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1.
Maturitas ; 142: 8-10, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33158491

RESUMO

Targeting older at-risk patients with decision-making algorithms is a priority at a time when hospitals are receiving an influx of Covid-19 patients that may exceed their capacity. Such screening could likely be extended to primary care settings in order to identify older community dwellers with Covid-19, but also those experiencing the adverse consequences of prolonged home confinement. The Centre of Excellence on Longevity of McGill University (Quebec, Canada) designed a short assessment for Montreal's housebound community-dwelling older adults. It acts as the first step in connecting older community dwellers who are housebound during the Covid-19 outbreak to telemedicine.


Assuntos
Infecções por Coronavirus , Avaliação Geriátrica , Pacientes Domiciliares , Pandemias , Pneumonia Viral , Atenção Primária à Saúde/métodos , Telemedicina , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Hospitais , Humanos , Quebeque
3.
Rev Med Suisse ; 16(714): 2156-2159, 2020 Nov 11.
Artigo em Francês | MEDLINE | ID: mdl-33174696

RESUMO

The older population is heterogenous: at the same age, elderly patients can be robust, frail or dependent. Screening decisions must be individualized, taking into account the remaining life expectancy, the Time to Benefit (TTB: delay until preventive care gives a benefit), and patient preferences. Thus, robust patients, who have a longer life expectancy, can still benefit from some screening tests over age 75 that are inappropriate in vulnerable or dependent patients whose life expectancy is shorter than the TTB. Discussing life expectancy issues remains difficult outside of crises but medical encounters are unique opportunities to inquire about individual preferences and expectations, in order to define care objectives and discuss advanced care planning.


Assuntos
Avaliação Geriátrica/métodos , Expectativa de Vida , Programas de Rastreamento , Idoso , Humanos , Planejamento de Assistência ao Paciente , Preferência do Paciente
4.
Rev Med Suisse ; 16(714): 2160-2164, 2020 Nov 11.
Artigo em Francês | MEDLINE | ID: mdl-33174697

RESUMO

What are the criteria for admitting an elderly polymorbid patient to intensive care ? The multidimensional geriatric evaluation is a tool to screen for geriatric syndromes, with the division of elderly patients into 3 categories: robust, vulnerable and dependent. Targeting certain co-morbidities such as cognitive disorders, delirium, frailty, polymedication and malnutrition, allows clinicians to estimate the risks of mortality and functional and cognitive handicaps during a stay in intensive care. Based on a review of the literature, this article offers some guidelines for triage of older patients for admission to intensive care, using an ethical, multidisciplinary approach that takes into account the patient's fears and preferences.


Assuntos
Cuidados Críticos/estatística & dados numéricos , Idoso Fragilizado , Fragilidade/diagnóstico , Avaliação Geriátrica , Idoso , Transtornos Cognitivos/diagnóstico , Delírio/diagnóstico , Idoso Fragilizado/psicologia , Humanos , Desnutrição/diagnóstico
5.
BMJ Open ; 10(10): e040341, 2020 10 13.
Artigo em Inglês | MEDLINE | ID: mdl-33051236

RESUMO

INTRODUCTION: Local activities that functioned to prevent frailty in the elderly have been suspended or reduced as a countermeasure against COVID-19. As a result, frailty rates are expected to increase, and frailty is expected to worsen as a secondary problem associated with COVID-19 countermeasures. Therefore, this study aims to determine the extent of frailty in the elderly associated with lifestyle changes implemented as COVID-19 countermeasures, to ascertain actual lifestyle changes and clarify the existence of Corona-Frailty. We will also conduct Corona-Frailty screening to verify the effect of support provided as feedback to supporters of the elderly. METHODS AND ANALYSIS: The survey target area is Takasaki City, Gunma Prefecture, Japan. Phase I aims to verify the short-term effects of COVID-19. A questionnaire will be distributed to 465 community-dwelling elderly people, and responses will be obtained by post. Frailty will be evaluated using the Frailty Screening Index. Respondents who are frail and have had many changes in their lifestyle will be screened as high-risk people, and feedback will be provided to local supporters. The aim of Phase II will be to verify the long-term effects of COVID-19 and the effect of screening. A similar survey will be distributed twice after the first survey, once after 6 months and again after 1 year and the frailty rate will be tested. Furthermore, out of the subjects identified with frailty in Phase I, the progress of those who were screened and those who were not screened will be compared between groups. ETHICS AND DISSEMINATION: This study has been approved by the Research Ethics Committee of the Takasaki University of Health and Welfare (approval number: 2009). The results of this study will be reported to the policymaker, presented at academic conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: UMIN000040335.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Idoso Fragilizado/estatística & dados numéricos , Fragilidade/epidemiologia , Avaliação Geriátrica/métodos , Vida Independente/estatística & dados numéricos , Estilo de Vida , Pneumonia Viral/epidemiologia , Atividades Cotidianas , Idoso , Envelhecimento/fisiologia , Comorbidade , Estudos Transversais , Feminino , Humanos , Masculino , Pandemias , Inquéritos e Questionários
6.
Arch Osteoporos ; 15(1): 166, 2020 10 20.
Artigo em Inglês | MEDLINE | ID: mdl-33079259

RESUMO

In our study investigating the prevalence of osteosarcopenic obesity (OSO) in community-dwelling older adults and possible factors responsible for falls, we have found that prevalence of OSO is 10.7%. OSO does not significantly increase the odds of falling, whereas lower handgrip strength, ALMi and gait speed were independent factors associated with falls. PURPOSES: The purposes of the study were (a) to determine the prevalence of osteosarcopenic obesity (OSO) in community-dwelling older adults and (b) to investigate the association between falls and possible factors in individuals with and without OSO. METHODS: Medical records of patients aged ≥ 65 years were retrospectively reviewed. Individuals were diagnosed with OSO based on their T-score assessed by dual x-ray absorptiometry, handgrip strength, appendicular lean mass index (ALMi), gait speed and body fat percentile. Comorbidities, history of falls, depressive state, medications and anthropometric measures were also noted. RESULTS: A sample of 460 individuals were assessed (337 females; 123 males) and 49 patients were diagnosed with OSO. There was no statistically significant difference in falls between the two groups (OR: 0.768, 95% CI: 0.409-1.440, p: 0.41) and the presence of OSO was not significantly associated with increased odds of falling (OR: 1.755, 95% CI: 0.547-5.628, p: 0.344). Handgrip strength (OR: 0.931, 95% CI: 0.893-0.971, p: 0.001), ALMi (OR: 0.799, 95% CI: 0.708-0.901, p < 0.0001) and gait speed (OR: 0.529, 95% CI: 0.283-0.988, p: 0.046) were independently associated with falls in overall group, whereas interaction analysis did not reveal any significant moderator effect of OSO vs. non-OSO in the associations between risk factors and falls. CONCLUSION: The prevalence of OSO was 10.7%. OSO was not associated with elevated odds of falling, whereas lower handgrip strength, ALMi and gait speed were independent factors associated with falls. Further prospective research is needed to clarify the effect of OSO on odds of falling, in consideration with possible risk factors. TRIAL REGISTRATION NUMBER AND DATE: NCT04288401 /26.02.2020.


Assuntos
Fragilidade/fisiopatologia , Avaliação Geriátrica/métodos , Força da Mão/fisiologia , Obesidade/epidemiologia , Osteoporose Pós-Menopausa/epidemiologia , Osteoporose/epidemiologia , Sarcopenia/epidemiologia , Absorciometria de Fóton/métodos , Idoso , Antropometria/métodos , Estudos Transversais , Feminino , Humanos , Vida Independente , Masculino , Obesidade/fisiopatologia , Osteoporose/fisiopatologia , Equilíbrio Postural/fisiologia , Prevalência , Estudos Retrospectivos , Sarcopenia/fisiopatologia
7.
Einstein (Sao Paulo) ; 18: eAO5309, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33111808

RESUMO

OBJECTIVE: To investigate the discriminative power of Nutritional Risk Screening 2002. METHODS: A cross sectional study involving one hundred participants aged ≥60 years. The original and adapted versions of Nutritional Risk Screening 2002 and the Mini Nutritional Assessment were used. Nutritional Risk Screening 2002 adaptation consisted of a lower age cutoff (60 years or older) for addition of one extra point to the final score. RESULTS: Screening using Nutritional Risk Screening 2002 revealed higher nutritional risk among patients aged ≥70 years (p=0.009), whereas screening using the adapted version of Nutritional Risk Screening 2002 revealed similar nutritional risk in both age groups (60-69 years and ≥70 years; p=0.117). Frequency of nutritional risk was highest when the Mini Nutritional Assessment was administered (52.7%), followed by the adapted and original versions of Nutritional Risk Screening 2002 (35.5% and 29.1%, respectively). CONCLUSION: The adapted version of Nutritional Risk Screening 2002 was more effective than the original version. However, further studies are needed to confirm these findings.


Assuntos
Desnutrição , Avaliação Nutricional , Idoso , Brasil , Estudos Transversais , Avaliação Geriátrica , Humanos , Desnutrição/diagnóstico , Desnutrição/epidemiologia , Pessoa de Meia-Idade , Estado Nutricional , Medição de Risco
8.
Geriatr Gerontol Int ; 20(9): 811-816, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33058420

RESUMO

AIM: The Geriatric Nutritional Risk Index (GNRI) can predict nutritional risk. However, just a few studies have validated the optimal cut-off value of GNRI for nutrition screening in older patients. Hence, this study aimed to determine the optimal value of GNRI to screen the risk of malnutrition among older patients. METHODS: This retrospective cross-sectional study was carried out with 5867 consecutive older adult patients who were admitted to an academic hospital in Japan. Receiver operating characteristic curve analyses were carried out to obtain the optimal cut-off value of GNRI, and the results were compared against the Mini Nutritional Assessment - Short Form and Malnutrition Universal Screening Tool. The validation of the obtained cut-off value was examined on the concordance rate of malnutrition diagnosis based on the European Society of Clinical Nutrition and Metabolism criteria. RESULTS: The mean age of the patients was 76.0 ± 7.0 years. The optimal cut-off value of GNRI for Mini Nutritional Assessment - Short Form ≤11 points was 95.92 (area under the curve 0.827 [0.817-0.838], P < 0.001), and that for Malnutrition Universal Screening Tool ≥1 point was 95.95 (area under the curve 0.788 [0.776-0.799], P < 0.001). By adapting GNRI <96 points as an initial screening cut-off in the European Society of Clinical Nutrition and Metabolism-defined malnutrition process, the concordance rates of comparisons were 98.5% and 98.5% for Mini Nutritional Assessment - Short Form-based and MUST-based diagnosis, respectively. CONCLUSIONS: The study showed GNRI <96 points as the optimal cut-off value for nutritional screening. GNRI might be one of the easy-to-use tools for nutritional screening and for diagnosing malnutrition in older adults. Geriatr Gerontol Int 2020; 20: 811-816.


Assuntos
Desnutrição/diagnóstico , Programas de Rastreamento/métodos , Avaliação Nutricional , Estado Nutricional/fisiologia , Idoso , Idoso de 80 Anos ou mais , Antropometria , Estudos Transversais , Feminino , Avaliação Geriátrica/métodos , Hospitalização , Hospitais Universitários , Humanos , Japão , Masculino , Curva ROC , Estudos Retrospectivos
9.
Medicine (Baltimore) ; 99(43): e22327, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120734

RESUMO

Frailty is a common geriatric condition due to aging and defined as a decline in strength and a decrease in the physiologic ability to maintain the homeostasis. Vitamin B12 (B12), water-soluble vitamins, are a cofactor in DNA synthesis and involved in the metabolism of every cell in the human body, including the central nervous system. Demyelination neuromuscular symptoms observed in the peripheral nervous system, along with signs of significant damage to nerve fibers, often cause weakness, numbness in distal limbs, impaired balance, gait ataxia, and even physical frailty. In this cross-sectional study, we aimed to investigate the relationship between frailty and B12 level in community-dwelling Korean older adults.Using the data from the Korean Frailty and Aging Cohort Study, 2938 participants (1400 men and 1538 women) were recruited in this study. To evaluate frailty, we compared the frail group and not-frail group based on the modified Korean version of the cardiovascular health study frailty index developed by Fried. SARC-F is used to screen for sarcopenia. The short physical performance battery (SPPB) timed up and go (TUG) test and activities-specific balance confidence scale used to evaluate the physical function and fall risk of participants. B12 concentrations were classified into clinically relevant categories: insufficient (<350 pg/mL) and sufficient (≥350 pg/mL). Linear and logistic regression analyses were used to evaluate the relationship between frailty and B12 levels.The mean age of the frail group was 77.8 (standard deviation = 3.7) years, while that of the not-frail group was 76.7 (SD = 4.0); of which the frail group's mean age was significantly high. In the unadjusted model, frailty was highly prevalent in the B12 insufficient group (odds ratio = 1.298). In the model fully adjusted for demographic data and comorbidities, these associations were attenuated. The B12 sufficiency group showed better total SPPB and TUG test scores. However, they were not statistically significant in the fully adjusted model.In this cross-sectional study, low B12 increased the incidence of frailty and affected physical performance, but it does not increase the incidence of frailty when considering the confounding factors. Frailty is caused by several factors rather than 1 factor, and B12 is one of these factors.


Assuntos
Fragilidade/sangue , Avaliação Geriátrica , Deficiência de Vitamina B 12/diagnóstico , Vitamina B 12/sangue , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Estudos Transversais , Teste de Esforço , Feminino , Fragilidade/diagnóstico , Humanos , Modelos Logísticos , Masculino , Desempenho Físico Funcional , República da Coreia , Sarcopenia/diagnóstico
10.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 3931-3935, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018860

RESUMO

The world population is aging, and this phenomenon is expected to continue for the next decades. This study aimed to propose a simple and reliable method that can be used for daily in-home monitoring of frailty and cognitive dysfunction in the elderly based on their walking-in-place characteristics. Fifty-four community-dwelling elderly people aged 65 years or older participated in this study. The participants were categorized into the robust and the non-robust groups according to the FRAIL scale. The mini-mental state examination was used to classify the cognitive impairment and the non-cognitive impairment groups. The 3-axis acceleration and the 3-axis angular velocity signals were measured using the inertial measurement units attached to the foot, shank, thigh, and posterior pelvis while each participant was walking in place for 20 seconds. The walking-in-place spectrograms were acquired by applying time-frequency analysis to the lower body movement signals measured in one stride. Four-fold cross-validation was applied to 80% of the total samples and the remaining 20% were used as test data. The deep convolutional neural network-based classifiers trained with the walking-in-place spectrograms enabled to categorize the robust and the non-robust groups with 94.63% accuracy and classify the cognitive impairment and the non-cognitive impairment groups with 97.59% accuracy. This study suggests that the walking-in-place spectrograms, which can be obtained without spacious experimental space, cumbersome equipment, and laborious processes, are effective indicators of frailty and cognitive dysfunction in the elderly.


Assuntos
Avaliação Geriátrica , Caminhada , Idoso , Estudos Transversais , Idoso Fragilizado , Humanos , Redes Neurais de Computação
12.
Maturitas ; 141: 39-45, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33036701

RESUMO

OBJECTIVES: To investigate the effect of omega-3 (ω-3) polyunsaturated fatty acid supplementation and a multidomain intervention (MI) (physical activity counselling, cognitive training and nutritional advice) among community-dwelling older adults on levels of intrinsic capacity (IC), a construct recently proposed by the World Health Organization. STUDY DESIGN: Secondary analysis from the factorial-design 3-year Multidomain Alzheimer Preventive Trial (MAPT) with 1445 subjects (64.2 % female, mean age 75.3 years, SD = 4.4) randomized to one group of MI plus ω-3 (800 mg docosahexaenoic acid and 225 mg eicosapentaenoic acid/day); MI plus placebo; ω-3 supplementation alone; or placebo alone. Data collection was held between 2008 and 2014. MAIN OUTCOME MEASURES: IC domains were examined with the Geriatric Depression Scale (psychological); Short Physical Performance Battery (mobility); Z-score combining four tests (cognitive function); and handgrip strength (vitality). All domains were combined into a composite IC Z-score. RESULTS: After 3 years, IC Z-score decreased among all groups when time was considered continuous (MI plus ω-3: -0.16, 95 %CI: -0.22 to -0.10; MI alone: -0.13, 95 %CI: -0.19 to -0.07; ω-3 alone: -0.19, 95 %CI: -0.25 to -0.10; placebo: -0.20, 95 %CI: -0.26 to -0.14; all p < 0.0001). There were no significant differences between groups. In a sensitivity analysis with categorical time, significant within-group declines were first identified at 24 months for all groups. CONCLUSIONS: This trial designed to improve cognitive function was unable to find effects of the intervention on the composite IC Z-score. Further investigations are needed, especially trials providing stronger interventions (such as exercise training and a controlled diet) and also embracing the sensorial domain of IC.


Assuntos
Doença de Alzheimer/prevenção & controle , Cognição/efeitos dos fármacos , Ácidos Graxos Ômega-3/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Suplementos Nutricionais , Ácidos Docosa-Hexaenoicos , Ácido Eicosapentaenoico/análogos & derivados , Exercício Físico , Ácidos Graxos Ômega-3/farmacologia , Feminino , Avaliação Geriátrica , Força da Mão , Estilo de Vida Saudável , Humanos , Vida Independente , Estilo de Vida , Estudos Longitudinais , Masculino , Amplitude de Movimento Articular/efeitos dos fármacos
13.
Anesth Analg ; 131(5): 1582-1588, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33079882

RESUMO

BACKGROUND: Frailty is a reduced capacity to recover from a physiologically stressful event. It is well established that preoperative frailty is associated with poor postoperative outcomes, but it is unclear if this includes cognitive decline following anesthesia and surgery. This retrospective observational study was a secondary analysis of data from a previous study (the Anaesthesia, Cognition, Evaluation [ACE] study). We aimed to identify if preoperative frailty or prefrailty is associated with preoperative and postoperative neurocognitive disorders or postoperative cognitive dysfunction. METHODS: The ACE study enrolled 300 participants aged ≥60 scheduled for elective total hip joint replacement and who underwent a full neuropsychological assessment at baseline and 3 and 12 months postoperatively. We applied patient data to 2 frailty models; both were based on an accumulation of deficits score: the reported Edmonton frail scale (REFS) and the comprehensive geriatric assessment-frailty index (CGA-FI) based on the comprehensive geriatric assessment. We calculated these 2 scores using baseline data collected from the medical history, demographic and clinical data as well as self-reported questionnaires. Some items on the REFS (3 of 18 or 17%) and the CGA-FI (37 of 51 or 27%) did not have an equivalent item in the ACE data. RESULTS: The mean age (standard deviation [SD]) was 70.1 years (6.6) with more women (197 [66%]). Using the REFS model, 40 of 300 (13.3%) patients were classified as vulnerable, mild, or moderately frail. Using the CGA-FI model, 69 of 300 (23%) were classified as intermediate or high frailty. The REFS and the CGA-FI were strongly correlated (r = 0.75; P < .01) with 34 of 300 (11%) meeting criteria for frailty by both the REFS and the CGA-FI.Frailty or prefrailty was associated with cognitive decline at 3 and 12 months using the REFS (odds ratio [OR], 1.51, 95% confidence interval [CI], 1.02-2.23 and OR, 2.00, 95% CI, 1.26-3.17, respectively) after adjusting for baseline mini-mental state examination (MMSE), smoking, hypertension, diabetes, history of acute myocardial infarction (AMI), and estimated intelligence quotient (IQ). Age did not modify this association. After adjusting for multiple comparisons, 3-month cognitive decline was no longer significantly associated with baseline frailty. CONCLUSIONS: This retrospective analysis demonstrates an association between baseline frailty and postoperative neurocognitive disorders, particularly using the more extensive REFS scoring method. This supports preoperative screening for frailty to risk-stratify patients, and identify and implement preventive strategies and to improve postoperative outcomes for older individuals.


Assuntos
Artroplastia de Quadril/efeitos adversos , Transtornos Cognitivos/etiologia , Fragilidade , Complicações Pós-Operatórias/psicologia , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/psicologia , Transtornos Cognitivos/epidemiologia , Feminino , Idoso Fragilizado , Avaliação Geriátrica , Humanos , Masculino , Testes de Estado Mental e Demência , Testes Neuropsicológicos , Complicações Pós-Operatórias/epidemiologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco , Autorrelato , Fatores Sexuais , Inquéritos e Questionários
16.
Aging Clin Exp Res ; 32(12): 2695-2701, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33034016

RESUMO

BACKGROUND: Symptomatic severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection incidence is higher in the elderly patients. Pre-existing geriatric conditions such as comorbidity and frailty seem related to worse hospital outcomes. AIMS: To assess the role of nutritional status as an independent prognostic factor for in-hospital death in elderly patients. METHODS: Consecutive elderly patients (age > 65 years) hospitalized for novel coronavirus disease (COVID-19) were enrolled. Demographics, laboratory and comorbidity data were collected. Nutritional status was evaluated using the Geriatric Nutritional Risk Index (GNRI). Uni- and multivariate Cox regression analyses to evaluate predictors for in-hospital death were performed. RESULTS: One hundred and nine hospitalized elderly patients (54 male) were consecutively enrolled. At univariate analysis, age (HR 1.045 [CI 1.008-1.082]), cognitive impairment (HR 1.949 [CI 1.045-3.364]), C-reactive protein (HR 1.004 [CI 1.011-1.078]), lactate dehydrogenases (HR 1.003 [CI 1.001-1.004]) and GNRI moderate-severe risk category (HR 8.571 [CI 1.096-67.031]) were risk factors for in-hospital death, while albumin (HR 0.809 [CI 0.822-0.964]), PaO2/FiO2 ratio (HR 0.996 [CI 0.993-0.999]) and body mass index (HR 0.875 [CI 0.782-0.979]) were protective factors. Kaplan-Meier survival curves showed a significative higher survival in patients without GNRI moderate or severe risk category (p = 0.0013). At multivariate analysis, PaO2/FiO2 ratio (HR 0.993 [CI 0.987-0.999], p = 0.046) and GNRI moderate-severe risk category (HR 9.285 [1.183-72.879], p = 0.034) were independently associated with in-hospital death. CONCLUSION: Nutritional status assessed by GNRI is a significative predictor of survival in elderly patients hospitalized for COVID-19. The association between GNRI and PaO2/FiO2 ratio is a good prognostic model these patients.


Assuntos
Infecções por Coronavirus , Pandemias , Pneumonia Viral , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Feminino , Avaliação Geriátrica , Humanos , Masculino , Desnutrição/diagnóstico , Desnutrição/epidemiologia , Avaliação Nutricional , Estado Nutricional , Prognóstico , Fatores de Risco
17.
Br J Anaesth ; 125(5): 730-738, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32891413

RESUMO

BACKGROUND: A threshold Clinical Frailty Scale (CFS) of 5 (indicating mild frailty) has been proposed to guide ICU admission for UK patients with coronavirus disease 2019 (COVID-19) pneumonia. However, the impact of frailty on mortality with (non-COVID-19) pneumonia in critical illness is unknown. We examined the triage utility of the CFS in patients with pneumonia requiring ICU. METHODS: We conducted a retrospective cohort study of adult patients admitted with pneumonia to 170 ICUs in Australia and New Zealand from January 1, 2018 to September 31, 2019. We classified patients as: non-frail (CFS 1-4) frail (CFS 5-8), mild/moderately frail (CFS 5-6),and severe/very severely frail (CFS 7-8). We evaluated mortality (primary outcome) adjusting for site, age, sex, mechanical ventilation, pneumonia type and illness severity. We also compared the proportion of ICU bed-days occupied between frailty categories. RESULTS: 1852/5607 (33%) patients were classified as frail, including1291/3056 (42%) of patients aged >65 yr, who would potentially be excluded from ICU admission under UK-based COVID-19 triage guidelines. Only severe/very severe frailty scores were associated with mortality (adjusted odds ratio [aOR] for CFS=7: 3.2; 95% confidence interval [CI]: 1.3-7.8; CFS=8 [aOR: 7.2; 95% CI: 2.6-20.0]). These patients accounted for 7% of ICU bed days. Vulnerability (CFS=4) and mild frailty (CFS=5) were associated with a similar mortality risk (CFS=4 [OR: 1.6; 95% CI: 0.7-3.8]; CFS=5 [OR: 1.6; 95% CI: 0.7-3.9]). CONCLUSIONS: Patients with severe and very severe frailty account for relatively few ICU bed days as a result of pneumonia, whilst adjusted mortality analysis indicated little difference in risk between patients in vulnerable, mild, and moderate frailty categories. These data do not support CFS ≥5 to guide ICU admission for pneumonia.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Idoso Fragilizado/estatística & dados numéricos , Avaliação Geriátrica/estatística & dados numéricos , Avaliação de Resultados da Assistência ao Paciente , Pneumonia Viral/epidemiologia , Idoso , Austrália/epidemiologia , Estudos de Coortes , Estado Terminal , Feminino , Avaliação Geriátrica/métodos , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Pandemias , Estudos Retrospectivos
18.
Emerg Med J ; 37(11): 714-716, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32972913

RESUMO

We describe the expansion and adaptation of a frailty response team to assess older people in their usual place of residence. The team had commenced a weekend service to a limited area in February 2020. As a consequence of demand related to the COVID-19 pandemic, we expanded it and adapted the model of care to provide a 7-day service to our entire catchment area. Five hundred and ninety two patient reviews have been completed in the first 105 days of operation with 43 patients transferred to hospital for further investigation or management following assessment.


Assuntos
Infecções por Coronavirus/epidemiologia , Serviços Médicos de Emergência/organização & administração , Idoso Fragilizado , Avaliação Geriátrica , Serviços de Saúde para Idosos/organização & administração , Serviços Hospitalares de Assistência Domiciliar/organização & administração , Pneumonia Viral/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Feminino , Humanos , Irlanda/epidemiologia , Masculino , Pandemias
19.
Nutrients ; 12(10)2020 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-32992538

RESUMO

Coronavirus disease 2019 (COVID-19) is associated with high risk of malnutrition, primarily in older people; assessing nutritional risk using appropriate screening tools is critical. This systematic review identified applicable tools and assessed their measurement properties. Literature was searched in the MEDLINE, Embase, and LILACS databases. Four studies conducted in China met the eligibility criteria. Sample sizes ranged from six to 182, and participants' ages from 65 to 87 years. Seven nutritional screening and assessment tools were used: the Nutritional Risk Screening 2002 (NRS-2002), the Mini Nutritional Assessment (MNA), the MNA-short form (MNA-sf), the Malnutrition Universal Screening Tool (MUST), the Nutritional Risk Index (NRI), the Geriatric NRI (GNRI), and modified Nutrition Risk in the Critically ill (mNUTRIC) score. Nutritional risk was identified in 27.5% to 100% of participants. The NRS-2002, MNA, MNA-sf, NRI, and MUST demonstrated high sensitivity; the MUST had better specificity. The MNA and MUST demonstrated better criterion validity. The MNA-sf demonstrated better predictive validity for poor appetite and weight loss; the NRS-2002 demonstrated better predictive validity for prolonged hospitalization. mNUTRIC score demonstrated good predictive validity for hospital mortality. Most instruments demonstrate high sensitivity for identifying nutritional risk, but none are acknowledged as the best for nutritional screening in older adults with COVID-19.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Avaliação Geriátrica , Desnutrição/diagnóstico , Avaliação Nutricional , Pneumonia Viral/complicações , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/virologia , Feminino , Humanos , Masculino , Desnutrição/virologia , Pessoa de Meia-Idade , Estado Nutricional , Pandemias , Pneumonia Viral/fisiopatologia , Pneumonia Viral/virologia , Reprodutibilidade dos Testes , Medição de Risco , Sensibilidade e Especificidade
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