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2.
J Am Med Dir Assoc ; 21(11): 1546-1554.e3, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33138936

RESUMO

OBJECTIVE: To determine predictors of in-hospital mortality related to COVID-19 in older patients. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: Patients aged 65 years and older hospitalized for a diagnosis of COVID-19. METHODS: Data from hospital admission were collected from the electronic medical records. Logistic regression and Cox proportional hazard models were used to predict mortality, our primary outcome. Variables at hospital admission were categorized according to the following domains: demographics, clinical history, comorbidities, previous treatment, clinical status, vital signs, clinical scales and scores, routine laboratory analysis, and imaging results. RESULTS: Of a total of 235 Caucasian patients, 43% were male, with a mean age of 86 ± 6.5 years. Seventy-six patients (32%) died. Nonsurvivors had a shorter number of days from initial symptoms to hospitalization (P = .007) and the length of stay in acute wards than survivors (P < .001). Similarly, they had a higher prevalence of heart failure (P = .044), peripheral artery disease (P = .009), crackles at clinical status (P < .001), respiratory rate (P = .005), oxygen support needs (P < .001), C-reactive protein (P < .001), bilateral and peripheral infiltrates on chest radiographs (P = .001), and a lower prevalence of headache (P = .009). Furthermore, nonsurvivors were more often frail (P < .001), with worse functional status (P < .001), higher comorbidity burden (P < .001), and delirium at admission (P = .007). A multivariable Cox model showed that male sex (HR 4.00, 95% CI 2.08-7.71, P < .001), increased fraction of inspired oxygen (HR 1.06, 95% CI 1.03-1.09, P < .001), and crackles (HR 2.42, 95% CI 1.15-6.06, P = .019) were the best predictors of mortality, while better functional status was protective (HR 0.98, 95% CI 0.97-0.99, P = .001). CONCLUSIONS AND IMPLICATIONS: In older patients hospitalized for COVID-19, male sex, crackles, a higher fraction of inspired oxygen, and functionality were independent risk factors of mortality. These routine parameters, and not differences in age, should be used to evaluate prognosis in older patients.


Assuntos
Infecções por Coronavirus/mortalidade , Mortalidade Hospitalar/tendências , Pneumonia Viral/mortalidade , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Comorbidade , Feminino , Previsões , Geriatria , Humanos , Masculino , Pandemias , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos
4.
J Cross Cult Gerontol ; 35(4): 455-478, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33064233

RESUMO

Successful aging is a concept that has gained popularity and relevance internationally among gerontologists in recent decades. Examining lay older adults' perspectives on successful aging can enhance our understanding of what successful aging means. We conducted a systematic review of peer reviewed studies from multiple countries published in 2010-2020 that contained qualitative responses of lay older adults to open-ended questions such as "What does successful aging mean to you?" We identified 23 studies conducted in 13 countries across North America, Western Europe, the Middle East, Asia, and Oceania. We identified no studies meeting our criteria in Africa, South America, Eastern Europe, North Asia, or Pacific Islands. Across all regions represented in our review, older adults most commonly referred to themes of social engagement and positive attitude in their own lay definitions of successful aging. Older adults also commonly identified themes of independence and physical health. Least mentioned were themes of cognitive health and spirituality. Lay definitions of successful aging varied by country and culture. Our findings suggest that gerontology professionals in fields including healthcare, health psychology, and public health may best serve older adults by providing services that align with older adults' priority of maintaining strong social engagement as they age. Lay perspectives on successful aging acknowledge the importance of positive attitude, independence, and spirituality, in addition to physical and cognitive functioning.


Assuntos
Envelhecimento/etnologia , Atitude Frente a Saúde/etnologia , Comparação Transcultural , Envelhecimento Saudável/etnologia , Adaptação Psicológica , Idoso , Idoso de 80 Anos ou mais , Ásia , Cognição , Europa (Continente) , Feminino , Geriatria , Nível de Saúde , Humanos , Masculino , Oriente Médio , América do Norte , Oceania , Pesquisa Qualitativa , Apoio Social , Espiritualidade
6.
Artigo em Inglês | MEDLINE | ID: mdl-32899652

RESUMO

Health and social care staff have had to quickly adapt, respond and improve teamwork, as a response to the COVID-19 pandemic. Our objective was to rapidly summarize the emerging evidence of new ways of working in the care of older people during this period. We conducted an exploration of the emerging evidence within the timeframe of 1 March 2020 to 11 May 2020. To capture a broad perspective, we undertook thematic analysis of Twitter data which was extracted through a broad search for new ways of working in health and social care. For a more in-depth focus on the health and social care of older people, we undertook a systematic scoping of newspapers using the Nexis UK database. We undertook a validation workshop with members of the interprofessional working group of the Irish National Integrated Care Programme for Older People, and with researchers. A total of 317 tweets were extracted related to six new ways of working. There was evidence of using telehealth to provide ongoing care to patients; interprofessional work; team meetings using online platforms; trust and collaboration within teams; as well as teams feeling empowered to change at a local level. 34 newspaper articles were extracted related to new ways of working in the care of older people, originating in England (n = 17), Wales (n = 6), Scotland (n = 6), Ireland (n = 4) and Germany (n = 1). Four main themes were captured that focused on role expansion, innovations in communication, environmental restructuring and enablement. The results of this exploration of emerging evidence show that health and social care teams can transform very rapidly. Much of the change was based on goodwill as a response to the pandemic. Further analysis of empirical evidence of changing practices should include the perspectives of older people and should capture the resources needed to sustain innovations, as well as evaluate gaps in service provision.


Assuntos
Infecções por Coronavirus/epidemiologia , Assistência à Saúde/métodos , Geriatria/métodos , Pneumonia Viral/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Inglaterra , Alemanha , Humanos , Irlanda , Jornais como Assunto , Pandemias , Escócia , Mídias Sociais , País de Gales
7.
Harefuah ; 159(9): 636-638, 2020 Sep.
Artigo em Hebraico | MEDLINE | ID: mdl-32955803

RESUMO

INTRODUCTION: Demographic changes in the developed world have resulted in population aging. Although Israel has a relatively young population, the older population is aging at a rapid rate. This has placed significant strains on health services in the community, in acute care, rehabilitation and long-term care. Geriatric medicine stands at the forefront of providing high quality care to the older population. The recognition of the importance of the "Geriatric Giants", which include immobility, instability (falls), incontinence, intellectual impairment (dementia and delirium), and iatrogenesis (including polypharmacy), has resulted in the development of improved diagnosis, prevention and treatment of these syndromes. The knowledge and understanding of aging and age-related diseases, and the development of a multidisciplinary function-based approach to assessment and treatment, have resulted in geriatricians playing a central role in the health care of older people. The current issue of Harefuah presents an overview of topics and studies of interest to Israeli researchers.


Assuntos
Geriatria , Acidentes por Quedas , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Avaliação Geriátrica , Humanos , Israel
8.
Sensors (Basel) ; 20(18)2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32932848

RESUMO

The emerging wearable medical devices open up new opportunities for the provision of health services and promise to accelerate the development of novel telemedical services. The main objective of this study was to investigate the desirable features and applications of telemedical services for the Polish older adults delivered by wearable medical devices. The questionnaire study was conducted among 146 adult volunteers in two cohorts (C.1: <65 years vs. C.2: ≥65 years). The analysis was based on qualitative research and descriptive statistics. Comparisons were performed by Pearson's chi-squared test. The questionnaire, which was divided into three parts (1-socio-demographic data, needs, and behaviors; 2-health status; 3-telemedicine service awareness and device concept study), consisted of 37 open, semi-open, or closed questions. Two cohorts were analyzed (C.1: n = 77; mean age = 32 vs. C.2: n = 69; mean age = 74). The performed survey showed that the majority of respondents were unaware of the telemedical services (56.8%). A total of 62.3% of C.1 and 34.8% of C.2 declared their understanding of telemedical services. The 10.3% of correct explanations regarding telemedical service were found among all study participants. The most desirable feature was the detection of life-threatening and health-threatening situations (65.2% vs. 66.2%). The findings suggest a lack of awareness of telemedical services and the opportunities offered by wearable telemedical devices.


Assuntos
Telemedicina/instrumentação , Dispositivos Eletrônicos Vestíveis , Adulto , Idoso , Betacoronavirus , Estudos de Coortes , Infecções por Coronavirus/epidemiologia , Feminino , Geriatria/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Ambulatorial/instrumentação , Determinação de Necessidades de Cuidados de Saúde , Pandemias , Pneumonia Viral/epidemiologia , Polônia/epidemiologia , Tecnologia de Sensoriamento Remoto/instrumentação , Inquéritos e Questionários , Tecnologia sem Fio/instrumentação
9.
Geriatr Gerontol Int ; 20(11): 1024-1028, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32964534

RESUMO

The Japan Geriatrics Society has so far announced "The Japan Geriatrics Society Position Statement 2012" and "Guidelines for the Decision-Making Processes in Medical and Long-Term Care for the Elderly - Focusing on the Use of Artificial Hydration and Nutrition" related to end-of-life care for older adults. In 2018, the Ministry of Health, Labor and Welfare revised the "Guidelines for the Decision-Making Processes in Medical and Long-Term Care in the End of Life," recommending the practice of advance care planning (ACP). This was the first time when the Japanese government publicized its stance on ACP. Immediately after the government's announcement, the Japan Medical Association announced its committee report, "The Super-aged Society and the End-of-life Care," which also recommended the practice of ACP. The guidelines were published when the society was experiencing substantial changes related to geriatric care in Japan, and required timely and ethically appropriate decision-making processes. However, because ACP is a concept imported from English-speaking countries, some Japanese people could find it difficult to understand the role and methodology of ACP because of differences in culture and the medical/long-term care system. Therefore, the Japan Geriatrics Society has decided to publish the "Recommendations for the Promotion of Advance Care Planning" for medical and long-term care professionals nationwide with the aim of using the recommendations on a daily basis. The society recognizes ACP as indispensable to improve end-of-life care for individuals, particularly for older adults. We anticipate that the recommendations will provide practical guidance for those strenuously working toward this goal. Geriatr Gerontol Int 2020; 20: 1024-1028..


Assuntos
Planejamento Antecipado de Cuidados , Tomada de Decisões , Geriatria/normas , Humanos , Japão , Assistência de Longa Duração , Sociedades Médicas , Assistência Terminal
10.
J Am Med Dir Assoc ; 21(11): 1555-1559.e2, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32978065

RESUMO

OBJECTIVES: To analyze whether frailty and comorbidities are associated with in-hospital mortality and discharge to home in older adults hospitalized for coronavirus disease 2019 (COVID-19). DESIGN: Single-center observational study. SETTING AND PARTICIPANTS: Patients admitted to geriatric care in a large hospital in Sweden between March 1 and June 11, 2020; 250 were treated for COVID-19 and 717 for other diagnoses. METHODS: COVID-19 diagnosis was clinically confirmed by positive reverse transcription polymerase chain reaction test or, if negative, by other methods. Patient data were extracted from electronic medical records, which included Clinical Frailty Scale (CFS), and were further used for assessments of the Hospital Frailty Risk Score (HFRS) and the Charlson Comorbidity Index (CCI). In-hospital mortality and home discharge were followed up for up to 25 and 28 days, respectively. Multivariate Cox regression models adjusted for age and sex were used. RESULTS: Among the patients with COVID-19, in-hospital mortality rate was 24% and home discharge rate was 44%. Higher age was associated with in-hospital mortality (hazard ratio [HR] 1.05 per each year, 95% confidence interval [CI] 1.01‒1.08) and lower probability of home discharge (HR 0.97, 95% CI 0.95‒0.99). CFS (>5) and CCI, but not HFRS, were predictive of in-hospital mortality (HR 1.93, 95% CI 1.02‒3.65 and HR 1.27, 95% CI 1.02‒1.58, respectively). Patients with CFS >5 had a lower probability of being discharged home (HR 0.38, 95% CI 0.25‒0.58). CCI and HFRS were not associated with home discharge. In general, effects were more pronounced in men. Acute kidney injury was associated with in-hospital mortality and hypertension with discharge to home. Other comorbidities (diabetes, cardiovascular disease, lung diseases, chronic kidney disease and dementia) were not associated with either outcome. CONCLUSIONS AND IMPLICATIONS: Of all geriatric patients with COVID-19, 3 out of 4 survived during the study period. Our results indicate that in addition to age, the level of frailty is a useful predictor of short-term COVID-19 outcomes in geriatric patients.


Assuntos
Comorbidade , Infecções por Coronavirus/diagnóstico , Idoso Fragilizado , Avaliação de Resultados em Cuidados de Saúde , Pneumonia Viral/diagnóstico , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Feminino , Geriatria , Humanos , Masculino , Modelos Estatísticos , Pandemias , Prognóstico , Análise de Sobrevida , Suécia
11.
Soins Gerontol ; 25(145): 31-33, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32988485

RESUMO

Geriatric caregivers are subjected to physically and psychologically demanding situations. A geriatric short-stay service has implemented measures with a unique, creative and dynamic approach. These include participatory management, benevolence and the enhancement of the quality of work.


Assuntos
Cuidadores , Geriatria , Idoso , Humanos
12.
Soins Gerontol ; 25(145): 34-39, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32988486

RESUMO

The malaise in the gerontology sector can be accounted for and new explanations for caregiver burnout can be proposed. Through a review of the literature, an overview of the issue can be drawn up and a theoretical and clinical reflection can be initiated. After having contextualized the extent of the phenomenon, we will present the plural conceptions of burn out and its origin. A new look will be taken at this syndrome by raising a set of factors potentially involved in the exhaustion of caregivers.


Assuntos
Esgotamento Profissional , Cuidadores/psicologia , Geriatria , Idoso , Humanos
14.
J Nutr Health Aging ; 24(7): 685-691, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32744561

RESUMO

A new coronavirus, called SARS-CoV-2, was identified in Wuhan, China, in December 2019. The SARS-CoV-2 spread very rapidly, causing a global pandemic, Coronavirus Disease 2019 (COVID-19). Older adults have higher peak of viral load and, especially those with comorbidities, had higher COVID-19-related fatality rates than younger adults. In this Perspective paper, we summarize current knowledge about SARS-CoV-2 and aging, in order to understand why older people are more affected by COVID-19. We discuss about the possibility that the so-called "immunosenescence" and "inflammaging" processes, already present in a fraction of frail older adults, could allow the immune escape of SARS-CoV-2 leading to COVID-19 serious complications. Finally, we propose to use geroscience approaches to the field of COVID-19.


Assuntos
Envelhecimento , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Geriatria , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Virologia , Idoso , Envelhecimento/imunologia , Envelhecimento/patologia , Humanos , Inflamação/imunologia , Inflamação/patologia , Pandemias
15.
J Nutr Health Aging ; 24(7): 705-707, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32744565

RESUMO

The COVID-19 pandemic, being the greatest challenge to our healthcare system for over a century, has its greatest impact on older patients. This subgroup has higher morbidity and mortality than younger age groups. Superimposed on this, the major preventative intervention resulting in social isolation has negative consequences. Prof. Bernard Isaacs described the "Geriatric Giant Symptoms" in 1965 and encouraged the development of interventions for immobility, instability, incontinence and impaired intellect/memory with careful management of these symptoms resulting in better outcomes for older patients including reduced admissions to Nursing Homes and mortality. The author's explore the impact of the current pandemic and, most particularly its aftermath on the provision of such interventions. In the context of a major economic crisis, resources for highly effective interventions such as joint replacement surgery, urological interventions, cataract surgery will be all be limited after this crisis. Moreover delayed access to day patient services with suboptimal access to assessments for conditions such as cognitive decline and falls as well as social care will likewise militate against addressing the "Geriatric Giant Symptoms". Thus the "Founding Fathers" of Geriatric Medicine including Prof Isaacs would be justifiably concerned regarding our ability to deliver interventions to address the "Geriatric Giant Symptoms". Current leaders in geriatric medicine, healthcare workers, funders and providers as well as advocacy groups must redouble their efforts to ensure gains made in management of older patients over 2 generations are not lost in the aftermath of this pandemic.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Geriatria , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Idoso , Infecções por Coronavirus/mortalidade , Assistência à Saúde , Pessoal de Saúde , Humanos , Casas de Saúde , Pneumonia Viral/mortalidade , Isolamento Social
16.
PLoS One ; 15(8): e0238064, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32841285

RESUMO

BACKGROUND: Inappropriate prescribing in the elderly is a critical issue in primary care, causing a higher risk of Adverse Drug Reactions (ADRs) and resulting in major patient safety concerns. At international level, many tools have been developed to identify Potentially Inappropriate Medications (PIMs). OBJECTIVE: The aim of this study was the application of Beers, Screening Tool of Older People's Prescriptions (STOPP)/Screening Tool to Alert to Right Treatment (START) and Improving Prescribing in the Elderly Tool (IPET) criteria as key tool to improve the quality of prescribing. METHODS: A retrospective study was conducted using the aforementioned criteria. Two different cohorts of elderly patients were enrolled between January 2015 and December 2016, 1800 at admission and 1466 at hospital stay. The index of each criterion divided by politherapy were correlated with comorbidities (Pearson correlation). A comparison was made between admission and hospital stay through a Student's t test of the average of the index. RESULTS: The Proton Pump Inhibitors (PPIs) were the most prescribed PIMs according Beers criteria in both patient cohorts (56%). The most detected drug-drug and drug-disease interactions at admission and at hospital stay were 3 or more drugs active on the Central Nervous System (CNS) as they can predispose to fall-risk. The most detected PIMs with STOPP criteria at admission were PPIs administered for more than 8 weeks. Inhaled ß2-agonists or antimuscarinics were the most prescribed Potential Prescription Omissions (PPOs) according to START criteria. Nonsteroidal Anti-inflammatory Drugs (NSAIDs) in patients with high blood pressure were the most detected PIMs according to IPET criteria during hospital stay. A significant correlation between the comorbidities and the all index at hospital stay, while at admission there was no significant correlation for Beers and IPET index. CONCLUSION: The prescriptive criteria were a useful tool for assessing the quality of prescriptions in the geriatric population and identifying their critical issues.


Assuntos
Prescrições de Medicamentos/normas , Medicina Baseada em Evidências , Geriatria , Admissão do Paciente/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Prescrição Inadequada/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Padrões de Referência
17.
Am J Emerg Med ; 38(9): 1834-1840, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32739854

RESUMO

Geriatric Emergency Medicine is an important frontier for study and innovation by emergency practitioners. The rapid growth of this patient population combined with complex medical and social needs has prompted research ranging from which tests and screening tools are most effective for geriatric evaluation to how we can safely manage pain in the elderly or address goals of care in the Emergency Department. This review summarizes emergency medicine articles focused on the older patient population published in 2019, which the authors consider critical to the practice of geriatric emergency medicine.


Assuntos
Bibliometria , Medicina de Emergência , Geriatria , Idoso , Humanos
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