Impact of influenza vaccination history in the clinical course of older adults hospitalized with COVID-19.

BACKGROUND AND PURPOSE: Some studies have shown that influenza vaccination is associated with a lower risk of SARS-CoV-2 infection; in patients with COVID-19 infection, admission to intensive care is reduced, with less need for mechanical ventilation, shorter hospital stays, and reduced mortality. This study aimed to determine if a history of annual influenza vaccination impacts the clinical course of SARS-CoV-2 infection during hospitalization. METHODS: This was an observational, prospective, cohort study of patients older than 65 admitted to the COVID-19 unit from January to June 2021. The history of influenza vaccination over the last 5 years was assessed in each patient during hospitalization. We measured the length of hospital stay, the need for admission to the intensive care unit (ICU), the patient's oxygen requirements, complications during hospitalization, and outcome (medical discharge or death). Patients with a history of vaccination against SARS-CoV-2 were not included. RESULTS: We analyzed 125 patients, 50.4% (n=63) with history of influenza vaccination and 49.6% (n=62) without a history of influenza vaccination. In-hospital mortality was 44.8%, higher in the unvaccinated (54.8%) population (p=0.008). ICU admission was 27% higher in vaccinated (35%) patients (p=0.05). Patients without a history of influenza vaccination had a higher prevalence of cardiac (8% vs. 5%, p=0.04) and renal complications (29% vs. 13%, p=0.02). Patients with a history of vaccination had a greater need for invasive mechanical ventilation (25.4%, p=0.02). CONCLUSION: In this study, a history of influenza vaccination in older adults with SARS-CoV-2 infection was related to lower in-hospital mortality.

Cognition in older adults with healthy aging: analysis of the Mexican Health and Aging Study 2012-2015.

Introduction: Maintaining older adults' health and well-being can be achieved through the optimization of physical and mental health, while preserving independence, social participation, and quality of life. Cognitive change has been described as a normal process of aging and it involves domains such as processing speed, attention, memory, language, visuospatial abilities, and executive functioning, among others. Objective: To describe cognitive changes in older adults with healthy aging. Methods: This is a study that involved data from 14,893 and 14,154 individuals aged >60 years or older from the 2012 and 2015 waves, respectively, who participated in the Mexican Health and Aging Study (MHAS). Participants with healthy aging were identified and described in the MHAS-2012 wave and followed to 2015. Eight cognitive domains evaluated in the Cross-Cultural Cognitive Evaluation (CCCE,) as well as sociodemographic and health characteristics, were described. Criteria for healthy aging involved the following: CCCE ≥ -1.5 standard deviations above the mean on reference norms, independence on basic and instrumental activities of daily living, self-reported "life close to ideal," and preserved functional and social performance. Results: From a total of n = 9,160 older adults from the MHAS-2012 wave, n = 1,080 (11.8%) had healthy aging. In the healthy aging group, the median age was 67 years (IQR: 63-73), 58.1% were female and the median for education was 6 (IQR: 3-8) years. The mean CCCE score was 57 (SD: 16.9) points. In the MHAS-2012 cross-sectional analysis, except for orientation, visuospatial abilities, and verbal fluency, all cognitive domain scores were lower with passing age. When comparing cognitive domain scores in the 225 older adults identified with healthy aging between the 2012 and 2015 MHAS waves, there were almost no observable differences. Conclusion: In the cross-sectional analysis, Mexican adults with healthy aging had lower scores in the verbal learning memory, visual scanning, numeracy, visual memory, and verbal recall domains', as well as lower global cognitive scores in the higher age groups. There were no cognitive changes in the 3 year follow-up, except for a lower gradient of scores in the verbal recall memory domain. Longer prospective studies are needed to characterize greater cognitive changes.

Prescripción potencialmente inapropiada y polifarmacia en adultos mayores con demencia moderada y severa / Potentially inappropriate prescription and polypharmacy in older adults with dementia moderate and severe

Objetivo: Determinar la prevalencia de polifarmacia y prescripciones potencialmente inapropiadas (PPI) en pacientes mayores con demencia moderada y grave. Material y métodos: Este estudio retrospectivo transversal incluyó 180 pacientes diagnosticados con demencia durante junio de 2018 a abril de 2019. Se analizaron variables demográficas, comorbilidades, tipo de demencia, número de fármacos prescritos y la prevalencia de prescripción inadecuada. Resultados: La edad media fue 80,5 (±7,4) años. La demencia más frecuente fue Alzheimer (50%). 150 (83%) y 90 (50%) pacientes fueron detectados con polifarmacia y PPI, respectivamente. Las PPI más frecuentes fueron: fármacos que afectan la probabilidad de caída (22%), el sistema nervioso central y cardiovascular (14%). El riesgo de PPI fue 2,29 veces mayor en aquellos con polifarmacia. Discusión: En pacientes con demencia moderada y severa la polifarmacia aumenta el riesgo de PPI, siendo ambas altamente prevalentes. Revisar constantemente la medicación en esta población es necesario para reducir los riesgos a la salud (AU)

Objective: To determine the prevalence of polypharmacy and potentially inappropriate prescriptions (PIP) in older patients with moderate and severe dementia. Methods: This retrospective, cross-sectional study included 180 patients diagnosed with dementia during June 2018 to April 2019. We analyzed demographic variables, comorbidities, type of dementia, number of drugs prescribed and the prevalence of inadequate prescription. Results: Mean age was 80.5 (±7.4) years. Alzheimer's disease was the most frequent dementia (50%). 150 (83%) and 90 (50%) patients were detected with polypharmacy and PIP, respectively. The most frequent PIP were about drugs that affect individual’s probability of falling (22%), the central nervous system and the cardiovascular system (14%). The risk of PIP was 2,29 times higher in those with polypharmacy. Discussion: Polypharmacy and PPI are highly prevalent in older adults with moderate and severe dementia. Polypharmacy increases the risk of PIP. A continuous evaluation of the medication in this population is necessary to reduce the risk of adverse events (AU)

A randomized placebo-controlled trial evaluating the effect of melatonin on sleep quality in patients with mild-moderate dementia.

BACKGROUND: Patients with dementia may suffer from poor sleep quality as well as insomnia and sleep-wake cycle alterations. OBJECTIVES: The main objective of this study was to evaluate the efficacy of melatonin in improving sleep quality. METHODS: This was a single-center randomized, double-blinded, placebo-controlled study carried out on outpatients with dementia and sleep alterations (according to Diagnostic and Statistical Manual V criteria) from January 2016 to December 2016. Patients aged 65 years or over with a diagnosis of mild-moderate dementia (Clinical Dementia Rating 1-2) were included. Patients were randomized to receive either 5 mg of melatonin or placebo every night for 8 weeks. The primary outcome was sleep quality according to the Pittsburgh Sleep Quality Index (PSQI). Secondary measurements included Mini-Mental State Examination, Neuropsychiatric Inventory (NPI), Geriatric Depression Scale and Katz and Lawton scales for functionality. RESULTS: 40 patients were included (21 in the melatonin group and 19 in the placebo group). Nine patients withdrew from the study, and data of 31 patients were analyzed (16 from the melatonin group and 15 in the placebo group). Baseline characteristics of the population were comparable. PSQI scores improved in both groups at every timepoint compared to baseline, but there were no significant differences between groups. At 8 weeks, there was no difference between groups in any of the secondary outcomes except for the sleep sub-item of the NPI, where melatonin group had lower median scores compared to placebo (1, Interquartile Range = 3, vs. 4.4, Interquartile Range = 4.6, p = 0.03). CONCLUSION: Melatonin administered nightly to older persons with dementia was not effective in improving sleep quality. Clinicaltrials.gov Identifier: NCT03066518.