Geriatrics

Editorial

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4 pages, 166 KiB

Open AccessEditorial

Frailty Assessment in Clinical Practice: Opportunity in the Midst of a Pandemic

by Victoria L. Keevil, Christopher N. Osuafor, Alistair J. Mackett and Richard Biram

Geriatrics 2020, 5(4), 92; https://doi.org/10.3390/geriatrics5040092 - 14 Nov 2020

Cited by 3 | Viewed by 2915

Abstract

Emerging evidence from studies of older adults hospitalised with COVID-19 suggests that there is a high prevalence of frailty in this patient group. We reflect on the measurement of frailty in older patients hospitalized as an emergency and the translation of frailty from [...] Read more.

Emerging evidence from studies of older adults hospitalised with COVID-19 suggests that there is a high prevalence of frailty in this patient group. We reflect on the measurement of frailty in older patients hospitalized as an emergency and the translation of frailty from a research to a clinical concept. We consider whether, despite the contemporary challenges in the care of older adults as a result of COVID-19, there are opportunities for care quality improvement during a pandemic. Full article

(This article belongs to the Special Issue SARS-CoV-2 Infections in the Elderly)

2 pages, 149 KiB

Open AccessEditorial

Decision-Making in COVID-19 and Frailty

by Susan Moug, Ben Carter, Phyo Kyaw Myint, Jonathan Hewitt, Kathryn McCarthy and Lyndsay Pearce

Geriatrics 2020, 5(2), 30; https://doi.org/10.3390/geriatrics5020030 - 6 May 2020

Cited by 23 | Viewed by 6273

Abstract

We write in response to the COVID-19 pandemic and the important recognition of co-existing frailty [COVID-19 rapid guideline: critical care in adults; NICE NG159] [...] Full article

(This article belongs to the Special Issue SARS-CoV-2 Infections in the Elderly)

4 pages, 205 KiB

Open AccessEditorial

Ageing and COVID-19: What Is the Role for Elderly People?

by Donatella Rita Petretto and Roberto Pili

Geriatrics 2020, 5(2), 25; https://doi.org/10.3390/geriatrics5020025 - 26 Apr 2020

Cited by 110 | Viewed by 18159

Abstract

Italy is one of the oldest countries in Europe and in the world and now it is also one of the first countries that are fighting against COVID-19. In our country, the increasing life expectancy (80.5 for males and 84.9 for females, with [...] Read more.

Italy is one of the oldest countries in Europe and in the world and now it is also one of the first countries that are fighting against COVID-19. In our country, the increasing life expectancy (80.5 for males and 84.9 for females, with a total life expectancy of 82.9) has led to very positive consequences for health and the well-being of elderly people: a very high number of older adults lives and acts independently in their daily life, even if they have one or more than one chronic disease. In the time of COVID-19′s outbreak in Italy, the focus of the media was on elderly people for two main reasons. First, many older people demonstrated a very high civic sense and they were helping society to fight against the pandemic. Second, also in Italy, like in China, the older adults are at higher risk in being infected with COVID-19 and if they get ill, they have a higher risk of death. The balance previously achieved between age-related disorders and a good quality of life and good health is now under high pressure. It is very important to protect elderly people from infection, but also it is important to respect them and to support them in this complex situation. There is a great risk of “ageism”. In agreement with Lloyd-Sherlock and colleagues (2020), in this editorial we propose some hints of analysis, starting from the ongoing experience in Italy. Full article

(This article belongs to the Special Issue SARS-CoV-2 Infections in the Elderly)

2 pages, 154 KiB

Open AccessEditorial

COVID-19: A Geriatric Emergency

by Virginia Boccardi, Carmelinda Ruggiero and Patrizia Mecocci

Geriatrics 2020, 5(2), 24; https://doi.org/10.3390/geriatrics5020024 - 26 Apr 2020

Cited by 28 | Viewed by 7174

Abstract

The older Italian population is posing a challenge in the number of deaths for coronavirus disease 2019 (COVID-19). According to previous data from China, pre-existing health conditions dramatically increase the risk of dying from COVID-19. The presence of multiple diseases in older patients [...] Read more.

The older Italian population is posing a challenge in the number of deaths for coronavirus disease 2019 (COVID-19). According to previous data from China, pre-existing health conditions dramatically increase the risk of dying from COVID-19. The presence of multiple diseases in older patients may be considered as a mark of frailty, which increases the person’s vulnerability to stress and impairs the multisystemic compensatory effort to restore homeostasis. The clinical complexity associated with the management of frailty may increase the risk of complications during infection as well as the lack of the early recognition of atypical symptoms. There is an urgent need to share expertise and clinical management skills with geriatricians as well as the need for early diagnosis to start treatment at the earliest convenience in the community, with the aim to avoid the collapse of intensive care units. Full article

(This article belongs to the Special Issue SARS-CoV-2 Infections in the Elderly)

Research

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12 pages, 1259 KiB

Open AccessArticle

Virtual Group Exercises and Psychological Status among Community-Dwelling Older Adults during the COVID-19 Pandemic—A Feasibility Study

by Amirah Ibrahim, Mei Chan Chong, Selina Khoo, Li Ping Wong, Ivy Chung and Maw Pin Tan

Geriatrics 2021, 6(1), 31; https://doi.org/10.3390/geriatrics6010031 - 22 Mar 2021

Cited by 18 | Viewed by 4483

Abstract

Social isolation, magnified by the restriction of movement order during the COVID-19 pandemic, may lead to negative psychosocial health impacts among community-dwelling older adults. We, therefore, aimed to evaluate recruitment rates, data collection, and group exercises conducted through virtual technology among individuals aged [...] Read more.

Social isolation, magnified by the restriction of movement order during the COVID-19 pandemic, may lead to negative psychosocial health impacts among community-dwelling older adults. We, therefore, aimed to evaluate recruitment rates, data collection, and group exercises conducted through virtual technology among individuals aged 60 years and over in Malaysia. Participants were recruited from the Promoting Independence in Seniors with Arthritis (PISA) pilot cohort through social media messaging. A four-week course of virtual group exercise was offered. Anxiety and depression were assessed with the Hospital Anxiety and Depression Scale (HADS) during the last attended follow-up of the cohort study (pre-pandemic), pre-intervention, and post-intervention. Exercise adherence was recorded using diaries with daily entries and attendance to the virtual group exercise sessions were also captured electronically daily. The outcomes of interest were changes in anxiety and depression scores from baseline to pre-intervention (pandemic-related) and post-intervention (virtual exercise related). Forty-three individuals were recruited. A significant increase in anxiety scores from baseline to pre-intervention was observed. Comparisons using repeated-measures analysis of variance between those who attendance ≥14 and <14 group exercise sessions revealed no between-within subject differences in depression scores. There was a 23% dropout rate in the post intervention survey and 60.5% of diaries were returned. Virtual group exercises could be conducted among older adults residing in a middle-income country, though recruitment would have been limited to those with internet access. Full article

(This article belongs to the Special Issue SARS-CoV-2 Infections in the Elderly)

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13 pages, 967 KiB

Open AccessArticle

Clinical Features, Inpatient Trajectories and Frailty in Older Inpatients with COVID-19: A Retrospective Observational Study

by Christopher N. Osuafor, Catriona Davidson, Alistair J. Mackett, Marie Goujon, Lelane Van Der Poel, Vince Taylor, Jacobus Preller, Robert J. B. Goudie and Victoria L. Keevil

Geriatrics 2021, 6(1), 11; https://doi.org/10.3390/geriatrics6010011 - 1 Feb 2021

Cited by 19 | Viewed by 4212

Abstract

Introduction: We describe the clinical features and inpatient trajectories of older adults hospitalized with COVID-19 and explore relationships with frailty. Methods: This retrospective observational study included older adults admitted as an emergency to a University Hospital who were diagnosed with COVID-19. Patient characteristics [...] Read more.

Introduction: We describe the clinical features and inpatient trajectories of older adults hospitalized with COVID-19 and explore relationships with frailty. Methods: This retrospective observational study included older adults admitted as an emergency to a University Hospital who were diagnosed with COVID-19. Patient characteristics and hospital outcomes, primarily inpatient death or death within 14 days of discharge, were described for the whole cohort and by frailty status. Associations with mortality were further evaluated using Cox Proportional Hazards Regression (Hazard Ratio (HR), 95% Confidence Interval). Results: 214 patients (94 women) were included of whom 142 (66.4%) were frail with a median Clinical Frailty Scale (CFS) score of 6. Frail compared to nonfrail patients were more likely to present with atypical symptoms including new or worsening confusion (45.1% vs. 20.8%, p < 0.001) and were more likely to die (66% vs. 16%, p = 0.001). Older age, being male, presenting with high illness acuity and high frailty were independent predictors of death and a dose–response association between frailty and mortality was observed (CFS 1–4: reference; CFS 5–6: HR 1.78, 95% CI 0.90, 3.53; CFS 7–8: HR 2.57, 95% CI 1.26, 5.24). Conclusions: Clinicians should have a low threshold for testing for COVID-19 in older and frail patients during periods of community viral transmission, and diagnosis should prompt early advanced care planning. Full article

(This article belongs to the Special Issue SARS-CoV-2 Infections in the Elderly)

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Other

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7 pages, 208 KiB

Open AccessBrief Report

The Clinical Frailty Scale: Estimating the Prevalence of Frailty in Older Patients Hospitalised with COVID-19. The COPE Study

by Jemima T. Collins, Roxanna Short, Ben Carter, Alessia Verduri, Phyo K. Myint, Terence J. Quinn, Arturo Vilches-Moraga, Michael J. Stechman, Susan Moug, Kathryn McCarthy and Jonathan Hewitt

Geriatrics 2020, 5(3), 58; https://doi.org/10.3390/geriatrics5030058 - 21 Sep 2020

Cited by 14 | Viewed by 4798

Abstract

Frailty assessed using Clinical Frailty Scale (CFS) is a good predictor of adverse clinical events including mortality in older people. CFS is also an essential criterion for determining ceilings of care in people with COVID-19. Our aims were to assess the prevalence of [...] Read more.

Frailty assessed using Clinical Frailty Scale (CFS) is a good predictor of adverse clinical events including mortality in older people. CFS is also an essential criterion for determining ceilings of care in people with COVID-19. Our aims were to assess the prevalence of frailty in older patients hospitalised with COVID-19, their sex and age distribution, and the completion rate of the CFS tool in evaluating frailty. Methods: Data were collected from thirteen sites. CFS was assessed routinely at the time of admission to hospital and ranged from 1 (very fit) to 9 (terminally ill). The completion rate of the CFS was assessed. The presence of major comorbidities such as diabetes and cardiovascular disease was noted. Results: A total of 1277 older patients with COVID-19, aged ≥ 65 (79.9 ± 8.1) years were included in the study, with 98.5% having fully completed CFS. The total prevalence of frailty (CFS ≥ 5) was 66.9%, being higher in women than men (75.2% vs. 59.4%, p < 0.001). Frailty was found in 161 (44%) patients aged 65–74 years, 352 (69%) in 75–84 years, and 341 (85%) in ≥85 years groups, and increased across the age groups (<0.0001, test for trend). Conclusion: Frailty was prevalent in our cohort of older people admitted to hospital with COVID-19. This indicates that older people who are also frail, who go on to contract COVID-19 may have disease severity significant enough to warrant hospitalization. These data may help inform health care planners and targeted interventions and appropriate management for the frail older person. Full article

(This article belongs to the Special Issue SARS-CoV-2 Infections in the Elderly)

4 pages, 167 KiB

Open AccessFeature PaperCase Report

COVID-19 and Gastrointestinal Symptoms—A Case Report

by Alistair J. Mackett and Victoria L. Keevil

Geriatrics 2020, 5(2), 31; https://doi.org/10.3390/geriatrics5020031 - 15 May 2020

Cited by 6 | Viewed by 4880

Abstract

COVID-19, a new illness secondary to a novel Coronavirus emerged in December 2019 in China. Our early understanding of the clinical features of COVID-19 has been based on case series emerging from the first outbreak in Wuhan. These features included fever, a dry [...] Read more.

COVID-19, a new illness secondary to a novel Coronavirus emerged in December 2019 in China. Our early understanding of the clinical features of COVID-19 has been based on case series emerging from the first outbreak in Wuhan. These features included fever, a dry cough, myalgia and dyspnea. Gastrointestinal symptoms were rarely reported as a key feature. We present a case report of a 74-year-old male who presented with symptoms of gastroenteritis and subsequently tested positive for COVID-19. This article aims to highlight an uncommon presentation of COVID-19 and that a high index of suspicion is required for COVID-19 in older people given their greater likelihood of presenting atypically. Full article

(This article belongs to the Special Issue SARS-CoV-2 Infections in the Elderly)

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