The effect of Psidium guajava Leaves' extract for mild and asymptomatic corona virus Disease-19.

COVID-19 is an emerging disease that attacks the respiratory and systemic systems. Various treatments have been used for COVID-19, but no antiviral agents seemed to be efficacious. Many medicinal plants are commonly used for viral infections in Indonesia, including the guajava leaf. The study aimed to determine the effects of Psidium guajava extract supplementation on inflammation markers of asymptomatic and mild COVID-19 patients. The conversion time of PCR results was also evaluated. This study was an experimental, single-blinded, randomized clinical trial (ClinicalTrials.gov: NCT04810728) comparing the efficacy of P. guajava extract at the dose of 1000 mg/8h on top of standard treatment with the standard treatment only for asymptomatic and mild COVID-19 subjects. The primary endpoints were neutrophil and lymphocyte percentages as well as the neutrophil/lymphocyte ratio (NLR) on day 7 of the treatment. The secondary endpoints were high-sensitivity c-reactive protein (hs-CRP) level, PCR-based conversion time, and recovery rate at weeks 2 and 4. A total of 90 subjects were enrolled, and there were 40 subjects in the P. guajava (experimental) group and 41 subjects in the control group who completed the research. On day 7, significantly lower percentage of neutrophil (52.4% vs 58.9%, p = 0.002), higher lymphocyte percentage (35.5%, vs 29.7%, p = 0.002), and lower NLR (1.5 vs 2.1, p = 0.001) were demonstrated in the experimental versus control group. The PCR-based conversion time was shorter (14 days vs 16 days, p < 0.001), and recovery rate at 2 and 4 weeks were higher (49% vs 27%, p = 0.03 and 100% vs 82%, p = 0.003, respectively) in the experimental group. There were no differences in the baseline characteristics. P. guajava extract supplementation reduced neutrophil and increased lymphocyte percentages which led to reduced NLR, accelerated PCR-based conversion time, and increased recovery rate in subjects with mild and asymptomatic COVID-19 infection.\.

Sarcopenia in a Multiethnic State: A Cross-Sectional Data Analysis of Multicentre Indonesia Longitudinal Aging Study.

BACKGROUND: Previous regional studies related to sarcopenia in multiethnic Indonesia suggested inconsistent findings. We aimed to find the prevalence of sarcopenia and its associated factors among Indonesian older adults. METHODS: In this cross-sectional analysis, we utilised the data of Indonesia Longitudinal Aging Study (INALAS) from community-dwelling outpatients in eight centres. Statistical analyses included descriptive, bivariate, and multivariate analyses. We categorised older adults into sarcopenia group based on the criteria of the SARC-F questionnaire, namely strength, assistance with walking, rising from a chair, climbing stairs, and falls questionnaire. RESULTS: Among 386 older adults, 17.6% were in sarcopenia group. The prevalence of sarcopenia was found to be the lowest in Sundanese group (8.2%). Following appropriate statistical adjustment, sarcopenia was associated with female sex (OR 3.01, 95% CI 1.34-6.73), dependent functional capacity (OR 7.38, 95% CI 3.26-16.70), frailty (OR 11.82, 95% CI 5.41-25.80), and history of fall (OR 5.17 (95% CI 2.36-11.32). Sarcopenia was not significantly associated with age 70 years and older (OR 1.67, 95% CI 0.81-3.45), Sundanese group (OR 0.44, 95% CI 0.15-1.29), and being at high risk for malnutrition or malnourished (OR 2.98, 95% CI 0.68-13.15). All centenarians had no sarcopenia nor frailty, and 80% of them were Sundanese older adults. CONCLUSION: One in five Indonesian community-dwelling older adults had sarcopenia, associated with female sex, dependent functional capacity, frailty, and history of fall. Albeit statistically nonsignificant, there may still be link between Sundanese, age 70 years and older, as well as being at high risk for malnutrition, and sarcopenia.

Indonesian Geriatrics Society Consensus on COVID-19 Management in Older Adults.

More than 80% of death cases and 95% of severe COVID-19 occur in patients aged over 60 years. Atypical clinical manifestations with high morbidity and mortality further emphasize the importance of COVID-19 management in older adults. Some older patients may appear asymptomatic while other may present with acute respiratory distress syndrome and multi organ failure. Fever, higher respiratory rate and crackles may present. The most common chest x-ray finding is ground glass opacity. Other imaging modalities that are often used are pulmonary computed tomography scan and lung ultrasonography. COVID-19 management in older adults should be comprehensive, starting from oxygen, fluid, nutritional, physical rehabilitation, pharmacology and psychosocial therapy. In this consensus, we also discuss about management of older adults with special condition such as diabetes mellitus, kidney disease, malignancy, frailty, delirium, immobilization and dementia. In post COVID-19 phase, we believe that physical rehabilitation is important as it is done to improve fitness.

Sedentary Lifestyle of Older Adults and Its Associated Factors: A Multicentre Cross-Sectional Study During COVID-19 Pandemic in Indonesia.

BACKGROUND: COVID-19 is here to stay, and humans ought to decide how to adapt. We aimed to describe lifestyle changes during COVID-19 pandemic, and to determine the prevalence and factors associated with sedentary lifestyle among older adults. METHODS: We obtained data from community-dwelling older adults aged ≥60 years. We presented the data descriptively and used multivariate analysis to assess the association between Physical Activity Scale for the Elderly (PASE) -based sedentary lifestyle and other variables in several tertiary geriatric centres. RESULTS: Among 601 participants, 21.1% had sedentary lifestyle. Ethnic groups with the highest prevalence of sedentary lifestyle were Minang, Balinese, and Sundanese. Changes related to food intake, body weight, and physical activity were seen in a small proportion of older adults. Sun exposure habit was described. Sedentary lifestyle was associated with less consumption of food (OR 2.59, 95% CI 1.07-6.30), weight loss (OR 3.00, 95% CI 1.64-5.48), and higher intensity of snacking (OR 0.45, 95% CI 0.20-0.99). CONCLUSION: During COVID-19 pandemic, one out of five older adults had sedentary lifestyle, which was positively associated with less consumption of food and weight loss, and negatively associated with higher intensity of snacking. The prevalence of sedentary lifestyle varied across ethnic groups. Adequate and appropriate food intake may be crucial to keep older adults active, preventing them from entering vicious cycle of malnutrition, sarcopenia, and frailty.

The Role of High Sensitivity C-reactive Protein to Predict Delirium Persistence in Elderly Patients with Pneumonia: A Prospective Cohort Study.

BACKGROUND: Delirium is a disorder of acute full attention, and cognitive function commonly occurs at elderly which  can prolong hospitalization, dependence rate, morbidity, and mortality, with pneumonia infection as one of its risk factors. Several markers have been studied for delirium, but relationship between delirium severity and persistence remains unclear. This study aimed to examine the role of hs-CRP, pNF-H, S100B, and NLR to predict delirium persistence.  Methods: A prospective  cohort study was  conducted among 80 subjects who were admitted to the internal ward in dr. M. Djamil Hospital in Padang. Subjects were grouped based on severity of delirium using the Memorial Delirium Assessment Scale and  followed up until discharged to determine delirium persistence event. RESULTS: Mean age of subjects is 70.7±7.4 years, 39 (48.8%) male and 41 (51.2%) female,consisting of 29 mild, 26 moderate, and 25 severe delirium. Levels of hs-CRP in mild, moderate, and severe delirium are 13.36±0.79, 13.56±0.78, and 13.88±0.59 mg/L (p=0.038), respectively. Median NLR values for mild, moderate, severe delirium were 6.80 (1.00-31.00), 9.50 (3.60-46.00), and 11.90 (2.80-46.50) (p=0.026). Cut off value hs-CRP 13.61 mg/L has significant difference for delirium persistence event (OR 2,54; 95% CI 1,01-6,39). Median levels of pNF-H and S100B are not significant in different delirium severity, regardless of non-persistent or persistent. CONCLUSION:   Hs-CRP levels exceeding 13.61 can predict risk of persistent delirium, but not with levels pNF-H, S100B, and NLR.

Frailty and Its Associated Risk Factors: First Phase Analysis of Multicentre Indonesia Longitudinal Aging Study.

Background: National long-term care development requires updated epidemiological data related to frailty. We aimed to find the prevalence of frailty and its associated factors among Indonesian elderly. Methods: We conducted first-phase cross-sectional analysis of Indonesia Longitudinal Aging Study (INALAS) data collected from community-dwelling outpatients aged 60 years and older without acute illness in nine geriatric service care centres. Descriptive, bivariate and multivariate analyses were conducted. Results: Among 908 elderly in this study, 15.10% were robust, 66.20% were pre-frail, and 18.70% were frail. Functional dependence was associated with frailty among Indonesian elderly (OR 5.97, 95% CI 4.04-8.80). Being depressed and at risk for malnutrition were also associated with frailty with OR 2.54, 95% CI 1.56-4.12, and OR 2.56, 95% CI 1.68-3.90, respectively. Prior history of fall (OR 1.77, 95% CI 1.16-2.72) and hospitalization (OR 1.46, 95% CI 0.97-2.20) in the previous 12 months were associated with frailty. There is also significant association between poly pharmacy and frailty (OR 2.42, 95% CI 1.50-3.91). Conclusion: Approximately one in five Indonesian community-dwelling elderly was frail. Frailty is associated with functional dependence, being at risk for malnutrition or being malnourished, depression, history of fall, history of hospitalization, and poly pharmacy. There may be bidirectional relationships between the risk factors and frailty. The development of long-term care in Indonesia should be considered, without forcing the elderly who need it.

The Effect of Ophiocephalus striatus Extract on the Levels of IGF-1 and Albumin in Elderly Patients with Hypoalbuminemia.

BACKGROUND: a freshwater fish Ophiocephalus striatus or known locally to Indonesian as haruan,can potentially increases IGF-1 and albumin levels in elderly patients with hypoalbuminemia due to the contents of amino acids, fatty acids, vitamins, and minerals. This study was conducted to investigate the effect of Ophiocephalus striatus extract on the level of IGF-1 and albumin in elderly patients with hypoalbuminemia. METHODS: the study is a double-blind randomized controlled trial involving malnourished elderly inpatients (≥60 years old) recovering from acute condition before hospital discharge, with Mini Nutritional Assessment score ≤23.5 and albumin level <3.5 g/dL. A total of 109 subjects were randomly divided into two groups: one group received 10 g Ophiocephalus striatus extract per day for 14 days and another group received placebo. Albumin and IGF-1 levels were obtained before and after intervention. RESULTS: ninety subjects completed the study (extract group=45 subjects; placebo group =45 subjects) for 14 days. The median of age were 69 (64;75) years and the male to female ratio were 2 : 3. The changes of IGF-1 and albumin levels from before to after intervention between extract group compared to placebo group were 14.7 (0.30;31.5) ng/mL vs 1.0 (-6;13.15) ng/mL (p=0.002) and 0.5 (0.15;0.70) g/dL vs 0.10 (0.0;0.50) g/dL (p=0.003), respectively. There were significant differences in the improvement of IGF-1 and albumin levels between extract and placebo group. CONCLUSION: supplementation of Ophiocephalus striatus extract was associated with a significant increase in IGF-1 and albumin levels in elderly patients with hypoalbuminemia.