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1.
BMC Med ; 18(1): 274, 2020 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-32892742

RESUMO

BACKGROUND: The coronavirus disease 2019 (COVID-19) has been a pandemic worldwide. Old age and underlying illnesses are associated with poor prognosis among COVID-19 patients. However, whether frailty, a common geriatric syndrome of reduced reserve to stressors, is associated with poor prognosis among older COVID-19 patients is unknown. The aim of our study is to investigate the association between frailty and severe disease among COVID-19 patients aged ≥ 60 years. METHODS: A prospective cohort study of 114 hospitalized older patients (≥ 60 years) with confirmed COVID-19 pneumonia was conducted between 7 February 2020 and 6 April 2020. Epidemiological, demographic, clinical, laboratory, and outcome data on admission were extracted from electronic medical records. All patients were assessed for frailty on admission using the FRAIL scale, in which five components are included: fatigue, resistance, ambulation, illnesses, and loss of weight. The outcome was the development of the severe disease within 60 days. We used the Cox proportional hazards models to identify the unadjusted and adjusted associations between frailty and severe illness. The significant variables in univariable analysis were included in the adjusted model. RESULTS: Of 114 patients, (median age, 67 years; interquartile range = 64-75 years; 57 [50%] men), 39 (34.2%), 39 (34.2%), and 36 (31.6%) were non-frail, pre-frail, and frail, respectively. During the 60 days of follow-up, 43 severe diseases occurred including eight deaths. Four of 39 (10.3%) non-frail patients, 15 of 39 (38.5%) pre-frail patients, and 24 of 36 (66.7%) frail patients progressed to severe disease. After adjustment of age, sex, body mass index, haemoglobin, white blood count, lymphocyte count, albumin, CD8+ count, D-dimer, and C-reactive protein, frailty (HR = 7.47, 95% CI 1.73-32.34, P = 0.007) and pre-frailty (HR = 5.01, 95% CI 1.16-21.61, P = 0.03) were associated with a higher hazard of severe disease than the non-frail. CONCLUSIONS: Frailty, assessed by the FRAIL scale, was associated with a higher risk of developing severe disease among older COVID-19 patients. Our findings suggested that the use of a clinician friendly assessment of frailty could help in early warning of older patients at high-risk with severe COVID-19 pneumonia.


Assuntos
Infecções por Coronavirus , Idoso Fragilizado , Fragilidade/diagnóstico , Fragilidade/virologia , Avaliação Geriátrica/métodos , Pandemias , Pneumonia Viral , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Prospectivos
2.
BMJ Open ; 10(9): e040569, 2020 09 29.
Artigo em Inglês | MEDLINE | ID: mdl-32994260

RESUMO

INTRODUCTION: This protocol describes an observational study which set out to assess whether frailty and/or multimorbidity correlates with short-term and medium-term outcomes in patients diagnosed with COVID-19 in a European, multicentre setting. METHODS AND ANALYSIS: Over a 3-month period we aim to recruit a minimum of 500 patients across 10 hospital sites, collecting baseline data including: patient demographics; presence of comorbidities; relevant blood tests on admission; prescription of ACE inhibitors/angiotensin receptor blockers/non-steroidal anti-inflammatory drugs/immunosuppressants; smoking status; Clinical Frailty Score (CFS); length of hospital stay; mortality and readmission. All patients receiving inpatient hospital care >18 years who receive a diagnosis of COVID-19 are eligible for inclusion. Long-term follow-up at 6 and 12 months is planned. This will assess frailty, quality of life and medical complications.Our primary analysis will be short-term and long-term mortality by CFS, adjusted for age (18-64, 65-80 and >80) and gender. We will carry out a secondary analysis of the primary outcome by including additional clinical mediators which are determined statistically important using a likelihood ratio test. All analyses will be presented as crude and adjusted HR and OR with associated 95% CIs and p values. ETHICS AND DISSEMINATION: This study has been registered, reviewed and approved by the following: Health Research Authority (20/HRA1898); Ethics Committee of Hospital Policlinico Modena, Italy (369/2020/OSS/AOUMO); Health and Care Research Permissions Service, Wales; and NHS Research Scotland Permissions Co-ordinating Centre, Scotland. All participating units obtained approval from their local Research and Development department consistent with the guidance from their relevant national organisation.Data will be reported as a whole cohort. This project will be submitted for presentation at a national or international surgical and geriatric conference. Manuscript(s) will be prepared following the close of the project.


Assuntos
Infecções por Coronavirus , Idoso Fragilizado , Fragilidade , Multimorbidade , Pandemias , Pneumonia Viral , Saúde Pública/métodos , Qualidade de Vida , Adulto , Idoso , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/terapia , Correlação de Dados , Europa (Continente)/epidemiologia , Feminino , Idoso Fragilizado/psicologia , Idoso Fragilizado/estatística & dados numéricos , Fragilidade/diagnóstico , Fragilidade/epidemiologia , Avaliação Geriátrica/métodos , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Estudos Multicêntricos como Assunto , Estudos Observacionais como Assunto , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade , Pneumonia Viral/terapia , Análise de Sobrevida
3.
J Frailty Aging ; 9(4): 219-225, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32996558

RESUMO

BACKGROUND: Early detection of frail older people is important. Timely intervention may allow health care professionals to prevent or delay the occurrence of adverse outcomes such as disability, increases in health care utilization, and premature death. OBJECTIVES: We assessed the construct and criterion validity of the SUNFRAIL tool, a questionnaire for measuring frailty among older people. DESIGN, SETTING AND PARTICIPANTS: This cross-sectional study was carried out in a sample of Dutch citizens. A total of 195 community-dwelling persons aged 71 years and older completed the questionnaire. MEASUREMENTS: Construct validity was examined by determining the correlation between the SUNFRAIL tool and the Tilburg Frailty Indicator (TFI). Criterion validity for the SUNFRAIL tool was determined by establishing the correlations with chronic diseases and adverse outcomes of frailty (disability, falls, indicators of health care utilization). Disability was measured using the Groningen Activity Restriction Scale. Participants also answered questions regarding falls and health care utilization. RESULTS: The construct validity of this tool was good and showed significant correlations with the TFI. The correlation between SUNFRAIL total and TFI total was 0.624. The criterion validity of the SUNFRAIL tool was good for chronic diseases and good-to-excellent for adverse outcomes disability, receiving nursing care, and falls. The area under the curve for these outcomes was 0.840 (95% CI 0.781-0.899), 0.782 (95% CI 0.696-0.868), and 0.769 (95% CI 0.686-0.859), respectively. CONCLUSIONS: The results of our study suggest that the SUNFRAIL tool is a valid instrument for assessing frailty in community-dwelling older people. It is an attractive instrument for use in practice because it takes little time for health care professionals and older people to complete the questionnaire, and it expresses the integral functioning of human beings.


Assuntos
Idoso Fragilizado , Fragilidade/diagnóstico , Avaliação Geriátrica/métodos , Idoso , Estudos Transversais , Humanos , Vida Independente , Países Baixos , Reprodutibilidade dos Testes
4.
Medicine (Baltimore) ; 99(37): e22217, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925799

RESUMO

The geriatric nutritional risk index (GNRI) is associated with the prognosis of many diseases. However, the association between the GNRI and the prognosis of patients aged ≥65 years with severe community-acquired pneumonia (SCAP) has not been studied. We aimed to evaluate the prognostic value of GNRI in elderly SCAP patients.This study retrospectively analyzed the clinical data of 346 patients aged ≥65 years with SCAP from December 2013 to September 2019. Patients were divided into 4 groups by the GNRI. The chi-square test or student's t test was used to compare the differences between the groups. Logistic regression analysis was used to evaluate the factors that affect prognosis. The receiver operating characteristic curve was used to compare the prognostic performance of the GNRI with other indicators. A GNRI-based nomogram was established based on the result of the multivariate analysis.Two hundred nine (60.4%) patients had a poor prognosis. GNRI scores were significantly lower in the poor prognosis group than in the group with a good prognosis. In the multivariate analysis, gender, mean arterial pressure, neutrophil counts, and the GNRI were independently correlated with the prognosis of elderly patients. The GNRI was a significantly better predictor for poor prognosis than other indicators. The GNRI-based nomogram had excellent prediction capabilities.GNRI is a simple and effective prognostic indicator for elderly patients with SCAP, and a GNRI-based nomogram can aid in developing individualized treatment plans for elderly patients with SCAP.


Assuntos
Avaliação Geriátrica/métodos , Estado Nutricional , Pneumonia/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Infecções Comunitárias Adquiridas , Comorbidade , Feminino , Nível de Saúde , Humanos , Unidades de Terapia Intensiva , Masculino , Pneumonia/mortalidade , Prognóstico , Curva ROC , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais
5.
Med Clin North Am ; 104(5): 777-789, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32773045

RESUMO

Geriatric assessment is a comprehensive, multifaceted, and interdisciplinary evaluation of medical, socioeconomic, environmental, and functional concerns unique to older adults; it can be focused or broadened according to the needs of the patient and the concerns of clinical providers. Herein, the authors present a high-yield framework that can be used to assess older adult patients across a variety of settings.


Assuntos
Função Executiva , Avaliação Geriátrica/métodos , Desempenho Físico Funcional , Polimedicação , Idoso , Meio Ambiente , Humanos , Múltiplas Afecções Crônicas/tratamento farmacológico , Fatores Socioeconômicos
6.
Med Clin North Am ; 104(5): 791-806, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32773046

RESUMO

A large body of research has addressed the assessment and management of fall risk among community-dwelling older adults. Persons with dementia are at higher risk for falls and fall-related injuries, yet less is known about effective strategies for reducing falls and injuries among those with dementia. Falls and dementia are regularly considered to be discrete conditions and are often managed separately. Increasing evidence shows that these conditions frequently co-occur, and one may precede the other. This article explores the relationship between falls and dementia, including the importance of rehabilitation strategies for reducing fall risk in these individuals.


Assuntos
Acidentes por Quedas , Demência , Avaliação Geriátrica/métodos , Medição de Risco/métodos , Acidentes por Quedas/prevenção & controle , Acidentes por Quedas/estatística & dados numéricos , Idoso , Causalidade , Demência/diagnóstico , Demência/epidemiologia , Humanos , Vida Independente/psicologia , Atenção Primária à Saúde/métodos
7.
Med Clin North Am ; 104(5): 873-884, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32773051

RESUMO

Osteoporosis and osteoporosis-related fractures are common causes of morbidity and mortality in older adults. Healthy adults should be counseled about measures to prevent osteoporosis. Women should be screened for osteoporosis beginning at age 65. Screening for osteoporosis in men should be considered when risk factors are present. Appropriate screening intervals are controversial. Women and men with osteoporosis should be offered pharmacologic therapy. Choice of therapy should be based on safety, cost, convenience, and other patient-related factors. Bisphosphonates are a first-line therapy for many patients with osteoporosis. Other treatments for osteoporosis include denosumab, teriparatide, abaloparatide, romosozumab, and selective estrogen receptor modulators.


Assuntos
Conservadores da Densidade Óssea/farmacologia , Osteoporose Pós-Menopausa/terapia , Osteoporose/terapia , Fraturas por Osteoporose/prevenção & controle , Idoso , Feminino , Avaliação Geriátrica/métodos , Humanos , Masculino , Fatores de Risco
9.
Med Clin North Am ; 104(5): 895-908, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32773053

RESUMO

Geriatric patients are not just older adult patients. Aging brings about unique physiologic, psychological, and sociologic changes within individuals. Recognition of these unique characteristics and measuring for their impact; instituting mitigating strategies; using age-specific anesthetic measures; and performing a systematic, algorithmic care model in the postoperative period overseen by a multidisciplinary team brings about enhanced outcomes and improved quality of care for this expanding group of patients.


Assuntos
Envelhecimento , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Operatórios , Idoso , Envelhecimento/fisiologia , Envelhecimento/psicologia , Avaliação Geriátrica/métodos , Humanos , Seleção de Pacientes , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/prevenção & controle , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Procedimentos Cirúrgicos Operatórios/métodos
10.
PLoS One ; 15(8): e0234698, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32780744

RESUMO

BACKGROUND: Brief assessments of functional status for community-dwelling older adults are needed given expanded interest in the measurement of functional decline. METHODS: As part of a 2015 prospective cohort study of older adults aged 60-89 years in Jiangsu Province, China, 1506 participants were randomly assigned to two groups; each group was administered one of two alternative 20-item versions of a scale to assess activities of daily living (ADL) and instrumental activities of daily living (IADL) drawn from multiple commonly-used scales. One version asked if they required help to perform activities (ADL-IADL-HELP-20), while the other version provided additional response options if activities could be done alone but with difficulty (ADL-IADL-DIFFICULTY-20). Item responses to both versions were compared using the binomial test for differences in proportion (with Wald 95% confidence interval [CI]). A brief 9-item scale (ADL-IADL-DIFFICULTY-9) was developed favoring items identified as difficult or requiring help by ≥4%, with low redundancy and/or residual correlations, and with significant correlations with age and other health indicators. We repeated assessment of the measurement properties of the brief scale in two subsequent samples of older adults in Hong Kong in 2016 (aged 70-79 years; n = 404) and 2017 (aged 65-82 years; n = 1854). RESULTS: Asking if an activity can be done alone but with difficulty increased the proportion of participants reporting restriction on 9 of 20 items, for which 95% CI for difference scores did not overlap with zero; the proportion with at least one limitation increased from 28.6% to 34.2% or an absolute increase of 5.6% (95% CI = 0.9-10.3%), which was a relative increase of 19.6%. The brief ADL-IADL-DIFFICULTY-9 maintained excellent internal consistency (α = 0.93) and had similar ceiling effect (68.1%), invariant item ordering (H trans = .41; medium), and correlations with age and other health measures compared with the 20-item version. The brief scale performed similarly when subsequently administered to older adults in Hong Kong. CONCLUSIONS: Asking if tasks can be done alone but with difficulty can modestly reduce ceiling effects. It's possible that the length of commonly-used scales can be reduced by over half if researchers are primarily interested in a summed indicator rather than an inventory of specific types of deficits.


Assuntos
Atividades Cotidianas , Avaliação da Deficiência , Desempenho Físico Funcional , Idoso , Idoso de 80 Anos ou mais , China , Estudos de Coortes , Feminino , Avaliação Geriátrica/métodos , Hong Kong , Humanos , Vida Independente , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
11.
Value Health ; 23(8): 1056-1062, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32828218

RESUMO

BACKGROUND: Previous studies have summarized evidence on health-related quality of life for older people, identifying a range of measures that have been validated, but have not sought to present results by degree of frailty. Furthermore, previous studies did not typically use quality-of-life measures that generate an overall health utility score. Health utility scores are a necessary component of quality-adjusted life-year calculations used to estimate the cost-effectiveness of interventions. METHODS: We calculated normative estimates in mean and standard deviation for EQ-5D-5L, short-form 36-item health questionnaire in frailty (SF-36), and short-form 6-dimension (SF-6D) for a range of established frailty models. We compared response distributions across dimensions of the measures and investigated agreement using Bland-Altman and interclass correlation techniques. RESULTS: The EQ-5D-5L, SF-36, and SF-6D scores decrease and their variability increases with advancing frailty. There is strong agreement between the EQ-5D-5L and SF-6D across the spectrum of frailty. Agreement is lower for people who are most frail, indicating that different components of the 2 instruments may have greater relevance for people with advancing frailty in later life. There is a greater risk of ceiling effects using the EQ-5D-5L rather than the SF-6D. CONCLUSIONS: We recommend the SF-36/SF-6D as an appropriate measure of health-related quality of life for clinical trials if fit older people are the planned target. In trials of interventions involving older people with increasing frailty, we recommend that both the EQ-5D-5L and SF36/SF6D are included, and are used in sensitivity analyses as part of cost-effectiveness evaluation.


Assuntos
Idoso Fragilizado , Avaliação Geriátrica/métodos , Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Análise Custo-Benefício , Feminino , Indicadores Básicos de Saúde , Humanos , Masculino
12.
Value Health ; 23(8): 1063-1071, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32828219

RESUMO

OBJECTIVES: To classify older people with multimorbidity according to their adherence patterns and to examine the association between medication adherence and health outcomes. METHODS: This is a secondary analysis of a cohort study. Community-dwelling adults aged ≥70 years were recruited from 15 general practices in Ireland in 2010 (wave 1) and followed up 2 years later (wave 2). Participants had ≥2 RxRisk-V multimorbidity conditions at wave 1 and had ≥2 dispensations of RxRisk-V medications (wave 1-wave 2). Average adherence across RxRisk-V conditions was estimated based on continuous multiple-interval measure of medication availability (CMA7 function in AdhereR). Group-based trajectory models were used to group participants' adherence patterns for RxRisk-V medications. Multilevel regression was used to examine the association between adherence and (1) EuroQol 5-dimension (EQ-5D) utility (linear) and (2) vulnerability, using the Vulnerable Elders Survey (≥3 defined as vulnerable; logistic) at wave 2, controlling for potential confounders. RESULTS: Average adherence (CMA7) was 77% across 501 participants. Group-based trajectory models identified 5 adherence groups: (1) initial low adherers, gradual increase; (2) high adherers, sharp decline; (3) steady adherers, gradual decline; (4) consistent high adherers; and (5) consistent nonadherers. Higher average adherence was associated with a significant increase in EQ-5D utility (adjusted ß = 0.11, robust standard error 0.04). Group 5 was associated with significantly increased vulnerability compared to group 4 (adjusted odds ratio = 1.88; 95% confidence interval 1.01-3.50). CONCLUSION: Increased average adherence was associated with higher EQ-5D utility. Adherence grouping did not significantly impact utility. Suboptimal adherence to multiple medications in older adults with multimorbidity was associated with vulnerability.


Assuntos
Avaliação Geriátrica/métodos , Adesão à Medicação/estatística & dados numéricos , Multimorbidade , Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Feminino , Nível de Saúde , Humanos , Irlanda/epidemiologia , Masculino , Polimedicação
13.
Rev. esp. cardiol. (Ed. impr.) ; 73(7): 569-576, jul. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-187328

RESUMO

La infección por SARS-CoV-2, denominada COVID-19 (Coronavirus Infectious Disease-19), es una enfermedad desconocida hasta diciembre de 2019 a la que nos enfrentamos en España desde el 31 de enero de 2020 -fecha del primer caso diagnosticado en nuestro país- y que ya ha causado la muerte de 7.340 personas (a 30 de marzo de 2020), sobre todo mayores. Es importante tener en cuenta que, dado que la información evoluciona con extremada rapidez en este campo, lo expuesto en el presente documento puede estar sujeto a modificaciones. La población de mayor edad es especialmente susceptible a la infección por COVID-19, así como a desarrollar criterios de gravedad. Este aumento de morbimortalidad en el paciente mayor se ha asociado tanto con las comorbilidades, especialmente la enfermedad cardiovascular, como con la situación de fragilidad, que conlleva una respuesta inmunológica más pobre. La situación actual, tanto por los países afectados como por el número de casos, constituye una pandemia y supone una emergencia sanitaria de primer nivel. Como España es uno de los países más envejecidos del mundo, la COVID-19 se ha convertido en una emergencia geriátrica. El presente documento se ha elaborado conjuntamente entre la Sección de Cardiología Geriátrica de la Sociedad Española de Cardiología y la Sociedad Española de Geriatría y Gerontología


SARS-CoV2 infection, also known as COVID-19 (coronavirus infectious disease-19), was first identified in December 2019. In Spain, the first case of this infection was diagnosed on 31 January, 2020 and, by 30 March 2020, has caused 7340 deaths, especially in the elderly. Due to the rapidly evolving situation regarding this disease, the data reported in this article may be subject to modifications. The older population are particularly susceptible to COVID-19 infection and to developing severe disease. The higher morbidity and mortality rates in older people have been associated with comorbidity, especially cardiovascular disease, and frailty, which weakens the immune response. Due to both the number of affected countries and the number of cases, the current situation constitutes an ongoing pandemic and a major health emergency. Because Spain has one of the largest older populations in the world, COVID-19 has emerged as a geriatric emergency. This document has been prepared jointly between the Geriatric Cardiology Section of the Spanish Society of Cardiology and the Spanish Society of Geriatrics and Gerontology


Assuntos
Humanos , Pneumonia Viral/diagnóstico , Síndrome Torácica Aguda/diagnóstico , Infecções por Coronavirus/epidemiologia , Avaliação Geriátrica/métodos , Avaliação de Sintomas/métodos , Indicadores de Morbimortalidade , Infecções por Coronavirus/complicações , Pandemias , Tratamento de Emergência/métodos , Estratégias Mundiais , Cuidados Críticos/métodos
14.
J Cross Cult Gerontol ; 35(3): 237-254, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32725292

RESUMO

Psychosocial, socioeconomic and sociocultural aspects can influence cognitive function among community-dwelling older adults. Life-space restriction is potentially related to cognitive status. We examined the longitudinal association between life-space mobility and changes in cognitive function in community-dwelling older adults in different social settings of North and South America and Europe. We used data from 1486 participants of the International Mobility in Aging Study (IMIAS) conducted at five sites: Tirana (Albania), Natal (Brazil), Manizales (Colombia), Kingston and Saint-Hyacinthe (Canada). Life-space mobility was assessed using the Life-Space Assessment (LSA) questionnaire at baseline (2012), and the Leganes Cognitive Test was used to evaluate cognitive function at baseline and follow-up (2016). The Quantile regressions (QR) were used to evaluate the factors associated with cognitive score in 2016 by adjusting for the cognitive score in 2012, with two distinct models for analyzing variables. A decrease in the cognitive function was observed at all research sites, except in Manizales. Participants with more restricted life-space at baseline had a decrease in their cognitive function 4 years later (ß = -0.79, 95% CI: -1.400 to -0.18, p value<0.01) compared to those with the highest level. This decrease was independent of gender, age, research site, education, income sufficiency, social support, depression, cognitive function at baseline, chronic conditions and physical performance. Restriction in life-space is an important prognostic factor for cognitive function. Maintaining life-space can be a goal in public policies aimed at encouraging healthy aging, and might be useful in clinical practice to promote health status and to monitor older people at higher risk of cognitive decline.


Assuntos
Disfunção Cognitiva/diagnóstico , Vida Independente/psicologia , Limitação da Mobilidade , Idoso , Albânia , Brasil , Canadá , Colômbia , Feminino , Avaliação Geriátrica/métodos , Humanos , Estudos Longitudinais , Masculino , Fatores de Risco , Fatores Sexuais , Apoio Social , Fatores Socioeconômicos
15.
Rev Med Suisse ; 16(699): 1316-1318, 2020 Jul 01.
Artigo em Francês | MEDLINE | ID: mdl-32608590

RESUMO

The Covid-19 pandemic has brought the concept of frailty back to the centre of debate, particularly for its relevance as a determinant of health outcomes. Frailty is concept that has long been a used gerontology. Today, several theoretical models of frailty are proposed in the literature, with as many tools to operationalize it. This article provides a brief outline of the three main models of frailty and the corresponding measurement instruments. The choice of the model as well as the choice of the assessment tool are discussed in the light of the clinical objectives pursued by health professionals. More generally, this article highlights the value of assessing frailty in routine practice to determine health outcomes and adapt care to individual needs.


Assuntos
Infecções por Coronavirus/epidemiologia , Fragilidade/diagnóstico , Fragilidade/epidemiologia , Avaliação Geriátrica/métodos , Pneumonia Viral/epidemiologia , Idoso , Betacoronavirus/patogenicidade , Infecções por Coronavirus/mortalidade , Idoso Fragilizado/estatística & dados numéricos , Humanos , Pandemias , Pneumonia Viral/mortalidade , Prognóstico , Resultado do Tratamento
16.
Age Ageing ; 49(4): 516-522, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32725209

RESUMO

Older people are particularly affected by the COVID-19 outbreak because of their vulnerability as well as the complexity of health organisations, particularly in the often-compartmentalised interactions between community, hospital and nursing home actors. In this endemic situation, with massive flows of patients requiring holistic management including specific and intensive care, the appropriate assessment of each patient's level of care and the organisation of specific networks is essential. To that end, we propose here a territorial organisation of health care, favouring communication between all actors. This organisation of care is based on three key points: To use the basis of territorial organisation of health by facilitating the link between hospital settings and geriatric sectors at the regional level.To connect private, medico-social and hospital actors through a dedicated centralised unit for evaluation, geriatric coordination of care and decision support. A geriatrician coordinates this multidisciplinary unit. It includes an emergency room doctor, a supervisor from the medical regulation centre (Centre 15), an infectious disease physician, a medical hygienist and a palliative care specialist.To organise an ad hoc follow-up channel, including the necessary resources for the different levels of care required, according to the resources of the territorial network, and the creation of a specific COVID geriatric palliative care service. This organisation meets the urgent health needs of all stakeholders, facilitating its deployment and allows the sustainable implementation of a coordinated geriatric management dynamic between the stakeholders on the territory.


Assuntos
Infecções por Coronavirus , Avaliação Geriátrica/métodos , Serviços de Saúde para Idosos , Pandemias , Administração dos Cuidados ao Paciente , Pneumonia Viral , Programas Médicos Regionais/organização & administração , Idoso , Betacoronavirus/isolamento & purificação , Redes Comunitárias/organização & administração , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , França/epidemiologia , Alocação de Recursos para a Atenção à Saúde/tendências , Serviços de Saúde para Idosos/ética , Serviços de Saúde para Idosos/organização & administração , Serviços de Saúde para Idosos/tendências , Humanos , Inovação Organizacional , Cuidados Paliativos/métodos , Pandemias/prevenção & controle , Administração dos Cuidados ao Paciente/ética , Administração dos Cuidados ao Paciente/organização & administração , Administração dos Cuidados ao Paciente/tendências , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Web Semântica , Participação dos Interessados
17.
J Am Med Dir Assoc ; 21(7): 937-938, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32674823

RESUMO

On February 20, 2020, a man living in the north of Italy was admitted to the emergency room with an atypical pneumonia that later proved to be COVID-19. This was the trigger of one of the most serious clusters of COVID-19 in the world, outside of China. Despite aggressive restraint and inhibition efforts, COVID-19 continues to increase, and the total number of infected patients in Italy is growing daily. After 6 weeks, the total number of patients reached 128,948 cases (April 5, 2020), with the higher case-fatality rate (15,887 deaths) dominated by old and very old patients. This sudden health emergency severely challenged the Italian Health System, in particular acute care hospitals and intensive care units. In 1 hospital, geriatric observation units were created, the experience of which can be extremely useful for European countries, the United States, and all countries that in the coming days will face a similar situation.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Surtos de Doenças/estatística & dados numéricos , Avaliação Geriátrica/métodos , Geriatras/estatística & dados numéricos , Controle de Infecções/organização & administração , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Idoso , Idoso de 80 Anos ou mais , Surtos de Doenças/prevenção & controle , Serviço Hospitalar de Emergência/organização & administração , Feminino , Serviços de Saúde para Idosos/organização & administração , Hospitalização/estatística & dados numéricos , Hospitais de Ensino , Humanos , Unidades de Terapia Intensiva/organização & administração , Itália/epidemiologia , Masculino , Avaliação de Resultados em Cuidados de Saúde , Pandemias , Papel do Médico , Medicina de Precisão/métodos , Medição de Risco
18.
BMJ Open Respir Res ; 7(1)2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32624494

RESUMO

Since the outbreak of COVID-19 in China in December 2019, a pandemic has rapidly developed on a scale that has overwhelmed health services in a number of countries. COVID-19 has the potential to lead to severe hypoxia; this is usually the cause of death if it occurs. In a substantial number of patients, adequate arterial oxygenation cannot be achieved with supplementary oxygen therapy alone. To date, there has been no clear guideline endorsement of ward-based non-invasive pressure support (NIPS) for severely hypoxic patients who are deemed unlikely to benefit from invasive ventilation. We established a ward-based NIPS service for COVID-19 PCR-positive patients, with severe hypoxia, and in whom escalation to critical care for invasive ventilation was not deemed appropriate. A retrospective analysis of survival in these patients was undertaken. Twenty-eight patients were included. Ward-based NIPS for severe hypoxia was associated with a 50% survival in this cohort. This compares favourably with Intensive Care National Audit and Research Centre survival data following invasive ventilation in a less frail, less comorbid and younger population. These results suggest that ward-based NIPS should be considered as a treatment option in an integrated escalation strategy in all units managing respiratory failure secondary to COVID-19.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas/métodos , Infecções por Coronavirus , Fragilidade , Avaliação Geriátrica/métodos , Pandemias , Pneumonia Viral , Unidades de Cuidados Respiratórios , Insuficiência Respiratória , Idoso de 80 Anos ou mais , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Feminino , Fragilidade/diagnóstico , Fragilidade/fisiopatologia , Fragilidade/terapia , Humanos , Pulmão/diagnóstico por imagem , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde , Oximetria/métodos , Oximetria/estatística & dados numéricos , Consumo de Oxigênio , Pneumonia Viral/epidemiologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Unidades de Cuidados Respiratórios/métodos , Unidades de Cuidados Respiratórios/organização & administração , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/mortalidade , Insuficiência Respiratória/fisiopatologia , Insuficiência Respiratória/terapia , Análise de Sobrevida , Tomografia Computadorizada por Raios X/métodos , Reino Unido/epidemiologia
19.
Aging Clin Exp Res ; 32(9): 1897-1905, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32705587

RESUMO

BACKGROUND: Frailty and multimorbidity have been suggested as risk factors for severe COVID-19 disease. AIMS: We investigated, in the UK Biobank, whether frailty and multimorbidity were associated with risk of hospitalisation with COVID-19. METHODS: 502,640 participants aged 40-69 years at baseline (54-79 years at COVID-19 testing) were recruited across UK during 2006-10. A modified assessment of frailty using Fried's classification was generated from baseline data. COVID-19 test results (England) were available for 16/03/2020-01/06/2020, mostly taken in hospital settings. Logistic regression was used to discern associations between frailty, multimorbidity and COVID-19 diagnoses, after adjusting for sex, age, BMI, ethnicity, education, smoking and number of comorbidity groupings, comparing COVID-19 positive, COVID-19 negative and non-tested groups. RESULTS: 4510 participants were tested for COVID-19 (positive = 1326, negative = 3184). 497,996 participants were not tested. Compared to the non-tested group, after adjustment, COVID-19 positive participants were more likely to be frail (OR = 1.4 [95%CI = 1.1, 1.8]), report slow walking speed (OR = 1.3 [1.1, 1.6]), report two or more falls in the past year (OR = 1.3 [1.0, 1.5]) and be multimorbid (≥ 4 comorbidity groupings vs 0-1: OR = 1.9 [1.5, 2.3]). However, similar strength of associations were apparent when comparing COVID-19 negative and non-tested groups. However, frailty and multimorbidity were not associated with COVID-19 diagnoses, when comparing COVID-19 positive and COVID-19 negative participants. DISCUSSION AND CONCLUSIONS: Frailty and multimorbidity do not appear to aid risk stratification, in terms of positive versus negative results of COVID-19 testing. Investigation of the prognostic value of these markers for adverse clinical sequelae following COVID-19 disease is urgently needed.


Assuntos
Técnicas de Laboratório Clínico , Infecções por Coronavirus , Fragilidade , Multimorbidade , Doenças Musculoesqueléticas , Pandemias , Pneumonia Viral , Idoso , Betacoronavirus/isolamento & purificação , Técnicas de Laboratório Clínico/métodos , Técnicas de Laboratório Clínico/estatística & dados numéricos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Feminino , Fragilidade/diagnóstico , Fragilidade/epidemiologia , Avaliação Geriátrica/métodos , Avaliação Geriátrica/estatística & dados numéricos , Humanos , Masculino , Doenças Musculoesqueléticas/diagnóstico , Doenças Musculoesqueléticas/epidemiologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Prognóstico , Estudos Prospectivos , Medição de Risco/métodos , Fatores de Risco , Reino Unido/epidemiologia
20.
Geriatr Gerontol Int ; 20(7): 709-714, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32634855

RESUMO

BACKGROUND: In December 2019, the outbreak of coronavirus disease 2019 (COVID-19) started in Wuhan, and is now causing a worldwide pandemic. However, the experience in very elderly patients is very limited, which has important implications for the investigation of hospital infection in medical and health institutions. METHODS: Seven patients with confirmed COVID-19 infection in the Department of Geriatrics at Zhongnan Hospital of Wuhan University were included. Clinical data were retrospectively collected and analyzed. Laboratory tests and chest computed tomography (CT) images from the patients before and after the COVID-19 infection were compared. RESULTS: The median age of patients was 91 years old (87-96). Six patients had pneumonia in the last 6 months. Dyspnea occurred in one patient 64 h after the onset of the disease. In the other six patients, minor fatigue with low fever were the only other manifestations of the disease. Lymphopenia and a significant reduction in plasma globulin level was observed compared with levels before the onset of the disease. None had typical chest CT phenotypes during the early stage, except the critically ill patient mentioned who had developed "white lung" and then died. One patient even showed absorption of inflammation compared with previous hypostatic pneumonia. CONCLUSIONS: The ratio of fatal cases in very elderly patients with COVID-19 is no higher than that reported in non-elderly patients was, and probably due to a low immune response. However, the elderly patients manifested minor clinical symptoms and atypical changes in chest CT images, which usually lead to misdiagnosis or delayed diagnosis. Geriatr Gerontol Int 2020; 20: 709-714.


Assuntos
Pulmão/diagnóstico por imagem , Idoso de 80 Anos ou mais , Betacoronavirus/isolamento & purificação , China/epidemiologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/fisiopatologia , Estado Terminal/epidemiologia , Erros de Diagnóstico/prevenção & controle , Feminino , Avaliação Geriátrica/métodos , Humanos , Masculino , Mortalidade , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade , Pneumonia Viral/fisiopatologia , Avaliação de Sintomas/métodos , Tomografia Computadorizada por Raios X/métodos
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