Clinical course and mortality in older patients with COVID-19: a cluster-based study in Hong Kong.

INTRODUCTION: Compared with previous waves of the coronavirus disease 2019 (COVID-19) pandemic in Hong Kong, the third wave involved a greater number of frail older patients. Because local healthcare policy required hospitalisation for all older adults with COVID-19, we aimed to investigate the clinical course and outcomes in such patients. METHODS: This retrospective observational study included all patients aged ≥65 years who were admitted to Tuen Mun Hospital for management of COVID-19 between 1 July 2020 and 31 August 2020. We reviewed baseline characteristics, clinical presentation, laboratory results, complications, and outcomes. We also investigated the associations of age and Clinical Frailty Scale (CFS) score with in-patient mortality. RESULTS: In total, 101 patients were included (median age, 73 years); 52.5% were men and 85% had at least co-morbid chronic disease. The most common symptoms were fever (80.2%) and cough (63.4%). Fifty-two patients (51.5%) developed hypoxia, generally on day 8 (interquartile range, 5-11) after symptom onset. Of the 16 patients who required intensive care unit support, 13 required mechanical ventilation. The overall mortality rate was 16.8%. Patients aged 65-69, 70-79, 80-89, and ≥90 years had mortality rates of 9.1%, 10%, 30%, and 25%, respectively. Patients with CFS scores of 1-2, 3-4, 5-6, and ≥7 had mortality rates of 5.7%, 14.7%, 23.5%, and 40%, respectively. A linear relationship was confirmed between the two mortality trends. CONCLUSION: Clinical deterioration was common in older patients with COVID-19; their overall mortality rate was 16.8%. Mortality increased linearly with both age and CFS score.

Natural clinical course of progressive supranuclear palsy in Chinese patients in Hong Kong.

INTRODUCTION: Progressive supranuclear palsy (PSP) is a common type of atypical parkinsonism. To the best of our knowledge, there has been no study of its natural clinical course among Chinese patients. METHODS: This retrospective study included 21 patients with PSP who had radiological evidence of midbrain atrophy (confirmed by magnetic resonance imaging) from the geriatrics clinics of Queen Mary Hospital and Tuen Mun Hospital. Clinical information was retrieved from clinical records, including age at onset, age at presentation, age at death, duration of symptoms, level of education, sex, presenting scores on Cantonese version of Mini-Mental State Examination, clinical symptoms, and history of levodopa or dopamine agonist intake and response. Clinical symptoms were clustered into the following categories and the dates of development of these symptoms were determined: motor symptoms, bulbar symptoms, cognitive symptoms, and others. RESULTS: Motor symptoms developed early in the clinical course of disease. Cox proportional hazards modelling showed that the number of episodes of pneumonia, time to vertical gaze palsy, and presence of pneumonia were predictive of mortality. Apathy, dysphagia, pneumonia, caregiver stress, and pressure injuries were predictive of mortality when analysed as time-dependent covariates. There was a significant negative correlation between the age at presentation and time to mortality from presentation (Pearson correlation=-0.54, P=0.04). Approximately 40% of caregivers complained of stress during the clinical course of disease. CONCLUSION: Important clinical milestones, including the development of dysphagia, vertical gaze palsy, significant caregiver stress, pressure injuries, and pneumonia, may guide advanced care planning for patients with PSP.

Suicidality and migration among adolescents in Hong Kong.

Suicide as a cause of death among adolescents and migration as a component of population have been growing in importance. Very little research has been conducted on the connections between migration and suicidality among adolescents in Hong Kong, and so is the aim of this article. It uses census and registration data to study suicide mortality, and sample survey data collected for this purpose to investigate suicide attempt, suicide ideation, and self-injurious behavior. Relations between suicidality and socio-demographic/psychological factors replicated those found in the literature. Duration of residence was found important for the study of suicide among migrants. In both the bivariate and multivariate analyses, although the suicidality levels for short-duration (less than 10 years) adolescent migrants were very much lower than the local-born counterparts, those for the long-duration (10 years or more) migrants were very much higher. The findings support the Healthy Migrant Hypothesis and other related hypotheses in migrant mortality studies. They also reveal, in the light of the Integration Theory of Suicide, the problem of migrant integration into the host culture and society, an important social problem for the government to solve.

Gender differences in suicide risk by socio-demographic factors in Hong Kong.

Some peculiarly low male-to-female suicide ratios have been reported in the Far Eastern populations. This article attempts to investigate whether there are gender differences in suicide risk by socio-demographic factors in Hong Kong, and hereby to explain the low male-to-female suicide ratios. The effects of marital status, duration-of-residence, and occupational status on suicide are first studied by periodic suicide rates in 1990-1992, and 2000-2002, then by Poisson regression. Some interesting results are found: Unlike most findings elsewhere, migration in Hong Kong did not induce suicide; occupational status was negatively related to suicide only for men but not for women; the particularly low male-to-female suicide ratio was not due to a larger protection from marriage for men than for women as reported in the literature, but very probably to a very high suicide rate for the non-working population. The authors suggest some plausible explanations of the findings and hence further research to be conducted.

Rheumatoid-like polyarthritis as a presenting feature of metastatic carcinoma: a case presentation and review of the literature.

The case of a 69-year-old woman who presented with abrupt onset of rheumatoid-like symmetrical polyarthritis but who was subsequently diagnosed to have disseminated abdominal carcinomatosis is reported. The temporal relationship between the joint symptoms and the discovery of carcinoma suggested that the arthritis was a paraneoplastic manifestation of the latter. An underlying malignancy should always be looked for in elderly patients who present with explosive polyarthritis for the first time, particular if unexplained anaemia or constitutional symptoms persist after treatment.

Biochemical, histomorphometric and densitometric changes in patients with multiple myeloma: effects of glucocorticoid therapy and disease activity.

It is unknown whether bone changes which can occur in multiple myeloma (MM) are due to cytokine-induced osteoclastic bone resorption from a clone of abnormal plasma cells or high-dose glucocorticoid therapy. We studied 25 MM patients treated for 1-12 years with combination chemotherapy, subdivided into two groups. Group 1 consisted of 12 patients with stage I and II myeloma and group 2 consisted of 13 patients with stage III MM. Their serum biochemistry, tetracycline-labelled bone histomorphometry and bone densitometry were compared to age- and sex-matched controls. Patients with MM demonstrated increased indices of bone resorption (P < 0.001 versus controls) and, to a lesser extent, increased indices of bone formation (P < 0.01 versus controls). No patient had evidence of a mineralization defect. Lumbar spine, femoral neck and total body bone mineral density measurements (BMD) were significantly lower in group 2 compared with group 1 (P < 0.05). Following 12 months of therapy, lumbar spine BMD decreased by 6.6% (95% CI, 2.7% to -9.3%) and femoral neck BMD decreased by 9.5% (95% CI, -3.2% to -15.9%). In a stepwise regression analysis, cumulative prednisolone dosage (B Coef. = -0.39; P = 0.03) and plasma cell infiltrate (B Coef. = -0.08; P = 0.05) were the most important predictors of lumbar spine bone loss, whereas serum paraprotein (B Coef.= -0.35; P = 0.02) and plasma cell infiltrate (B Coef. = -0.20; P = 0.04) were the most important predictors of femoral neck bone loss. We conclude that MM is characterized by high bone turnover with osteoblast-osteoclast uncoupling. Both disease activity and high-dose glucocorticoid therapy may be responsible for the ongoing bone loss seen with MM.

A health status indicator for the Chinese elderly in Hong Kong.

This paper proposes an instrument comprising of 28 questions on seven dimensions to assess the quality of life of a subpopulation. Our hierarchical model which utilizes Thurstone's Law of comparative judgment and Mckenna's modification will give a score from 0 to 100 of an individual's overall health quality. Also reported are the results of an implementation of the instrument on an elderly Chinese subpopulation in Hong Kong.