Efficiency of Diagnostic Test for SARS-CoV-2 in a Nursing Home.

BACKGROUND: there is no consensus on how to optimally use diagnostic tests in each stage of COVID-19 pandemic. The objective of this research is to determine the efficiency of sorting positive antibody test quarterly. METHODS: this research uses a retrospective, observational study. COVID-19 diagnostic tests performed and avoided refer to a Spanish nursing home. POPULATION: 261 employees and 107 residents. A quarterly antibody test was performed on subjects who had tested positive during the first wave of coronavirus, and a antibody rapid test on the remaining subjects. RESULTS: during the first wave, 24.0% of the employees and 51.4% of the residents had a positive antibody test. Seronegativization was observed in 7.6% of employees and 1.6% of residents. An employee was infected with COVID-19 in September 2020, followed by a nursing home outbreak in October: 118 Polymerase Chain Reactions tests were avoided in residents and 18 in employees, which in turn prevented 15 workers from going on sick leave and the quarantine of 59 residents. This represents savings of about $15,000. CONCLUSIONS: our study supports the need to know and apply the strategies for early detection, surveillance and control of COVID-19 for future outbreaks. We conclude that surveillance for positive COVID-19 serology among long-term care staff and residents may be a cost-effective strategy during a pandemic.

Immunogenicity after 6 months of BNT162b2 vaccination in frail or disabled nursing home residents: The COVID-A Study.

BACKGROUND: There is incomplete information regarding evolution of antibody titers against SARS-CoV-2 after a two-dose strategy vaccination with BNT162b2 in older adults in long-term care facilities (LTCFs) with frailty, disability, or cognitive impairment. We aimed to determine IgG antibody titer loss in older adults in LTCFs. METHODS: This is a multicenter longitudinal cohort study including 127 residents (90 females and 37 males) with a mean age of 82.7 years (range 65-99) with different frailty and disability profiles in two LTCFs in Albacete, Spain. Residents received two doses of BNT162b2 as per label, and antibody levels were determined 1 and 6 months after the second dose. Age, sex, previous history of coronavirus disease 2019 (COVID-19), comorbidity (Charlson Index), performance in activities of daily living (Barthel Index), frailty (FRAIL instrument), and cognitive status were assessed. RESULTS: The mean antibody titers 1 and 6 months after the second vaccine dose were 32,145 AU/ml (SD 41,206) and 6182 AU/ml (SD 13,316), respectively. Across all participants, the median antibody titer loss measured 77.6% (interquartile range [IQR] 23.8%). Notably, the decline of titers in individuals with pre-vaccination COVID-19 infection was significantly lower than in those without a history of SARS-CoV-2 infection (72.2% vs. 85.3%; p < 0.001). The median titer decrease per follow-up day was 0.47% (IQR 0.14%) and only pre-vaccination COVID-19 was associated with lower rate of antibody decline at 6 months (hazard ratio 0.17; 95% confidence interval 0.07-0.41; p < 0.001). Frailty, disability, older age, cognitive impairment, or comorbidity were not associated with the extent of antibody loss. CONCLUSIONS: Older adults in LTCFs experience a rapid loss of antibodies over the first 6 months after the second dose of BNT162b2 vaccine. Only pre-vaccination COVID-19 is associated with a slower rate of antibody decrease. Our data support immunization with a third dose in this vulnerable, high-risk population.

[Anemia and frailty in older adults from Spain. The FRADEA Study]. / Anemia y fragilidad en ancianos españoles. Estudio FRADEA.

INTRODUCTION: The objective was to examine the prevalence of anemia according to the state of frailty and to analyze the relationship between anemia, hemoglobin concentration and frailty in a cohort of Spanish older adults. MATERIAL AND METHODS: Cross-sectional substudy of the FRADEA (Frailty and Dependency in Albacete) cohort, a population-based concurrent cohort study conducted in people older than 69 years of Albacete (Spain). Of the 993 participants included in the first wave, 790 were selected with valid data on anemia and frailty. Anemia was defined according to the criteria of the World Health Organization (hemoglobin less than 13 g/dL in men and 12 g/dL in women). Frailty was assessed using the Fried's phenotype. The association between anemia, hemoglobin concentration and frailty was determined by binary logistic regression adjusted for age, sex, educational level, institutionalization, comorbidity, cognitive status, body mass index, polypharmacy, creatinine, glucose and total white blood cell count. RESULTS: The mean age was 79 years. The prevalence of anemia was 19.6%. The prevalence of anemia was significantly higher in frail subjects (29.6%) compared to prefrail (16.6%) and robust ones (6%), p<0.001. The average hemoglobin concentrations were significantly lower in frail (12.7 g/dL), compared to the prefrail (13.5 g/dL) and robust participants (14.4 g/dL), p < 0.001. In the fully adjusted regression model, anemia was associated with frailty (OR 1.95; 95% CI: 1.02-3.73, p<0.05), and similarly, the average hemoglobin concentrations showed a significant association with frailty (OR 0.79; 95% CI: 0.66-0.96, p < 0.05). CONCLUSION: Anemia in older adults, defined according to WHO criteria, is independently associated with frailty.

Immunogenicity of the BNT162b2 vaccine in frail or disabled nursing home residents: COVID-A study.

BACKGROUND/OBJECTIVES: The safety and immunogenicity of the BNT162b2 coronavirus disease 2019 (COVID-19) vaccine in older adults with different frailty and disability profiles have not been well determined. Our objective was to analyze immunogenicity of the BNT162b2 mRNA COVID-19 vaccine in older adults across frailty and disability profiles. DESIGN: Multicenter longitudinal cohort study. SETTING AND PARTICIPANTS: A total of 134 residents aged ≥65 years with different frailty and disability profiles in five long-term care facilities (LTCFs) in Albacete, Spain. INTERVENTION AND MEASUREMENTS: Residents were administered two vaccine doses as per the label, and antibody levels were determined 21.9 days (SD 9.3) after both the first and second dose. Functional variables were assessed using activities of daily living (Barthel Index), and frailty status was determined with the FRAIL instrument. Cognitive status and comorbidity were also evaluated. RESULTS: Mean age was 82.9 years (range 65-99), and 71.6% were female. The mean antibody titers in residents with and without previous COVID-19 infection were 49,878 AU/ml and 15,274 AU/ml, respectively (mean difference 34,604; 95% confidence interval [CI]: 27,699-41,509). No severe adverse reactions were observed, after either vaccine dose. Those with prevaccination COVID-19 had an increased antibody level after the vaccine (B = 31,337; 95% CI: 22,725-39,950; p < 0.001). Frailty, disability, older age, sex, cognitive impairment, or comorbidities were not associated with different antibody titers. CONCLUSIONS: The BNT162b2 mRNA COVID-19 vaccine in older adults is safe and produces immunogenicity, independently of the frailty and disability profiles. Older adults in LTCFs should receive a COVID-19 vaccine.

La anemia aumenta el riesgo de mortalidad debido a fragilidad y discapacidad en mayores: Estudio FRADEA / Anemia increases mortality risk associated with frailty or disability in older adults. The FRADEA Study

OBJETIVO: Analizar si la presencia de anemia incrementa el riesgo de mortalidad a largo plazo asociado al estado de fragilidad y discapacidad en adultos mayores. DISEÑO: Subestudio de la cohorte concurrente de base poblacional FRADEA (Fragilidad y Dependencia en Albacete), con 10 años de seguimiento (2007-2017), en mayores de 69 años. EMPLAZAMIENTO: Albacete capital, España. PARTICIPANTES: De los 993 participantes incluidos en la primera oleada se seleccionaron 790 sujetos con datos válidos de función (fragilidad y discapacidad), anemia y estado vital a los 10 años. MEDICIONES PRINCIPALES: La anemia se definió según los criterios de la Organización Mundial de la Salud (hemoglobina < 13 g/dl en hombres y < 12 g/dl en mujeres). Se creó la variable «clasificación funcional» incluyendo fragilidad y discapacidad, e identificando cuatro niveles progresivos: robusto, prefrágil, frágil y con discapacidad en actividades básicas de la vida diaria, empleando el fenotipo de fragilidad e índice de Barthel, respectivamente. Se construyó una nueva variable de ocho categorías combinando las cuatro funcionales con la presencia o ausencia de anemia. La asociación con mortalidad se determinó mediante Kaplan-Meier y análisis de riesgos proporcionales de Cox ajustado por edad, sexo, comorbilidad, polifarmacia, institucionalización y creatinina. RESULTADOS: Edad media 79 años, siendo el 59,6% mujeres. Un total de 393 participantes (49,7%) fallecieron durante el periodo de seguimiento. La mediana de supervivencia fue de 98,4 meses (rango intercuartil 61). El riesgo de mortalidad aumentó desde los niveles con mejor clasificación funcional hasta aquellos con peor, y para cada subgrupo fue mayor en los participantes con anemia. Prefrágiles sin anemia hazard ratio (HR): 1,59, I C95%: 1,07-2,36, y con anemia HR: 2,37, IC 95%: 1,38-4,05. Frágiles sin anemia HR: 3,18, IC 95%: 1,68-6,02, y con anemia HR: 4,42, IC 95%: 1,99-9,84. Discapacitados sin anemia HR: 3,81, IC 95%: 2,45-5,84, y con anemia HR: 5,48, IC 95%: 3,43-8,76. CONCLUSIÓN: La anemia incrementa el riesgo de mortalidad asociado a la fragilidad y discapacidad en adultos mayores

OBJECTIVE: To analyze if anemia increases 10-year mortality risk associated to frailty and disability in older adults. DESIGN: Substudy of the FRADEA population-based concurrent cohort study (Frailty and dependence in Albacete), with a 10-year follow-up (2007-2017) in people older than 69 years. SETTING: Albacete city, Spain. PARTICIPANTS: Of the 993 participants included in the first wave, 790 were selected with valid data on function (frailty and disability), anemia and vital status at 10 years. MAIN MEASUREMENTS: Anemia was defined according to the criteria of the World Health Organization (hemoglobin < 13 g/dL in men and < 12 g/dL in women). A functional classification variable was created, including frailty and disability, identifying four progressive functional levels: robust, prefrail, frail and disabled in basic activities of daily life, using frailty phenotype and Barthel index respectively. A new eight categories variable was constructed combining the four functional groups with the presence or absence of anemia. The association with mortality was determined by Kaplan-Meier and Cox proportional hazards analysis adjusted for age, sex, comorbidity, polypharmacy, institutionalization and creatinine. RESULTS: Mean age was 79years and 59.6% were women. 393 participants (49.7%) died during the follow-up period. The median survival was 98.4months (interquartile range 61). The risk of mortality increased from the levels with better functionality to those with worse functionality, and for each subgroup it was higher in the participants with anemia. Prefrail without anemia HR [hazard ratio] 1.59 (95% CI 1.07-2.36) and with anemia HR 2.37 (95% CI 1.38-4.05). Frail without anemia HR 3.18 (95% CI 1.68-6.02) and with anemia HR 4.42 (95% CI 1.99-9.84). Disabled without anemia HR 3.81 (95%CI 2.45-5.84) and with anemia HR 5.48 (95% CI 3.43-8.76). CONCLUSION: Anemia increases the risk of mortality associated with frailty and disability in older adults

[Anemia increases mortality risk associated with frailty or disability in older adults. The FRADEA Study]. / La anemia aumenta el riesgo de mortalidad debido a fragilidad y discapacidad en mayores: Estudio FRADEA.

OBJECTIVE: To analyze if anemia increases 10-year mortality risk associated to frailty and disability in older adults. DESIGN: Substudy of the FRADEA population-based concurrent cohort study (Frailty and dependence in Albacete), with a 10-year follow-up (2007-2017) in people older than 69years. SETTING: Albacete city, Spain. PARTICIPANTS: Of the 993 participants included in the first wave, 790 were selected with valid data on function (frailty and disability), anemia and vital status at 10years. MAIN MEASUREMENTS: Anemia was defined according to the criteria of the World Health Organization (hemoglobin <13g/dL in men and <12g/dL in women). A functional classification variable was created, including frailty and disability, identifying four progressive functional levels: robust, prefrail, frail and disabled in basic activities of daily life, using frailty phenotype and Barthel index respectively. A new eight categories variable was constructed combining the four functional groups with the presence or absence of anemia. The association with mortality was determined by Kaplan-Meier and Cox proportional hazards analysis adjusted for age, sex, comorbidity, polypharmacy, institutionalization and creatinine. RESULTS: Mean age was 79years and 59.6% were women. 393 participants (49.7%) died during the follow-up period. The median survival was 98.4months (interquartile range 61). The risk of mortality increased from the levels with better functionality to those with worse functionality, and for each subgroup it was higher in the participants with anemia. Prefrail without anemia HR [hazard ratio] 1.59 (95%CI 1.07-2.36) and with anemia HR 2.37 (95%CI 1.38-4.05). Frail without anemia HR 3.18 (95%CI 1.68-6.02) and with anemia HR 4.42 (95%CI 1.99-9.84). Disabled without anemia HR 3.81 (95%CI 2.45-5.84) and with anemia HR 5.48 (95%CI 3.43-8.76). CONCLUSION: Anemia increases the risk of mortality associated with frailty and disability in older adults.

Valores normativos de instrumentos de valoración funcional en ancianos españoles: estudio FRADEA / Normal data of functional assessment tools of the elderly in Spain: The FRADEA Study

Objetivo: Determinar los valores normativos de algunos de los diferentes instrumentos de valoración funcional más usados en España. Diseño: Estudio transversal del primer corte de una cohorte concurrente de base poblacional. Emplazamiento: Área de salud de Albacete capital. Participantes: 993 sujetos con edad igual o mayor a 70 años participantes en la cohorte FRADEA. Mediciones principales: Se recogieron cuestionarios de discapacidad y función, Barthel, Lawton e Instrumento Abreviado de Discapacidad y Función en la Edad Avanzada (SF-LLFDI), escala de deambulación de Holden (FAC), y pruebas de ejecución: velocidad de marcha (m/s), levántese y ande cronometrado (TUG) (s), tiempo de equilibrio unipodal (s), sentarse y levantarse 5 veces de una silla cronometrado (5STS) (s), Short Physical Performance Battery (SPPB), fuerza prensora (kg), y fuerza flexora codo (kg). Se describen medias, cuartiles y percentiles en la cohorte global, y en los subgrupos de hombres y mujeres con edad entre 70 y 79 o igual o mayor a 80 años. Resultados: Los cuartiles de los diferentes instrumentos fueron respectivamente Barthel (80, 95, 100), Lawton (3, 6, 8), SF-LLFDI (70, 111, 131), FAC (4, 5, 5), velocidad de marcha (0,51, 0,79, 1,00), TUG (13,8, 11,4, 9,8), tiempo de equilibrio unipodal (3, 7, 15), 5STS (16,3, 13,0, 10,7), SPPB (7, 9, 11), fuerza prensora (15, 20, 29), y fuerza flexora de codo (11, 20, 32). Los más jóvenes, los hombres y los residentes en la comunidad, presentaron mejores rendimientos en todos los instrumentos. Conclusiones: Se presentan los valores normativos de diferentes instrumentos de valoración funcional de una cohorte de ancianos de Albacete de base poblacional. Éstos pueden ser útiles para su empleo en clínica o en investigación(AU)

Objective: To determine the normal values of some of the functional assessment tools most used in Spain. Design: Cross-sectional study of the first cut of a concurrent population based cohort. Setting: Albacete city Health Area. Participants: A total of 993 subjects aged 70 years or over and participants in the FRADEA (Frailty and dependence in Albacete, Spain) cohort. Main measurements: An analysis was made of disability and function questionnaires, which included, Barthel, Lawton and Short Form of the Late-Life Function and Disability Instrument (SF-LLFDI), Holden's Functional Ambulation Category (FAC), and functional tests: walking speed (m/s), Timed Up and Go (TUG) (sec), one-leg balance time (sec), timed 5 Times Sit to Stand Test (5STS) (seg), Short Physical Performance Battery (SPPB), grip strength (kg), and elbow flexion strength (kg). The means, quartiles and percentiles are described, in the global cohort and in the male and female sub-groups aged between 70 and 79 years or aged 80 years or over. Results: The quartiles of the different instruments were as follow: Barthel (80, 95, 100), Lawton (3, 6,8), SF-LLFDI (70, 111, 131), FAC (4, 5, 5), walking speed (0.51, 0.79, 1.00), TUG (13.8, 11.4, 9.8), one-leg balance time (3, 7, 15), 5STS (16.3, 13.0, 10.7), SPPB (7, 9, 11), grip strength (15, 20, 29), and elbow flexion strength (11, 20, 32). The younger ones, males and those living within the community showed a better performance in all the instruments. Conclusions: The normal values of a cohort of the elderly population based in Albacete using different functional assessment instruments are presented. These could be useful in clinical practice or research(AU)

[Normal data of functional assessment tools of the elderly in Spain: the FRADEA study]. / Valores normativos de instrumentos de valoración funcional en ancianos españoles: estudio FRADEA.

OBJECTIVE: To determine the normal values of some of the functional assessment tools most used in Spain. DESIGN: Cross-sectional study of the first cut of a concurrent population based cohort. SETTING: Albacete city Health Area. PARTICIPANTS: A total of 993 subjects aged 70 years or over and participants in the FRADEA (Frailty and dependence in Albacete, Spain) cohort. MAIN MEASUREMENTS: An analysis was made of disability and function questionnaires, which included, Barthel, Lawton and Short Form of the Late-Life Function and Disability Instrument (SF-LLFDI), Holden's Functional Ambulation Category (FAC), and functional tests: walking speed (m/s), Timed Up and Go (TUG) (sec), one-leg balance time (sec), timed 5 Times Sit to Stand Test (5STS) (seg), Short Physical Performance Battery (SPPB), grip strength (kg), and elbow flexion strength (kg). The means, quartiles and percentiles are described, in the global cohort and in the male and female sub-groups aged between 70 and 79 years or aged 80 years or over. RESULTS: The quartiles of the different instruments were as follow: Barthel (80, 95, 100), Lawton (3, 6,8), SF-LLFDI (70, 111, 131), FAC (4, 5, 5), walking speed (0.51, 0.79, 1.00), TUG (13.8, 11.4, 9.8), one-leg balance time (3, 7, 15), 5STS (16.3, 13.0, 10.7), SPPB (7, 9, 11), grip strength (15, 20, 29), and elbow flexion strength (11, 20, 32). The younger ones, males and those living within the community showed a better performance in all the instruments. CONCLUSIONS: The normal values of a cohort of the elderly population based in Albacete using different functional assessment instruments are presented. These could be useful in clinical practice or research.

Fragilidad y dependencia en Albacete (estudio FRADEA): razonamiento, diseño y metodología / Frailty and dependence in Albacete (FRADEA study): reasoning, design and methodology

Objetivo. Obtener una cohorte de sujetos con edad igual o mayor a 70 años, representativa de una población urbana española, para estimar la prevalencia de fragilidad y seguirla en el tiempo para analizar factores asociados. Material y métodos. Estudio de cohortes concurrente de base poblacional. Sobre un universo de 18.137 ancianos, se realizó un muestreo aleatorio estratificado para obtener una muestra representativa de 1.172. Aceptaron participar 993 personas (84,7%). Se recogieron variables sociodemográficas, de comorbilidad, funcionales (n=825), cognitivas, afectivas y de calidad de vida. A los sujetos que aceptaron se les determinó la composición corporal por bioimpedanciometría (n=557), el gasto energético basal por calorimetría indirecta (n=450) y se obtuvo muestra de sangre para la determinación de biomarcadores (n=859). La fragilidad se definió por la presencia de 3 o más de los criterios Fried: pérdida de peso no intencionada, baja fuerza, cansancio, lentitud al caminar y baja actividad física. La cohorte será seguida en el tiempo hasta el fallecimiento de los sujetos. Resultados. Edad media±desviación estándar 79,4±6,4 años, con 601 (60,5%) mujeres. Institucionalizados el 21,3%. Fueron frágiles el 16,9%, prefrágiles 48,5%, no frágiles 21,8%, y no se dispuso de 3 criterios para poder determinar su estado en el 12,8%, de los cuales el 9,5% tenía una discapacidad moderada-severa, por lo que la prevalencia de fragilidad podría aumentar hasta el 26,4%. Conclusiones. Se ha construido la cohorte FRADEA, representativa de los mayores de una población urbana de España. La prevalencia de fragilidad en la cohorte fue del 16,9%(AU)

Objective. To obtain a cohort of subjects of equal to or greater than 70 years, representative of a Spanish urban population, to estimate the prevalence of frailty and follow it up over time to analyse associated factors. Material and methods. A prospective, population-based cohort study. From a population of 18,137 elderly persons, a representative sample of 1172 was randomly stratified, of which 993 (84.7%) agreed to take part. The variables collected were; sociodemographic, comorbidity, functional (n=825), cognitive, affective and quality of life. On the patients who agreed, body composition was determined by bioimpedance analysis (n=557), basal metabolic rate by indirect calorimetry (n=450) and a blood sample was obtained for biomarkers (n=859). Frailty was defined by the presence of 3 or more Fried criteria: unintentional weight loss, low energy, exhaustion, slow walking, and low physical activity. The cohort will be followed up over time until the death of the subjects. Results. Mean age 79.4 (SD 6.4) years, with 601 (60.5%) women. A total of 21.3% were institutionalised; 16.9% were frail, 48.5% pre-frail, 21.3% non-frail, and 12.8% did not have the 3 criteria to be able to determine their state, of which 9.5% had moderate-severe incapacity, which would increase the prevalence of frailty to 26.4%. Conclusions. A FRADEA cohort has been constructed, representative of an urban population in Spain. The prevalence of frailty in the cohort was 16.9%(AU)

[Frailty and dependence in Albacete (FRADEA study): reasoning, design and methodology]. / Fragilidad y dependencia en Albacete (estudio FRADEA): razonamiento, diseño y metodología.

OBJECTIVE: To obtain a cohort of subjects of equal to or greater than 70 years, representative of a Spanish urban population, to estimate the prevalence of frailty and follow it up over time to analyse associated factors. MATERIAL AND METHODS: A prospective, population-based cohort study. From a population of 18,137 elderly persons, a representative sample of 1172 was randomly stratified, of which 993 (84.7%) agreed to take part. The variables collected were; sociodemographic, comorbidity, functional (n=825), cognitive, affective and quality of life. On the patients who agreed, body composition was determined by bioimpedance analysis (n=557), basal metabolic rate by indirect calorimetry (n=450) and a blood sample was obtained for biomarkers (n=859). Frailty was defined by the presence of 3 or more Fried criteria: unintentional weight loss, low energy, exhaustion, slow walking, and low physical activity. The cohort will be followed up over time until the death of the subjects. RESULTS: Mean age 79.4 (SD 6.4) years, with 601 (60.5%) women. A total of 21.3% were institutionalised; 16.9% were frail, 48.5% pre-frail, 21.3% non-frail, and 12.8% did not have the 3 criteria to be able to determine their state, of which 9.5% had moderate-severe incapacity, which would increase the prevalence of frailty to 26.4%. CONCLUSIONS: A FRADEA cohort has been constructed, representative of an urban population in Spain. The prevalence of frailty in the cohort was 16.9%.