Psychological and Functional Impact of COVID-19 in Long-Term Care Facilities: The COVID-A Study.

OBJECTIVE: To analyze the psychological and functional sequelae of the COVID-19 pandemic among older adults living in long term care facilities (LTCFs). DESIGN: Cohort longitudinal study SETTING ANT PARTICIPANTS: A total of 215 residents ≥ 65 years without moderate-to-severe cognitive impairment, living in five LTCFs in Albacete (Spain). MEASUREMENTS: Baseline on-site data were collected between March - June 2020 and three-month follow-up between June to September 2020. Symptoms of depression, anxiety, posttraumatic stress disorder (PTSD), and sleep disturbances were measured as psychological variables. Disability in basic activities of daily living (BADL), ambulation and frailty were assessed as functional variables. Differences were analyzed in relation to level of comorbidity and test positivity for COVID-19. RESULTS: At baseline, residents with COVID-19 presented worse functionality, higher frailty levels and malnutrition risk compared to non-COVID-19 residents. At three-month follow-up, higher rates of clinically significant depressive symptoms (57.7%), anxiety symptoms (29.3%), PTSD symptoms (19.1%) and sleep disturbances (93.0%) were found among residents regardless of COVID status. Thus, among 215 residents, 101 (47%) experienced a decline in BADL from baseline to the 3-month follow-up (median functional loss = 5 points in Barthel Index). In multivariate analyses, COVID-19 status did not explain either the functional or the ambulation loss. By contrast, residents with low comorbidity and COVID-19 presented higher PTSD symptoms (effect 2.58; 95% CI 0.93 to 4.23) and anxiety symptoms (effect 2.10; 95% CI 0.48 to 3.73) compared to the low comorbidity/non-COVID19 group. CONCLUSION: COVID-19 pandemic was associated, after three-months, with high psychological impact in older adults in LTCFs., specifically with higher post-traumatic stress and anxiety symptoms. Functional decline did not differ in relation to COVID-19 status but could be related to isolation strategies used for pandemic control.

Validity and usefulness of hand-held dynamometry for measuring muscle strength in community-dwelling older persons.

The aim was to determine the validity and usefulness of hand-held dynamometry for measuring muscle strength in independent community-dwelling older persons. Cross-sectional study was performed in 281 subjects aged over 65, mean age of 74.3 years. The strength of six muscle groups was measured in three consecutive attempts using JAMAR hand-held dynamometers. Individual values, maximums and means, intra- and inter-individual variability, test-retest reliability and concurrent validity with functional tests are described. The main results were: strength increased with each attempt for all muscle groups, suggesting technique learning, except for pinch and grip, suggesting muscle fatigability. Relative intra- and inter-individual variability was higher in women; it was lower for the pinch and grip strength. Test-retest reliability was very good and concurrent validity with functional tests was good. We conclude that hand-held dynamometry is valid and useful for determining functionality. It is recommended to perform three attempts for all strength measurements, except for pinch and grip, in which one is sufficient.

Evaluación de la comorbilidad en la población anciana: utilidad y validez de los instrumentos de medida / Comorbidity in the elderly: utility and validity of assessment tools

La comorbilidad es un problema frecuente en ancianos que contribuye a la complejidad de este grupo poblacional y supone un factor de riesgo de eventos adversos de salud (deterioro funcional, discapacidad, dependencia, institucionalización, hospitalización, mala calidad de vida y muerte), aunque no el principal. La comorbilidad entendida como una compilación de enfermedades no es la principal característica que define la población que debe ser atendida por un geriatra. La edad y el riesgo de declinar funcional deben primar sobre otras características. Los índices de comorbilidad en ancianos no deben ser interpretados de manera aislada, sino en un contexto de valoración integral que incluya disfunciones preclínicas asociadas al envejecimiento, a las medidas de fragilidad, a los aspectos funcionales, mentales y psicosociales. El manejo clínico de la comorbilidad en ancianos requiere conocimientos avanzados en Geriatría, puesto que el tratamiento de varias condiciones puede empeorar otras o hacer aparecer nuevas y porque las disfunciones fisiológicas preclínicas modulan la respuesta a los fármacos. Aunque recomendar un índice de comorbilidad en particular es complejo y depende de numerosas variables, por sus características psicométricas, su aplicabilidad en ancianos y su constructo, la Cumulative Illness Rating Scale en su versión adaptada a ancianos podría ser el más recomendable. Otros, como el índice de Charlson, el Index of CoExistent Disease y el índice de Kaplan, son también métodos válidos y reproducibles(AU)

Comorbidity is common in the elderly and contributes to the complexity of this population subgroup. This problem is a risk factor for major adverse events such as functional decline, disability, dependency, poor quality-of-life, institutionalization, hospitalization and death, but is not the most important factor. Age and risk of functional decline rather than comorbidity (understood as a compilation of diseases) are the main characteristics defining the target population attended by geriatricians. Comorbidity indexes should not be interpreted independently in the elderly, but within a context of comprehensive geriatric assessment that includes age-related preclinical dysfunctions, frailty measures, and functional, mental and psychosocial issues. The clinical management of comorbidity in the elderly requires advanced knowledge of geriatrics because the treatment of one condition may worsen or lead to the development of others and because preclinical physiological dysfunctions modulate drug response. Recommending a specific comorbidity index is difficult and depends on multiple factors, due to their psychometric characteristics, applicability in the elderly and their construct. However, the Cumulative Illness Rating Scale, in the version adapted to the elderly, could be highly suitable. Other instruments, such as the Charlson index, the Index of CoExistent Disease and the Kaplan index are also valid and reproducible(AU)

Aterosclerosis subclínica, un predictor de limitación funcional al año en ancianos con alto nivel funcional: estudio Albacete / Subclinial atherosclerosis as a predictor of functional limitation at one year in high-functioning older adults: the Albacete study

IntroducciónLa aterosclerosis subclínica se ha asociado con morbimortalidad cardiovascular, pero no se ha analizado su relación con limitación funcional como antesala de la discapacidad.Material y métodosEstudio longitudinal sobre 171 mayores de 64 años con alto nivel funcional. Edad media 73,7 años, 110 mujeres. Se les realizó eco-Doppler carotídeo al inicio del estudio determinando la presencia de placas y la suma del diámetro axial máximo de todas las placas (SDP) y fueron seguidos 12 meses. Analizamos la asociación entre aterosclerosis subclínica y limitación funcional valorada con el timed up and go (TUG) al año, ajustada por covariables sociodemográficas, funcionales, afectivas, cognitivas y factores de riesgo cardiovascular.ResultadosTreinta y siete sujetos (21,6%) realizaron el TUG un 20% más lentamente al año que al inicio, 30 con placa (30,7%) y 7 sin placa (9,5%) (p=0,001). Aquellos con placa tuvieron un mayor riesgo ajustado de enlentecer el TUG más del 20% que aquéllos sin placa (OR: 5,8; IC del 95%: 2,2–15,8). Los que enlentecieron el TUG más del 20% tuvieron una SDP 1,48mm mayor (3,34 vs. 1,85; IC del 95%: 0,52–2,44). Por cada aumento de 2mm en la SDP, los sujetos tuvieron un riesgo ajustado 1,9 veces mayor de realizar el TUG más lentamente al año (IC del 95%: 1,4–2,5).ConclusiónLa aterosclerosis subclínica es un predictor independiente de limitación funcional al año en ancianos con alto nivel funcional(AU)

IntroductionSubclinical atherosclerosis is associated with cardiovascular morbidity and mortality, but its relationship with functional limitation as a precursor of disability has not been determined.Material and methodsA longitudinal cohort study was performed in 171 high-functioning community-dwelling adults aged more than 64 years old (mean age 73.7 years, 110 women). All received a carotid ultrasound examination at the beginning of the study. Subclinical atherosclerosis was determined by the presence or absence of atherosclerotic plaques and the sum of the diameters of all the plaques (SDP) in the carotid bilateral tree. Subjects were followed-up at 12 months. The association between subclinical atherosclerosis and functional limitation was assessed with the Timed Up and Go test (TUG) at entry and at 1 year, adjusted by demographic, functional, affective, cognitive and cardiovascular risk factors as covariables.ResultsAt 1 year after baseline, 37 subjects (21.6%) performed the TUG 20% more slowly: 30 with plaque (30.7%) and seven without plaque (9.5%) (p=0.001). Those with plaque had an adjusted increased risk of performing the TUG 20% more slowly than those without plaque [OR 5.5, 95% CI 2.2–15.8]. SDP was 1.48mm greater in subjects with more than 20% slowing on the TUG [3.34 vs 1.85; 95% CI 0.52–2.44]. For each 2-mm increment in the SDP, subjects had a 1.9-fold greater adjusted risk of performing the TUG 20% more slowly at 1 year [95% CI 1.4–2.5].ConclusionSubclinical atherosclerosis is an independent predictor of functional limitation at 1 year in high-functioning older adults(AU)

Cardiovascular risk factors are associated with subclinical atherosclerosis in high functioning older adults.

BACKGROUND: The prevalence of subclinical atherosclerosis and its relationship with cardiovascular risk factors (CVRFs) is not well known in high functioning older adults. These data can help to decide if the implementation of preventive measures is necessary in this population. OBJECTIVE: To determine the prevalence and progression of subclinical atherosclerosis in high functioning older adults, the relationship between subclinical atherosclerosis and CVRFs, and the influence of the CVRFs on subclinical atherosclerosis progression. METHODS: Longitudinal cohort study. 246 high functioning older adults without clinical atherosclerotic disease. All subjects underwent carotid Doppler ultrasound at entry and 176 at 24 months. RESULTS: Plaque was observed in 146 (59.3%) subjects at baseline. CVRFs showed a linear relationship to the presence of plaque: plaque was observed in 32% of subjects with no CVRFs, 54.2% with 1 factor, 61.6% with 2 factors, and 69.3% with 3 or more (p=.001). Only hypertension was independently associated with the presence of plaque (OR 2.0; 95% CI 1.2-3.6; p=.013), adjusted for CVRFs. At 24 months, new plaque was observed in 20 (11.4%) subjects and carotid intima-media thickness had increased 0.02 mm per year. Subjects with plaque at baseline had a higher risk of greater total carotid plaque diameter at 2 years (OR 58.0; 95% CI, 19.7-170.5; p<.001), adjusted for all other CVRFs. CONCLUSIONS: Subclinical atherosclerosis is common in high functioning older adults and is associated with the classic CVRFs. Controlling these factors could be helpful in reducing atherosclerosis in older patients.

[Comorbidity in the elderly: utility and validity of assessment tools]. / Evaluación de la comorbilidad en la población anciana: utilidad y validez de los instrumentos de medida.

Comorbidity is common in the elderly and contributes to the complexity of this population subgroup. This problem is a risk factor for major adverse events such as functional decline, disability, dependency, poor quality-of-life, institutionalization, hospitalization and death, but is not the most important factor. Age and risk of functional decline rather than comorbidity (understood as a compilation of diseases) are the main characteristics defining the target population attended by geriatricians. Comorbidity indexes should not be interpreted independently in the elderly, but within a context of comprehensive geriatric assessment that includes age-related preclinical dysfunctions, frailty measures, and functional, mental and psychosocial issues. The clinical management of comorbidity in the elderly requires advanced knowledge of geriatrics because the treatment of one condition may worsen or lead to the development of others and because preclinical physiological dysfunctions modulate drug response. Recommending a specific comorbidity index is difficult and depends on multiple factors, due to their psychometric characteristics, applicability in the elderly and their construct. However, the Cumulative Illness Rating Scale, in the version adapted to the elderly, could be highly suitable. Other instruments, such as the Charlson index, the Index of CoExistent Disease and the Kaplan index are also valid and reproducible.

[Subclinial atherosclerosis as a predictor of functional limitation at one year in high-functioning older adults: the Albacete study]. / Aterosclerosis subclínica, un predictor de limitación funcional al año en ancianos con alto nivel funcional: estudio Albacete.

INTRODUCTION: Subclinical atherosclerosis is associated with cardiovascular morbidity and mortality, but its relationship with functional limitation as a precursor of disability has not been determined. MATERIAL AND METHODS: A longitudinal cohort study was performed in 171 high-functioning community-dwelling adults aged more than 64 years old (mean age 73.7 years, 110 women). All received a carotid ultrasound examination at the beginning of the study. Subclinical atherosclerosis was determined by the presence or absence of atherosclerotic plaques and the sum of the diameters of all the plaques (SDP) in the carotid bilateral tree. Subjects were followed-up at 12 months. The association between subclinical atherosclerosis and functional limitation was assessed with the Timed Up and Go test (TUG) at entry and at 1 year, adjusted by demographic, functional, affective, cognitive and cardiovascular risk factors as covariables. RESULTS: At 1 year after baseline, 37 subjects (21.6%) performed the TUG 20% more slowly: 30 with plaque (30.7%) and seven without plaque (9.5%) (p=0.001). Those with plaque had an adjusted increased risk of performing the TUG 20% more slowly than those without plaque [OR 5.5, 95% CI 2.2-15.8]. SDP was 1.48 mm greater in subjects with more than 20% slowing on the TUG [3.34 vs 1.85; 95% CI 0.52-2.44]. For each 2-mm increment in the SDP, subjects had a 1.9-fold greater adjusted risk of performing the TUG 20% more slowly at 1 year [95% CI 1.4-2.5]. CONCLUSION: Subclinical atherosclerosis is an independent predictor of functional limitation at 1 year in high-functioning older adults.

Síntomas psicológicos y conductuales en deterioro cognitivo leve y enfermedad de Alzheimer / Neuropsychiatric symptoms in mild cognitive impairment and Alzheimer's disease

IntroducciónAnalizar la distribución de los síntomas psicológicos y conductuales de la demencia (SPCD) en mayores con enfermedad de Alzheimer (EA) y deterioro cognitivo leve (DCL) y su utilidad en el diagnóstico diferencial de ambas entidades.Material y métodosCiento setenta y nueve mayores de 64 años diagnosticados de DCL (n = 90) o EA (n = 89), estadio de la Global Deterioration Scale 4 o 5. Se determinaron los SPCD con la escala Neuropsychiatric Inventory. Se describe la prevalencia de los síntomas en cada grupo y se determina el riesgo que supone el presentar cada uno de los SPCD para que un paciente sea diagnosticado de EA en lugar de DCL.ResultadosSesenta y siete pacientes con DCL (74,4%) y 82 con EA (92,1%) presentaron algún SPCD (p<0,01) siendo los más prevalentes la depresión y la apatía en ambos grupos. La media de SPCD fue de 2,1 en los DCL y de 3,2 en los EA y fueron más frecuentes en pacientes con mayores lesiones isquémicas de sustancia blanca (LISB) (p<0,05). La presencia de algún SPCD aumentó el riesgo de que los pacientes fueran diagnosticados de EA en lugar de DCL (odds ratio [OR] de 3,6; intervalo de confianza [IC] del 95%: 1,4–5,7; p<0,01) tras ajustar por edad, sexo, Mini-Mental State Examination y LISB. Los SPCD asociados independientemente al diagnóstico de EA fueron los delirios (OR de 4,9; IC del 95%: 1,3–18,6; p<0,05), la apatía (OR de 2,5; IC del 95%: 1,3–4,7; p<0,01), la desinhibición (OR de 3,1; IC del 95%: 1,5–6,4; p<0,01) y las conductas motoras sin finalidad (OR de 6,3; IC del 95%: 1,7–23,4; p<0,01).ConclusionesLos SPCD son frecuentes en mayores con DCL y EA leve-moderada y pueden ayudar a diferenciar entre estas dos patologías(AU)

Material and methodsA total of 179 subjects, aged more than 64 years old, with either MCI (n=90) or AD (n=89) and Global Deterioration Scale stage 4-5 were studied. NPS were assessed using the Neuropsychiatric Inventory scale. We identified the prevalence of the symptoms in each group and determined the risk conferred by each symptom to the differential diagnosis between the two entities.ResultsSixty-seven patients with MCI (74.4%) and 82 with AD (92.1%) showed at least one NPS (p<0.01), the most prevalent being depression and apathy in both groups. The mean number of NPS was 2.1 in MCI and 3.2 in AD. NPS were more frequent in patients with more white matter ischemic lesions (WMIL) (p<0.05). The presence of at least one NPS increased the risk of being diagnosed with AD rather than MCI (odds ratio [OR] 3.6: 95% confidence interval [CI] 1.4–5.7; p<0.01) adjusted by age, sex, Mini-Mental State Examination and WMIL. The NPS independently associated with a diagnosis of AD were delusions (OR 4.9; 95% CI 1.3–18.6; p<0.05), apathy (OR 2.5; 95% CI 1.3–4.7 p<0.01), disinhibition (OR 3.1; 95% CI 1.5–6.4; p<0.01) and aberrant motor behavior (OR 6.3; 95% CI 1.7–23.4; p<0.01).ConclusionsNPS are frequent in elderly individuals with MCI and mild-moderate AD and may help to differentiate between these two entities(AU9

Síntomas psicológicos y conductuales en deterioro cognitivo leve y enfermedad de Alzheimer / Neuropsychiatric symptoms in mild cognitive impairment and Alzheimer's disease

IntroducciónAnalizar la distribución de los síntomas psicológicos y conductuales de la demencia (SPCD) en mayores con enfermedad de Alzheimer (EA) y deterioro cognitivo leve (DCL) y su utilidad en el diagnóstico diferencial de ambas entidades.Material y métodosCiento setenta y nueve mayores de 64 años diagnosticados de DCL (n = 90) o EA (n = 89), estadio de la Global Deterioration Scale 4 o 5. Se determinaron los SPCD con la escala Neuropsychiatric Inventory. Se describe la prevalencia de los síntomas en cada grupo y se determina el riesgo que supone el presentar cada uno de los SPCD para que un paciente sea diagnosticado de EA en lugar de DCL.ResultadosSesenta y siete pacientes con DCL (74,4%) y 82 con EA (92,1%) presentaron algún SPCD (p<0,01) siendo los más prevalentes la depresión y la apatía en ambos grupos. La media de SPCD fue de 2,1 en los DCL y de 3,2 en los EA y fueron más frecuentes en pacientes con mayores lesiones isquémicas de sustancia blanca (LISB) (p<0,05). La presencia de algún SPCD aumentó el riesgo de que los pacientes fueran diagnosticados de EA en lugar de DCL (odds ratio [OR] de 3,6; intervalo de confianza [IC] del 95%: 1,4–5,7; p<0,01) tras ajustar por edad, sexo, Mini-Mental State Examination y LISB. Los SPCD asociados independientemente al diagnóstico de EA fueron los delirios (OR de 4,9; IC del 95%: 1,3–18,6; p<0,05), la apatía (OR de 2,5; IC del 95%: 1,3–4,7; p<0,01), la desinhibición (OR de 3,1; IC del 95%: 1,5–6,4; p<0,01) y las conductas motoras sin finalidad (OR de 6,3; IC del 95%: 1,7–23,4; p<0,01).ConclusionesLos SPCD son frecuentes en mayores con DCL y EA leve-moderada y pueden ayudar a diferenciar entre estas dos patologías(AU)

Material and methodsA total of 179 subjects, aged more than 64 years old, with either MCI (n=90) or AD (n=89) and Global Deterioration Scale stage 4-5 were studied. NPS were assessed using the Neuropsychiatric Inventory scale. We identified the prevalence of the symptoms in each group and determined the risk conferred by each symptom to the differential diagnosis between the two entities.ResultsSixty-seven patients with MCI (74.4%) and 82 with AD (92.1%) showed at least one NPS (p<0.01), the most prevalent being depression and apathy in both groups. The mean number of NPS was 2.1 in MCI and 3.2 in AD. NPS were more frequent in patients with more white matter ischemic lesions (WMIL) (p<0.05). The presence of at least one NPS increased the risk of being diagnosed with AD rather than MCI (odds ratio [OR] 3.6: 95% confidence interval [CI] 1.4–5.7; p<0.01) adjusted by age, sex, Mini-Mental State Examination and WMIL. The NPS independently associated with a diagnosis of AD were delusions (OR 4.9; 95% CI 1.3–18.6; p<0.05), apathy (OR 2.5; 95% CI 1.3–4.7 p<0.01), disinhibition (OR 3.1; 95% CI 1.5–6.4; p<0.01) and aberrant motor behavior (OR 6.3; 95% CI 1.7–23.4; p<0.01).ConclusionsNPS are frequent in elderly individuals with MCI and mild-moderate AD and may help to differentiate between these two entities(AU)

[Neuropsychiatric symptoms in mild cognitive impairment and Alzheimer's disease]. / Síntomas psicológicos y conductuales en deterioro cognitivo leve y enfermedad de Alzheimer.

INTRODUCTION: To describe the neuropsychiatric symptoms (NPS) in elderly patients with either mild cognitive impairment (MCI) or Alzheimer's disease (AD) and their relevance in the differential diagnosis between the two entities. MATERIAL AND METHODS: A total of 179 subjects, aged more than 64 years old, with either MCI (n=90) or AD (n=89) and Global Deterioration Scale stage 4-5 were studied. NPS were assessed using the Neuropsychiatric Inventory scale. We identified the prevalence of the symptoms in each group and determined the risk conferred by each symptom to the differential diagnosis between the two entities. RESULTS: Sixty-seven patients with MCI (74.4%) and 82 with AD (92.1%) showed at least one NPS (p<0.01), the most prevalent being depression and apathy in both groups. The mean number of NPS was 2.1 in MCI and 3.2 in AD. NPS were more frequent in patients with more white matter ischemic lesions (WMIL) (p<0.05). The presence of at least one NPS increased the risk of being diagnosed with AD rather than MCI (odds ratio [OR] 3.6: 95% confidence interval [CI] 1.4-5.7; p<0.01) adjusted by age, sex, Mini-Mental State Examination and WMIL. The NPS independently associated with a diagnosis of AD were delusions (OR 4.9; 95% CI 1.3-18.6; p<0.05), apathy (OR 2.5; 95% CI 1.3-4.7 p<0.01), disinhibition (OR 3.1; 95% CI 1.5-6.4; p<0.01) and aberrant motor behavior (OR 6.3; 95% CI 1.7-23.4; p<0.01). CONCLUSIONS: NPS are frequent in elderly individuals with MCI and mild-moderate AD and may help to differentiate between these two entities.