and June 6, 2021. Patients were also excluded for unknown age, missing data resulting in unknown geriatric risk measure, inadequate data quality, or incomplete follow-up resulting in unknown COVID-19 severity. The exposure of interest was the CCC19 geriatric risk index. The primary outcome was COVID-19 severity and the secondary outcome was 30-day all-cause mortality; both were assessed in the full dataset. Adjusted odds ratios (ORs) and 95% CIs were estimated from ordinal and binary logistic regression models. FINDINGS 5671 patients with cancer and COVID-19 were included in the analysis. Median follow-up time was 56 days (IQR 22-120), and median age was 72 years (IQR 66-79). The CCC19 geriatric risk index identified 2365 (41·7%) patients as standard risk, 2217 (39·1%) patients as intermediate risk, and 1089 (19·2%) as high risk. 36 (0·6%) patients were excluded due to non-calculable geriatric risk index. Compared with standard-risk patients, high-risk patients had significantly higher COVID-19 severity (adjusted OR 7·24; 95% CI 6·20-8·45). 920 (16·2%) of 5671 patients died within 30 days of a COVID-19 diagnosis, including 161 (6·8%) of 2365 standard-risk patients, 409 (18·5%) of 2217 intermediate-risk patients, and 350 (32·1%) of 1089 high-risk patients. High-risk patients had higher adjusted odds of 30-day mortality (adjusted OR 10·7; 95% CI 8·54-13·5) than standard-risk patients. INTERPRETATION The CCC19 geriatric risk index was strongly associated with COVID-19 severity and 30-day mortality. Our CCC19 geriatric risk index, based on readily available clinical factors, might provide clinicians with an easy-to-use risk stratification method to identify older adults most at risk for severe COVID-19 as well as mortality. FUNDING US National Institutes of Health National Cancer Institute Cancer Center.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Orestis A Panagiotou
- Department of Health Services Policy and Practice, Brown University School of Public Health, Providence, RI, USA
| | | | | | | | - Lisa Tachiki
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Ryan C Lynch
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Catherine Stratton
- Yale Cancer Center at Yale University School of Medicine, New Haven, CT, USA
| | - Rawad Elias
- Hartford Healthcare Cancer Institute, Hartford, CT, USA
| | - Gerald Batist
- Segal Cancer Centre, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Anup Kasi
- The University of Kansas Medical Center, Kansas City, KS, USA
| | - Dimpy P Shah
- Mays Cancer Center at UT Health San Antonio MD Anderson Cancer Center, San Antonio, TX, USA
| | | | - Angelo Cabal
- Moores Comprehensive Cancer Center at the University of California, San Diego (UCSD), San Diego, CA, USA
| | | | | | | | | | - Stacy L Fry
- University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA
| | - Punita Grover
- University of Cincinnati Cancer Center, Cincinnati, OH, USA
| | - Shuchi Gulati
- University of Cincinnati Cancer Center, Cincinnati, OH, USA
| | - Shilpa Gupta
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - Clara Hwang
- Henry Ford Cancer Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Hina Khan
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Soo Jung Kim
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Elizabeth J Klein
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Rana R McKay
- Moores Comprehensive Cancer Center at the University of California, San Diego (UCSD), San Diego, CA, USA
| | - Amanda Nizam
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | | | | | | | | | - Justin A Shaya
- Moores Comprehensive Cancer Center at the University of California, San Diego (UCSD), San Diego, CA, USA
| | | | - Sarah Wall
- The Ohio State University, Columbus, OH, USA
| | | | | | - Sanjay Mishra
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Petros Grivas
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle Cancer Care Alliance, Seattle, WA, USA
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Clinical Frailty Scale (CFS) indicated frailty is associated with increased in-hospital and 30-day mortality in COVID-19 patients: a systematic review and meta-analysis. Ann Intensive Care 2022; 12:17. [PMID: 35184215 PMCID: PMC8858439 DOI: 10.1186/s13613-021-00977-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 12/22/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The concept of frailty provides an age-independent, easy-to-use tool for risk stratification. We aimed to summarize the evidence on the efficacy of frailty tools in risk assessment in COVID-19 patients. METHODS The protocol was registered (CRD42021241544). Studies reporting on frailty in COVID-19 patients were eligible. The main outcomes were mortality, length of hospital stay (LOH) and intensive care unit (ICU) admission in frail and non-frail COVID-19 patients. Frailty was also compared in survivors and non-survivors. Five databases were searched up to 24th September 2021. The QUIPS tool was used for the risk of bias assessment. Odds ratios (OR) and weighted mean differences (WMD) were calculated with 95% confidence intervals (CI) using a random effect model. Heterogeneity was assessed using the I2 and χ2 tests. RESULTS From 3640 records identified, 54 were included in the qualitative and 42 in the quantitative synthesis. Clinical Frailty Scale (CFS) was used in 46 studies, the Hospital Frailty Risk Score (HFRS) by 4, the Multidimensional Prognostic Index (MPI) by 3 and three studies used other scores. We found that patients with frailty (CFS 4-9 or HFRS ≥ 5) have a higher risk of mortality (CFS: OR: 3.12; CI 2.56-3.81; HFRS OR: 1.98; CI 1.89-2.07). Patients with frailty (CFS 4-9) were less likely to be admitted to ICU (OR 0.28, CI 0.12-0.64). Quantitative synthesis for LOH was not feasible. Most studies carried a high risk of bias. CONCLUSIONS As determined by CFS, frailty is strongly associated with mortality; hence, frailty-based patient management should be included in international COVID-19 treatment guidelines. Future studies investigating the role of frailty assessment on deciding ICU admission are strongly warranted.
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Lionis C, Anastasaki M, Petelos E, Souliotis K, Tsiligianni I. Family Medicine at the Forefront: Lessons Learnt From the COVID-19 Vaccine Rollout in Crete, Greece. Front Public Health 2022; 10:815825. [PMID: 35174124 PMCID: PMC8841835 DOI: 10.3389/fpubh.2022.815825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/04/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Christos Lionis
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
- *Correspondence: Christos Lionis
| | - Marilena Anastasaki
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Elena Petelos
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
- Health Services Research, Faculty of Health, Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Kyriakos Souliotis
- Faculty of Social and Political Sciences, University of Peloponnese, Corinth, Greece
- Health Policy Institute, Athens, Greece
| | - Ioanna Tsiligianni
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
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Subramaniam A, Shekar K, Afroz A, Ashwin S, Billah B, Brown H, Kundi H, Lim ZJ, Ponnapa Reddy M, Curtis JR. Frailty and mortality associations in patients with
COVID
‐19: A Systematic Review and Meta‐analysis. Intern Med J 2022; 52:724-739. [PMID: 35066970 PMCID: PMC9314619 DOI: 10.1111/imj.15698] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 01/04/2022] [Accepted: 01/17/2022] [Indexed: 01/08/2023]
Abstract
Background Observational data during the pandemic have demonstrated mixed associations between frailty and mortality. Aim To examine associations between frailty and short‐term mortality in patients hospitalised with coronavirus disease 2019 (COVID‐19). Methods In this systematic review and meta‐analysis, we searched PubMed, Embase and the COVID‐19 living systematic review from 1 December 2019 to 15 July 2021. Studies reporting mortality and frailty scores in hospitalised patients with COVID‐19 (age ≥18 years) were included. Data on patient demographics, short‐term mortality (in hospital or within 30 days), intensive care unit (ICU) admission and need for invasive mechanical ventilation (IMV) were extracted. The quality of studies was assessed using the Newcastle−Ottawa Scale. Results Twenty‐five studies reporting 34 628 patients were included. Overall, 26.2% (n = 9061) died. Patients who died were older (76.7 ± 9.6 vs 69.2 ± 13.4), more likely male (risk ratio (RR) = 1.08; 95% confidence interval (CI): 1.06–1.11) and had more comorbidities. Fifty‐eight percent of patients were frail. Adjusting for age, there was no difference in short‐term mortality between frail and non‐frail patients (RR = 1.04; 95% CI: 0.84–1.28). The non‐frail patients were commonly admitted to ICU (27.2% (4256/15639) vs 29.1% (3567/12274); P = 0.011) and had a higher mortality risk (RR = 1.63; 95% CI: 1.30–2.03) than frail patients. Among patients receiving IMV, there was no difference in mortality between frail and non‐frail (RR = 1.62; 95% CI 0.93–2.77). Conclusion This systematic review did not demonstrate an independent association between frailty status and short‐term mortality in patients with COVID‐19. Patients with frailty were less commonly admitted to ICU and non‐frail patients were more likely to receive IMV and had higher mortality risk. This finding may be related to allocation decisions for patients with frailty amidst the pandemic.
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Affiliation(s)
- Ashwin Subramaniam
- Department of Intensive Care Medicine Peninsula Health Frankston Victoria Australia
- Monash University, Peninsula Clinical School Frankston Victoria Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
| | - Kiran Shekar
- Adult Intensive Care Services, The Prince Charles Hospital Brisbane Queensland Australia
- University of Queensland, Brisbane; Queensland University of Technology Brisbane and Bond University Gold Coast Queensland Australia
| | - Afsana Afroz
- Centre for Integrated Critical Care, Department of Medicine and Radiology Melbourne Medical School Melbourne Victoria Australia
| | - Sushma Ashwin
- Department of Health Economics School of Health and social development, Deakin University Melbourne Victoria Australia
| | - Baki Billah
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
| | - Hamish Brown
- Department of Intensive Care Medicine Peninsula Health Frankston Victoria Australia
| | - Harun Kundi
- Department of Cardiology Ankara City Hospital Ankara Turkey
| | - Zheng Jie Lim
- Department of Anaesthesiology, Austin Health Heidelberg Victoria Australia
| | - Mallikarjuna Ponnapa Reddy
- Department of Intensive Care Medicine Peninsula Health Frankston Victoria Australia
- Department of Intensive Care Medicine, Calvary Hospital Canberra Australian Capital Territory Australia
| | - J Randall Curtis
- Cambia Palliative Care Centre of Excellence University of Washington Seattle Washington United States of America
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine University of Washington Seattle Washington United States of America
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Jachymek M, Cader A, Ptak M, Witkiewicz W, Szymański AG, Kotfis K, Kaźmierczak J, Szylińska A. The Value of Clinical Frailty Scale (CFS) as a Prognostic Tool in Predicting Mortality in COVID-19—A Retrospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031104. [PMID: 35162123 PMCID: PMC8834053 DOI: 10.3390/ijerph19031104] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/04/2022] [Accepted: 01/07/2022] [Indexed: 02/05/2023]
Abstract
Background: Due to the unpredictable nature of COVID-19, there is a need to identify patients at high risk of severe course of the disease and a higher mortality rate. Objective: This study aims to find the correlation between frailty and mortality in adult, hospitalized patients with COVID-19. Methods: Clinical records of 201 patients who suffered from COVID-19 and were hospitalized between October 2020 and February 2021 were retrospectively analyzed. Demographic, clinical, and biochemical data were collected. Patients were assessed using Clinical Frailty Scale (CFS) and were divided into three groups: CFS 1–3 fit; CFS 4–6 vulnerable and with mild to moderate frailty; CSF 7–9, severe frailty. The association between frailty and in-hospital mortality was the primary outcome. Results: Severe frailty or terminal illness was observed in 26 patients (12.94%) from a cohort of 201 patients. Those patients were older (median age 80.73, p < 0.001) and had more comorbidities. Frailty was also associated with higher requirement for oxygen supplementation, greater risk of in-hospital complications and worse biochemical laboratory results. An increase in CFS score also correlated with higher mortality (OR = 1.89, p < 0.001). The Conclusions: Clinical Frailty Scale (CFS) can be used as a potentially useful tool in predicting mortality in patients with COVID-19.
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Affiliation(s)
- Magdalena Jachymek
- Department of Cardiology, Pomeranian Medical University, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland; (M.J.); (W.W.); (A.G.S.); (J.K.)
| | - Aleksandra Cader
- Department of Nephrology, Transplantology and Internal Medicine, Pomeranian Medical University, Powskańców Wielkopolskich 72, 70-111 Szczecin, Poland; (A.C.); (M.P.)
| | - Michał Ptak
- Department of Nephrology, Transplantology and Internal Medicine, Pomeranian Medical University, Powskańców Wielkopolskich 72, 70-111 Szczecin, Poland; (A.C.); (M.P.)
| | - Wojciech Witkiewicz
- Department of Cardiology, Pomeranian Medical University, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland; (M.J.); (W.W.); (A.G.S.); (J.K.)
| | - Adam Grzegorz Szymański
- Department of Cardiology, Pomeranian Medical University, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland; (M.J.); (W.W.); (A.G.S.); (J.K.)
| | - Katarzyna Kotfis
- Department Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland;
| | - Jarosław Kaźmierczak
- Department of Cardiology, Pomeranian Medical University, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland; (M.J.); (W.W.); (A.G.S.); (J.K.)
| | - Aleksandra Szylińska
- Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University in Szczecin, Żołnierska 54, 71-210 Szczecin, Poland
- Correspondence:
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Characteristics and Outcomes of Patients With Frailty Admitted to ICU With Coronavirus Disease 2019: An Individual Patient Data Meta-Analysis. Crit Care Explor 2022; 4:e0616. [PMID: 35072081 PMCID: PMC8769107 DOI: 10.1097/cce.0000000000000616] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Supplemental Digital Content is available in the text. Frailty is often used in clinical decision-making for patients with coronavirus disease 2019, yet studies have found a variable influence of frailty on outcomes in those admitted to the ICU. In this individual patient data meta-analysis, we evaluated the characteristics and outcomes across the range of frailty in patients admitted to ICU with coronavirus disease 2019.
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Predictors of Mortality in Hemodialyzed Patients after SARS-CoV-2 Infection. J Clin Med 2022; 11:jcm11020285. [PMID: 35053983 PMCID: PMC8778392 DOI: 10.3390/jcm11020285] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/30/2021] [Accepted: 12/31/2021] [Indexed: 02/06/2023] Open
Abstract
Introduction: The determinants of COVID-19 mortality are well-characterized in the general population. Less numerous and inconsistent data are among the maintenance hemodialysis (HD) patients, who are the population most at risk of an unfavorable prognosis. Methods: In this retrospective cohort study we included all adult HD patients from the Pomeranian Voivodeship, Poland, with laboratory-confirmed SARS-CoV-2 infection hospitalized between 6 October 2020 and 28 February 2021, both those who survived, and also those who died. Demographic, clinical, treatment, and laboratory data on admission, were extracted from the electronic medical records of the dedicated hospital and patients’ dialysis unit, and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with 3-month all-cause mortality. Results: The 133 patients (53.38% males) aged 73.0 (67–79) years, with a median duration of hemodialysis of 42.0 (17–86) months, were included in this study. At diagnosis, the majority were considered to have a mild course (34 of 133 patients were asymptomatic, another 63 subjects presented mild symptoms), while 36 (27.07%) patients had low blood oxygen saturation and required oxygen supplementation. Three-month mortality was 39.08% including an in-hospital case fatality rate of 33.08%. Multivariable logistic regression showed that the frailty clinical index of 4 or greater (OR 8.36, 95%CI 1.81–38.6; p < 0.01), D-Dimer of 1500 ng/mL or greater (6.00, 1.94–18.53; p < 0.01), and CRP of >118 mg/L at admission (3.77 1.09–13.01; p = 0.04) were found to be predictive of mortality. Conclusion: Very high 3-month all-cause mortality in hospitalized HD patients was determined mainly by frailty. High CRP and D-dimer levels upon admission further confer mortality risk.
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Zhu Y, Sealy MJ, Jager-Wittenaar H, Mierau JO, Bakker SJL, Navis GJ. Frailty and risk of hospitalization from COVID-19 infection among older adults: evidence from the Dutch Lifelines COVID-19 Cohort study. Aging Clin Exp Res 2022; 34:2693-2702. [PMID: 36244048 PMCID: PMC9572827 DOI: 10.1007/s40520-022-02268-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 09/25/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Frailty is associated with COVID-19 severity in clinical settings. No general population-based studies on the association between actual frailty status and COVID-19 hospitalization are available. AIMS To investigate the association between frailty and the risk of COVID-19 hospitalization once infected. METHODS 440 older adults who participated in the Lifelines COVID-19 Cohort study in the Northern Netherlands and reported positive COVID-19 testing results (54.2% women, age 70 ± 4 years in 2021) were included in the analyses. COVID-19 hospitalization status was self-reported. The Groningen Frailty Indicator (GFI) was derived from 15 self-reported questionnaire items related to daily activities, health problems, and psychosocial functioning, with a score ≥ 4 indicating frailty. Both frailty and COVID-19 hospitalization were assessed in the same period. Poisson regression models with robust standard errors were used to analyze the associations between frailty and COVID-19 hospitalization. RESULTS Of 440 older adults included, 42 were hospitalized because of COVID-19 infection. After adjusting for sociodemographic and lifestyle factors, a higher risk of COVID-19 hospitalization was observed for frail individuals (risk ratio (RR) [95% CI] 1.97 [1.06-3.67]) compared to those classified as non-frail. DISCUSSION Frailty was positively associated with COVID-19 hospitalization once infected, independent of sociodemographic and lifestyle factors. Future research on frailty and COVID-19 should consider biomarkers of aging and frailty to understand the pathophysiological mechanisms and manifestations between frailty and COVID-19 outcomes. CONCLUSIONS Frailty was positively associated with the risk of hospitalization among older adults that were infected with COVID-19. Public health strategies for frailty prevention in older adults need to be advocated, as it is helpful to reduce the burden of the healthcare system, particularly during a pandemic like COVID-19.
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Affiliation(s)
- Yinjie Zhu
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands.
| | - Martine J Sealy
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, 9714 CA, Groningen, The Netherlands
- FAITH Research, Petrus Driessenstraat 3, 9714 CA, Groningen, The Netherlands
| | - Harriët Jager-Wittenaar
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, 9714 CA, Groningen, The Netherlands
- FAITH Research, Petrus Driessenstraat 3, 9714 CA, Groningen, The Netherlands
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Jochen O Mierau
- Department of Economics, Econometrics and Finance, Faculty of Economics and Business, University of Groningen, University complex, 9747 AJ, Groningen, The Netherlands
- Lifelines Cohort Study and Biobank, Groningen, The Netherlands
- Team Strategy and External Relations, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Stephan J L Bakker
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
| | - Gerjan J Navis
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
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Nikolina BJ, Sanjin R, Ivana T, Mirna A, Batric B, Ivana J, Vesna FC, Lea K, Dubravka M, Sofija V, Enisa M, Bojan J, Zeljko K. Hospitalization and death after recovery from acute COVID-19 among renal transplant recipients. Clin Transplant 2021; 36:e14572. [PMID: 34967958 DOI: 10.1111/ctr.14572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 12/01/2022]
Abstract
Data on post-COVID-19 infection in renal transplant recipients (RTR) are scarce. We investigated the rate of hospitalization, reasons for hospital admission, and mortality rate among RTR who survived acute COVID-19. A multi-center retrospective observational cohort study measured hospital admission and death to 180 days after acute SARS-CoV-2 infection in 308 adult patients. The median age was 57 years; 64.9% were male. All patients had at least one comorbidity, and 26.3% had diabetes. Data on the post-COVID-19 course was available for 267 patients, and 49 of them (15,9%) required hospitalization after recovery from the acute infection. The most common indications included pneumonia (24.5%) and renal allograft dysfunction (22,4%); 7 (14,3%) had sepsis and 52 had thrombotic events. A median duration of the hospital stay was 12 days. Six patients (2.2%) died due to multiorgan failure3, respiratory insufficiency2 and urosepsis1. The strongest predictor for hospitalization after acute COVID-19 was hospitalization for the initial acute SARS-CoV-2 infection, while better allograft function decreased the probability of hospitalization. In conclusion, delayed consequences of acute COVID-19 are highly prevalent, and the health care systems should be prepared to respond to the needs of RTR suffering from post-COVID-19 complications. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Basic-Jukic Nikolina
- Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, School of medicine, University of Zagreb
| | - Racki Sanjin
- Department of Nephrology, Dialysis and Transplantation, University hospital Centre Rijeka
| | - Tolj Ivana
- Department of Nephrology, Dialysis and Transplantation, University hospital Centre Osijek
| | - Aleckovic Mirna
- Department of Nephrology, Dialysis and Transplantation, University hospital Centre Tuzla, Bosnia and Herzegovina
| | | | - Juric Ivana
- Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, School of medicine, University of Zagreb
| | - Furic-Cunko Vesna
- Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, School of medicine, University of Zagreb
| | - Katalinic Lea
- Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, School of medicine, University of Zagreb
| | - Mihaljevic Dubravka
- Department of Nephrology, Dialysis and Transplantation, University hospital Centre Osijek
| | - Vujic Sofija
- Department of Nephrology, Dialysis and Transplantation, University hospital Centre Rijeka
| | - Mesic Enisa
- Department of Nephrology, Dialysis and Transplantation, University hospital Centre Tuzla, Bosnia and Herzegovina
| | - Jelakovic Bojan
- Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, School of medicine, University of Zagreb
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Chang R, Low H, McDonald A, Park G, Song X. Web-based software applications for frailty assessment in older adults: a scoping review of current status with insights into future development. BMC Geriatr 2021; 21:723. [PMID: 34922466 PMCID: PMC8683817 DOI: 10.1186/s12877-021-02660-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 11/15/2021] [Indexed: 11/30/2022] Open
Abstract
Background A crucial aspect of continued senior care is the early detection and management of frailty. Developing reliable and secure electronic frailty assessment tools can benefit virtual appointments, a need especially relevant in the context of the COVID-19 pandemic. An emerging effort has targeted web-based software applications to improve accessibility and usage. The objectives of this scoping review are to identify and evaluate web-based frailty assessment tools currently available and to identify challenges and opportunities for future development. Methods We conducted a review with literature (e.g., using MEDLINE databases) and Google searches (last updated on October 10, 2021). Each of the identified web applications were assessed based on eight featured categories and assigned a rating score accordingly. Results Twelve web-based frailty assessment applications were found, chiefly provided by the USA (50%) or European countries (41%) and focused on frailty grading and outcome prediction for specific patient groups (59%). Categories that scored well among the applications included the User Interface (2.8/3) and the Cost (2.7/3). Other categories had a mean score of 1.6/3 or lower. The least developed feature was Data Saving. Conclusions Web-based applications represent a viable option for remote frailty assessments and multidisciplinary integrated care of older adults. Despite the available web-based frailty assessments on the Internet, many missed certain needed features for professional use in healthcare settings. This situation calls for fully comprehensive web-based applications, taking into consideration a number of key functions linking graphical user interface and functionalities, and paying special attention to secure data management. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02660-6.
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Affiliation(s)
- Riley Chang
- Clinical Research, Surrey Memorial Hospital, Fraser Health, Critical Care Tower T2-820, 13750 96th Avenue, Surrey, BC, V3V 1Z2, Canada
| | - Hilary Low
- Clinical Research, Surrey Memorial Hospital, Fraser Health, Critical Care Tower T2-820, 13750 96th Avenue, Surrey, BC, V3V 1Z2, Canada.,Department of Evaluation and Research Services, Fraser Health, Surrey, BC, Canada
| | - Andrew McDonald
- Clinical Research, Surrey Memorial Hospital, Fraser Health, Critical Care Tower T2-820, 13750 96th Avenue, Surrey, BC, V3V 1Z2, Canada.,Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Grace Park
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Primary Care and Home Health, Fraser Health, Surrey, BC, Canada
| | - Xiaowei Song
- Clinical Research, Surrey Memorial Hospital, Fraser Health, Critical Care Tower T2-820, 13750 96th Avenue, Surrey, BC, V3V 1Z2, Canada. .,Department of Evaluation and Research Services, Fraser Health, Surrey, BC, Canada. .,Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada.
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