Atypical presentations in the hospitalised older adult testing positive for SARS-CoV-2: a retrospective observational study in Glasgow, Scotland.

Introduction: Understanding of how SARS-CoV-2 manifests itself in older adults was unknown at the outset of the pandemic. We undertook a retrospective observational analysis of all patients admitted to older people's services with confirmed COVID-19 in one of the largest hospitals in Europe. We detail presenting symptoms, prognostic features and vulnerability to nosocomial spread. Methods: We retrospectively collected data for each patient with a positive SARSCoV-2 RT PCR between 18th March and the 20th April 2020 in a department of medicine for the elderly in Glasgow. Results: 222 patients were included in our analysis. Age ranged from 56 to 99 years (mean = 82) and 148 were female (67%). 119 patients had a positive swab for SARS-CoV-2 within the first 14 days of admission, only 32% of these patients presented with primarily a respiratory type illness. 103 patients (46%) tested positive after 14 days of admission - this was felt to represent likely nosocomial infection. 95 patients (43%) died by day 30 after diagnosis. Discussion: This data indicates that older people were more likely to present with non-respiratory symptoms. High clinical frailty scores, severe lymphopenia and cumulative comorbidities were associated with higher mortality rates. Several contributing factors will have led to nosocomial transmission.

Assessment of Dietary Intake Using Food Photography and Video Recording in Free-Living Young Adults: A Comparative Study.

BACKGROUND: Conventional methods of dietary assessment are prone to recall bias and place burden on participants. OBJECTIVE: Our aim was to compare the performance of image-based dietary assessment (IBDA), including food photography (FP) and video recording (VR), with the criterion of weighed food records (WFR). DESIGN: In this comparative study, participants captured meals using FP and VR before and after consumption, over 2 days. Food type and portion size were assessed using the images and videos. Energy and nutrient intakes (mean of 2 days) were compared against WFR. PARTICIPANTS/SETTINGS: Eighty-four healthy adults (mean [standard deviation] age = 29 [8] years), recruited through advertisement in Glasgow, UK, between January and August 2016 were enrolled in the study. Eighty participants (95%) (mean [standard deviation] age = 28 [7] years) completed the study and were included in the analysis. MAIN OUTCOME MEASURES: Agreement in estimated energy and nutrient intake between WFR and IBDA. The IBDA method feasibility was evaluated using a questionnaire. Inter-rater and intra-rater reliability were assessed. STATISTICAL ANALYSIS PERFORMED: The performance of the IBDA methods against WFR and their inter and intra-rater reliability were tested with Bland-Altman plots and Spearman correlations. Intra-class agreement between methods was assessed using κ statistics. RESULTS: Inter-rater reliability was strong for both IBDA methods in estimating energy intake (ρ-coefficients: FP = 0.80; VR = 0.81). There was no difference in the agreement between the 2 assessors. Intra-rater reliability was high. FP and VR underestimated energy intake by a mean (95% agreement limits) of -13.3% (-56.4% and 29.7%) and -4.5% (-45.5% and 36.4%), respectively. IBDA demonstrated moderate-to-strong correlations in nutrient intake ranking, median ρ-coefficients for all nutrients: FP = 0.73 (interquartile range, 0.09) and VR = 0.82 (interquartile range, 0.02). Inter-class agreement of IBDA methods was moderate compared with the WFR in energy intake estimation. IBDA was more practical and enjoyable than WFR. CONCLUSIONS: IBDA and VR in particular demonstrated a moderate-to-strong ability to rank participants' dietary intake, and considerable group and inter-class agreement compared with the WFR. However, IBDA was found to be unsuitable for assessment in individuals.

Does vitamin D stop inpatients falling? A randomised controlled trial.

BACKGROUND: Vitamin D deficiency is common in older people and may increase risk of falls and fracture. Hospital inpatients are at particular risk of falling. Previous studies suggest that vitamin D improves neuromuscular function and reduces falls. OBJECTIVE: To determine whether routine supplementation with vitamin D plus calcium reduces numbers of fallers and falls in a cohort of hospital admissions while they are inpatients. DESIGN: Randomised, double-blind, controlled study. PARTICIPANTS: two hundred and five acute admissions >65 years to a geriatric medical unit. METHODS: Patients were randomised to intervention of daily vitamin D 800 iu plus calcium 1,200 mg or control group of daily calcium 1,200 mg, until discharge or death. RESULTS: Baseline characteristics were similar in both groups with a median age 84 years and a median length of stay = 30 days (IQR 14.75-71.00). In a pre-selected sub-group (54/205 participants), median admission vitamin D level = 22.00 nmol/l (IQR 15.00-30.50). This did not significantly increase in the treatment versus control group. Median study drug adherence = 88%, with no significant difference between study groups (Mann-Whitney: P = 0.711). Although there were fewer fallers in the vitamin D cohort, this did not reach statistical significance (vitamin D: calcium = 36:45 fallers; RR 0.82 (CI 0.59-1.16). Neither the mean number of falls (vitamin D: calcium = 1.040:1.155; Mann-Whitney P = 0.435) or time to first fall (Log-rank test P = 0.377) differed between groups. CONCLUSIONS: In a population of geriatric hospital inpatients, vitamin D did not reduce the number of fallers. Routine supplementation cannot be recommended to reduce falls in this group.

Can doctors predict patients' abbreviated mental test scores.

OBJECTIVES: the abbreviated mental test is widely used in the assessment of cognitive impairment in elderly patients. However, many doctors do not administer the full 10 questions, preferring to estimate the patient's score instead. We have studied the accuracy of doctors in predicting patients' abbreviated mental test scores. METHODS: we assessed 102 patients in the geriatric unit. We asked doctors to predict the patient's abbreviated mental test during the admission interview. A true abbreviated mental test was then recorded. RESULTS: mean age was 80.9 years with a male:female ratio of 27:74. The mean predicted abbreviated mental test score was 6.57 (SD 2.9); the mean actual abbreviated mental test score being 6.36 (SD 3.2). Comparing the two groups, abbreviated mental test scores were predicted most accurately at the extremes and correlation between the two groups of scores was high (P<0.001 Spearman test). Kappa statistics revealed moderate agreement between the two groups, (0.56, 95% CI 0.48-0.63). A predicted score of 5/10 showed the greatest spread of true abbreviated mental test scores (0-10, mean 4.5). However in total, only 31% of the predicted abbreviated mental test scores were accurate, with 42% being incorrect by >1. Using the accepted cut-off of <7/10, this revealed that 13% were underdiagnosed and 19% were overdiagnosed as being cognitively impaired. CONCLUSIONS: clinicians are poor at predicting abbreviated mental tests in the midrange but are more accurate at predicting lower and higher scores. This descriptive study reinforces the importance of using an objective assessment of cognitive impairment rather than clinicians estimating its presence or absence.