Dose-Response Relationship Between Exercise Duration and Enhanced Function and Cognition in Acutely Hospitalized Older Adults: A Secondary Analysis of a Randomized Clinical Trial.

Background and Objectives: Exercise may reverse functional decline in hospitalized older adults, but the optimal duration is unclear. This study examined the potential relationship between in-hospital multicomponent exercise program duration and changes in physical function, cognition, and muscle function to maximize exercise-related health benefits in acutely hospitalized older patients. Research Design and Methods: This secondary analysis of a multicenter randomized controlled trial examined the relationship between the duration of an in-hospital multicomponent exercise program and changes in physical function, cognition, and muscle strength in 570 acutely hospitalized older adults. Participants completed 3, 4, or 5-7 consecutive days of exercise based on the progression of their acute medical illness. The acute clinical condition of the older patients was similar across the study groups (i.e., 3/4/5-7 days) at admission. Outcomes included the Short Physical Performance Battery (SPPB) for functional capacity, Gait Velocity Test for gait speed, handgrip for muscle strength, and cognitive tests. Results: Of the 570 patients included in the analysis, 298 were women (52.3%), and the mean (SD) age was 87.3 (4.8) years. Exercise groups increased SPPB scores compared with controls, with gains of 1.09 points after three days, 1.97 points after four days, and 2.02 points after 5-7 days (p < .001). The 4-day program showed the most significant benefit for functional capacity. Gait velocity increased by 0.11 m/s after 4 and 5-7 days (p = .032). Similar dose-response relationships were seen for handgrip strength and cognition, with 5-7 days showing more significant gains than three days (p < .05). Discussion and Implications: Multicomponent exercise programs enhance physical and cognitive function in hospitalized older adults, regardless of exercise dosage. A 4-day program significantly boosts functional capacity, although 5-7 days improves handgrip strength and cognition, highlighting the importance of exercise dosage in countering functional decline. Implementing evidence-based inpatient exercise prescriptions can help reverse muscle weakness and improve cognitive and physical function.Clinical Trial Registration: NCT04600453.

[Utility and safety of direct admission to acute geriatric unit after Nursing Home Geriatric Team assessment]. / Utilidad y seguridad de los ingresos directos a una unidad hospitalaria de agudos de un servicio de geriatría valorados por atención geriátrica en residencias.

BACKGROUND AND OBJECTIVE: More than half of institutionalized older people need a emergency department visit annually, with high resources consumption and higher risk of adverse events, due to high complexity. Direct admission to Acute Geriatric Unit (AGU), after geriatric consultant and nursing home medical team assessment, could be a safety and effective alternative to emergency department (ED) admission. METHODS: Retrospective observational study of AGU patients admitted by Nursing Home Geriatric Team between January, 1st and December, 31st, 2021. Planned admissions and SARS-CoV-2 positive patients were excluded. Medical (sociodemographic, clinical, functional and cognitive) records and outcomes data (inpatient mortality, hospital and ED lenght of stay, transfer to ED and delirium within 48h after admission, hospital discharge location) were collected. RESULTS: Two hundred and six patients directly admitted, 101 through ED (N 307). 62.5% with Barthel index <40, 65% with dementia, 56.4% with Charlson index ≥3. Inpatient mortality was 14.6% in direct admission, 20.8% in ED referral group, p=0.14. Hospital lenght of stay was 9.61±6.01 days in direct admission, 11.22±5.36 days in ED group, p=0.02. 27.7% of patients with delirium in direct admission and 36.6% in ED group; only one patient was transferred to ED, within 48h after admission. CONCLUSIONS: Direct admission is a safety and effective alternative to ED referral in institutionalized older people after geriatric assessment, due to no increased mortality, shorter length of stay and hospital cost reduction.

Could olfactory identification be a prognostic factor in detecting cognitive impairment risk in the elderly?

Aging contributes to the deterioration of the olfactory system in humans. Several studies indicate that the olfactory identification test alone may function as a screening test for olfactory dysfunction and they are more feasible to apply in clinical practice. Olfactory identification may be a predictor for cognitive impairment. Multiple studies have considered the use of odor identification as a measure to identify the conversion from normality to mild cognitive impairment or dementia. The objectives were (i) to elucidate the associations between cognitive status and olfactory identification performance in aging; (ii) understand the predictive value of olfactory capacity in identifying subjects with cognitive impairment risk; and (iii) to study how cognitive status and olfactory identification relate with other variables of wellness in aging, such as functional capabilities and clinical measures. For this purpose, a group of 149 participants (77.15 ± 7.29 years; 73 women of 76.7 ± 8 years and 76 men of 77.6 ± 6.52 years) were recruited and were subjected to a sociodemographic questionnaire, a psychological screening tool of general cognitive status, an olfactory identification evaluation, and clinical measures. The participants were divided into groups based on their cutoff scores of previous scientific reports about the Spanish version of Montreal Cognitive Assessment. Our results indicate an age-associated decline in olfactory identification ability and intensity of odor perception. The predictive ability of olfactory identification scores for the risk of mild and severe impairment is around 80%. Olfactory identification decreases with cognitive function. Performance in odor identification is associated with impairment of episodic memory and executive functions. These findings further our current understanding of the association between cognition and olfaction, and support olfactory assessment in screening those at higher risk of dementia.

[The impact of the first pandemic waves of COVID-19 in older people with dementia]. / El impacto de las primeras olas pandémicas de la COVID-19 en las personas mayores con demencia.

Patients with dementia are in themselves more vulnerable, and have been especially affected by the effect of the COVID-19 pandemic, both directly due to the disease itself, and indirectly due to the deprivation of cognitive stimulation due to isolation social due to confinement. SARS-CoV-2 virus infection has given rise to a wide variety of symptoms, including neurological symptoms and especially delirium in the elderly with dementia. The virus has affected the central nervous system, both directly due to the neurotropism of the virus, and indirectly due to inflammation and tissue hypoxia of vascular origin. The different causes that have been able to lead, in the different waves prior to the omicron variant, to the significant increase in morbidity and mortality in patients with dementia, especially the elderly, are analyzed.

Prevalence of transthyretin cardiac amyloidosis in elderly patients diagnosed with heart failure.

OBJECTIVE: There is increased interest in studying ATTR-CA, a pathology that primarily affects patients of geriatric age and is frequently underdiagnosed. We aim to establish the prevalence of ATTR-CA in a cohort of patients with a history of HFpEF and to describe its characteristics. METHODS: We conducted a prospective observational study. Patients ≥75 years, clinical history of HFpEF, atrial dilation ≥34ml/m2 and left ventricular wall thickening >13mm, were included. Demographic and analytical parameters were collected, and a comprehensive geriatric assessment was performed, along with a transthoracic echocardiogram and cardiac scintigraphy. Finally, telephone follow-up was carried out at 6 and 12 months. RESULTS: 50 patients were recruited, mean age 86±6 years, 54% women. Age and functional class (I-II vs. III-IV) were factors associated with presenting with ATTR-CA. Patients with positive scintigraphy had a median time to admission of 5.2 months (confidence interval [CI] 95% 0-10.9), while in those with negative scintigraphy, it was 12.2 months (95% CI 11.7-12.8); log-rank: p=0.064. Patients with positive scintigraphy had a median time to the combined endpoint (death and readmission) of 1.9 months (95% CI 0-6.1), and patients with negative scintigraphy of 11.9 months (95% CI 11.7-12); log-rank: p=0.027. CONCLUSIONS: ATTR-CA appears to be a prevalent etiology in elderly patients within the spectrum of HFpEF. Patients with a diagnosis of ATTR-CA had a shorter time to admission for HF and the combined event of death and admission than patients with a negative result on scintigraphy.

[Evolution of the profile of patients attended by a hospital Geriatric Home Care Unit in the last 20 years]. / Evolución del perfil de las personas mayores atendidas por una unidad de atención domiciliaria especializada en geriatría en los últimos 20 años.

OBJECTIVE: To describe the evolution of the profile of patients attended by a Geriatric Home Care (GHC) Unit and its care activity in the last two decades. METHODS: Data on the historical activity of the AGD Unit from 2001 to 2020, grouped into 5-year periods, were recorded. Sociodemographic, clinical, functional (Functional Red Cross Scale and Barthel index) and mental (Mental Red Cross Scale) variables were collected, baseline and at inclusion to AGD. Also the waiting time until first visit, mean follow-up, origin of referral, destination at the end of the intervention, reason for consultation and cause of functional dependence were also included. A descriptive analysis was performed with the SPSSv.23 program. RESULTS: Ten thousand six hundred fifty-four patients attended in AGD (1 January 2001 to 31 December 2020). A progressive increase in age and in the number of geriatric syndromes was observed. Patients presented higher functional and cognitive decline, and the number of patients living alone and in need of private assistance increased. The duration of the intervention decreases and Primary Care remains the main source and destination at the end of the intervention, with dementia standing out as the main cause for functional dependence. CONCLUSION: The vulnerability of the populations in need of specialised geriatric care is increasing: patients are older, and have more geriatric syndromes, high functional and cognitive decline, and suffer social frailty; more work is needed to address the role of these support units in the community, as well as their coordination with Primary Care teams.

Safety, Effectiveness, and Immunogenicity 6 Months After BNT162B2 mRNA Vaccine in Frail Nursing Home Residents.

BACKGROUND: Elderly people who reside in long-term care facilities form a frail and vulnerable population, with multiple pathologies and high percentages of cognitive and functional disability. OBJECTIVES: The aims of this study were to assess the safety of vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in frail nursing home residents and to evaluate its effectiveness 6 months after full vaccination. DESIGN: This was an ambispective observational study. SETTING: Residents of a long-term care facility in Madrid, Spain. PARTICIPANTS: One hundred and thirty-seven nursing home residents (81.8% female, mean age 87.77 ± 8.31 years) with high comorbidity (61.3% Charlson Index ≥ 3) and frailty (75% Clinical Frail Scale ≥ 7) who received the BNT162B2 mRNA vaccine. MEASUREMENTS: Safety data were collected to evaluate the type of adverse drug reactions and their duration, severity, and causality. Immunogenicity was tested 6 months after the primary vaccination and effectiveness was evaluated by the incidence of SARS-CoV-2 infection, the number of hospital admissions, and mortality due to coronavirus disease 2019 (COVID-19). RESULTS: Safety: Of the residents, 21.9% had some adverse reaction and 5.8% had a severe or more serious adverse reaction. The most frequent adverse reactions were fatigue (13.1%), pyrexia (12.4%), and headache (7.3%). No association was observed between frailty (including a need for palliative care) and clinical, functional or cognitive status of the participants and the occurrence of adverse events. Immunogenicity and Effectiveness: After 6 months of vaccination, only one case of SARS-CoV-2 infection was confirmed in the vaccinated residents. Most of the nursing home residents presented positive serology (95.2%). Loss of immunogenicity was associated with older age (95.12 ± 3.97 vs. 87.24 ± 8.25 years; p = 0.03) and no previous COVID-19 infection (16.6% vs. 70%; p < 0.001). Binary logistic regression models did not reveal this association. CONCLUSION: The BNT162B2 vaccine is well tolerated and effective in nursing home residents, independently of their clinical, functional, cognitive, or frailty characteristics. For the most part, immunogenicity has been maintained over time, regardless of comorbidity, functional status or frailty.

[Coordination between primary care and a geriatrics service, 20 years later]. / Coordinación entre atención primaria y un servicio de geriatría, 20 años después.

OBJECTIVE: To describe the evolution of the care and coordination activity of a specialized hospital team (Geriatric Home Care-AGD team) in support of Primary Care (PC) for the care of geriatric patients. LOCATION: Health-5 area of the Community of Madrid. PARTICIPANTS, INTERVENTIONS AND MAIN MEASUREMENTS: Evaluation of patients attended at home at the request of PC by AGD, in 1997-1999 and twenty years later, in 2017-2019. Sociodemographic, clinical, functional and mental variables were recorded. Also care data such as time to first visit, average length of stay, origin and destination of patients, reason for consultation and main reason for disability. RESULTS: 524 patients (58% of the total) requested from AP in 1997-1999 and 1196 (72.2% of the total) in 2017-2019 were attended. Currently we show an older patient, more physically and mentally disabled, with a higher prevalence of geriatric syndromes and greater social fragility. Dementia has increased as the main reason for incapacity, with an increase in Comprehensive Geriatric Assessment and clinical control as the main reasons for referral. CONCLUSIONS: in our setting, after 20 years, AGD continues to be an important support for PC in the complex approach to frail elderly patients confined to their homes, who are increasingly vulnerable from a clinical, functional, cognitive and social point of view. It contributes to the management of geriatric syndromes, deprescription, direct hospital admissions when needed without having to go to the emergency department, and a decrease in institutionalization, facilitating the maintenance of the patient at home.

Health impact on the elderly survivors of COVID-19: Six months follow up.

PURPOSE: To analyse factors associated with mortality at 6 months in survivors older than 70 years after hospital admission for SARS-CoV-2. METHODS: Descriptive observational study with follow-up at 6 months. All patients over 70 years of age, discharged from the Hospital Central de la Cruz Roja, after hospitalization for COVID-19 consecutively during the months March to May 2020 were included. The outcome at 6 months (mortality, readmissions) were collected. RESULTS: A total of 165 patients were included. Mean age 88.5±6.73, women 69.1%. High comorbidity 33.9%. Mean previous Barthel Index was 65.39±33.64 and at discharge 58.12±34.04. 24.2% had severe polypharmacy and 47.9% severe frailty. Six months after hospital discharge, 13% died and 23.8% required at least one readmission. More than half of the sample had some of the following sequelae: dyspnea 20%(33), functional impairment 41.7%(69), cognitive impairment 31.3%(52) or depressive symptoms 42.4%(70). Functional impairment at discharge was associated with an increased risk of mortality (OR 5.33; 95% CI 1.11-25.73). CONCLUSIONS: The functional status was a factor associated with risk of mortality at 6 months.

Health status in survivors older than 70 years after hospitalization with COVID-19: observational follow-up study at 3 months.

PURPOSE: To analyze factors associated with mortality at 3 months and readmissions, functional and cognitive decline, anorexia and affective disorders in patients aged > 70 years surviving after hospital admission for SARS-CoV-2. METHODS: Patients aged > 70 years, discharged after hospitalization with COVID-19. OUTCOME VARIABLES: mortality, readmissions, functional and cognitive impairment, anorexia and mood disorder. RESULTS: 165 cases at 3 months after hospital discharge, 8.5% died and 20% required at least one hospital readmission. The presence of severe dependence at discharge (BI < 40) was associated at 3 months with a higher risk of mortality (OR 5.08; 95% CI 1.53-16.91) and readmissions (OR 4.53; 95% CI 1.96-10.49). The post-hospitalization functional deterioration was associated with persistence of deterioration at 3 months (OR 24.57; 95% CI 9.24-65.39), cognitive deterioration (OR 2.32; 95% CI 1.03-5.25) and affective (OR 4.40; 95% CI 1.84-10.55) CONCLUSIONS: Loss function in older people after hospitalization by COVID-19 may contribute to identify patients with a higher risk of sequelae in the short term that require closer follow-up.

[Cross-speciality geriatrics: A health-care challenge for the 21st century]. / Geriatría transversal. Un reto asistencial para el siglo xxi.

Increasing numbers of older persons are being treated by specialties other than Geriatric Medicine. Specialists turn to Geriatric Teams when they need to accurately stratify their patients' risk and prognosis, predict the potential impact of their, often, invasive interventions, optimise their clinical status, and contribute to discharge planning. Oncology and Haematology, Cardiology, General Surgery, and other surgical departments are examples where such collaborative working is already established, to a varying extent. The use of the term "Cross-speciality Geriatrics" is suggested when geriatric care is provided in clinical areas traditionally outside the reach of Geriatric Teams. The core principles of Geriatric Medicine (comprehensive geriatric assessment, patient-centred multidisciplinary targeted interventions, and input at point-of-care) are adapted to the specifics of each specialty and applied to frail older patients in order to deliver a holistic assessment/treatment, better patient/carer experience, and improved clinical outcomes. Using Comprehensive Geriatric Assessment methodology and Frailty scoring in such patients provides invaluable prognostic information, helps in decision making, and enables personalised treatment strategies. There is evidence that such an approach improves the efficiency of health care systems and patient outcomes. This article includes a review of these concepts, describes existing models of care, presents the most commonly used clinical tools, and offers examples of excellence in this new era of geriatric care. In an ever ageing population it is likely that teams will be asked to provide Cross-specialty Geriatrics across different Health Care systems. The fundamentals for its implementation are in place, but further evidence is required to guide future development and consolidation, making it one of the most important challenges for Geriatrics in the coming years.