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1.
Acta Med Indones ; 53(1): 1-4, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33818400

RESUMO

It has been a year since the Indonesian government announced its first COVID-19 identified in Jakarta. Since then, there have been more than 900,000 cases in Indonesia with case fatality rate (CFR) of 2.9%. The number of new cases per day is now ranging from 9,000 cases to almost 13,000 cases. Not only in Indonesia, but the number of new cases along with the mortality rate in other countries, such as Malaysia, Japan, United States, and Europe region also increased dramatically. COVID-19 vaccines are being investigated and the world hopes that vaccines will be the answer to tackle this pandemic. Is it really so? Immunization is an effort to induce immunity in individuals to prevent a disease or the complication related to the diseases that may be catastrophic. Immunization can be divided into passive, which is by giving certain type of antibody and active, which means that either we get the disease, or we get the antigen injected into our body.Having prior vaccination or past COVID-19 does not mean that someone is totally immune to COVID-19 as a recent study suggested that the antibody related to COVID-19 past infection is significantly decreasing after 3 months post-infection. Compliance to implementation of health protocol remained the most crucial strategy during this pandemic.


Assuntos
Fragilidade , Risco Ajustado , Vacinação , Idoso , /prevenção & controle , /efeitos adversos , Feminino , Idoso Fragilizado/estatística & dados numéricos , Fragilidade/diagnóstico , Fragilidade/epidemiologia , Avaliação Geriátrica , Humanos , Indonésia/epidemiologia , Masculino , Risco Ajustado/métodos , Risco Ajustado/organização & administração , Fatores de Risco , Soroconversão , Vacinação/métodos , Vacinação/normas , Vacinação/estatística & dados numéricos
2.
Medicine (Baltimore) ; 100(4): e24400, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530237

RESUMO

ABSTRACT: Frailty is a common geriatric condition due to aging, defined as a decrease in the functional reserve to maintain the homeostasis. As part of the aging process, body composition changes occur. This study investigated the relationship between body composition and frailty in a community-dwelling elderly Korean population.This cross-sectional cohort study analyzed data of 2,385 elderly participants (aged 70-84 years, 1131 males and 1254 females) of the Korean Frailty and Aging Cohort Study from 2016 to 2017. Body composition, including total and trunk fat masses and fat-free mass, were measured with dual-energy X-ray absorptiometry. Fat mass index (FMI), trunk fat mass index, and fat-free mass index (FFMI) represented total fat mass, trunk fat mass, and fat-free mass according to height. Based on the frailty index developed by Fried, we compared the frail and non-frail groups. Poor physical performance assessed with the short physical performance battery score of < 9 is considered frailty. To evaluate the relationship between the variables, simple and fully adjusted multivariable logistic regression analyses were performed according to sex.Among the participants, 462 (19.3%) were defined as the frail group, with a significantly high mean age of 77.9 ±â€Š4.0 years. In the logistic regression analysis of frailty based on body mass index (BMI) categories, underweight (BMI < 18 kg/m2) participants showed a high incidence of frailty in both sexes. BMI showed an association with frailty only in males. Lower FFMI was associated with a higher incidence of frailty in both sexes, which was statistically significant in the fully adjusted models. In the female, fat-related indexes including body fat percentage, FMI, and trunk fat mass index showed a significant association with poor physical performance. In contrast, males with low FFMI only showed a significant association with poor physical performance.Frailty was closely correlated with lower FFMI in both sexes. The poor physical performance associated with frailty correlated with fat-related body composition in females and fat-free mass in males, owing to the difference in body composition between the sexes. In the assessment of frailty, body composition and sex-related differences should be analyzed.


Assuntos
Idoso Fragilizado/estatística & dados numéricos , Fragilidade/epidemiologia , Vida Independente/estatística & dados numéricos , Desempenho Físico Funcional , Fatores Sexuais , Absorciometria de Fóton , Idoso , Idoso de 80 Anos ou mais , Composição Corporal , Índice de Massa Corporal , Estudos Transversais , Feminino , Fragilidade/fisiopatologia , Avaliação Geriátrica , Humanos , Modelos Logísticos , Masculino , Prevalência , República da Coreia/epidemiologia , Medição de Risco
3.
Am Fam Physician ; 103(4): 219-226, 2021 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-33587574

RESUMO

Frailty, which is a geriatric syndrome that affects 5% to 17% of older adults, is a state of increased vulnerability across multiple health domains that leads to adverse health outcomes. Frail older adults are at increased risk of falls, disability, hospitalizations, and death. Frailty may initially be overlooked or incorrectly identified as part of the normal aging process because of the variable nature of the presentation and diagnosis. Symptoms include generalized weakness, exhaustion, slow gait, poor balance, decreased physical activity, cognitive impairment, and weight loss. There is no current recommendation for routine screening. A comprehensive geriatric assessment can identify risk factors and symptoms that suggest frailty. Several validated frailty assessment tools can evaluate a patient for frailty. Patients are diagnosed as not-frail, prefrail, or frail. Patients with a larger number of frail attributes are at higher risk of poor outcomes. The management of frail patients must be individualized and tailored to each patient's goals of care and life expectancy. Physical activity and balance exercises may be suitable for patients who are less frail. Palliative care and symptom control may be appropriate for those who are more frail.


Assuntos
Pessoas com Deficiência , Terapia por Exercício/métodos , Idoso Fragilizado/estatística & dados numéricos , Fragilidade/diagnóstico , Fragilidade/terapia , Avaliação Geriátrica/métodos , Cuidados Paliativos/métodos , Idoso , Idoso de 80 Anos ou mais , Currículo , Educação Médica Continuada , Feminino , Humanos , Masculino , Fatores de Risco , Estados Unidos
4.
J Frailty Aging ; 10(1): 44-48, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33331621

RESUMO

BACKGROUND: While a multitude of definitions and operationalizations of frailty have been developed, rarely have these considered the perspective of the older adult themselves. This knowledge gap was addressed by examining older adults' self-rating of frailty. OBJECTIVES: To assess the validity of self-rated frailty and to determine whether self-rated frailty relates to mortality. DESIGN: The Manitoba Follow-up Study was initiated in 1948 as a prospective cohort study of 3,983 men. SETTING: Community dwelling older adult men. PARTICIPANTS: Survivors of the original cohort (231 men) were sent a quality of life survey in 2015. A response was received from 186 men, including 146 surveys completed by the participant himself and thus were eligible to include (completion rate of 78.4%). MEASUREMENTS: The quality of life survey is sent out annually to the study participants to ascertain information about mental, physical, and social functioning. In 2015, the Clinical Frailty Scale was adapted and added to the survey as a simple self-rating of frailty. RESULTS: The mean age of the 146 respondents in 2015 was 93.7 years (SD 2.7) Self-ratings of "moderate-severe" frailty, received from 132 men, were associated with worse measures of physical health and functional impairment, thus supporting the significance of self-rated frailty. Adjusted for age, the Hazard Ratio for mortality over the next 3 years was 3.3 (95% CI: 1.5, 7.1) for those who rated themselves as "mildly to severely frail" vs. "very fit or well, with no disease". CONCLUSION: The present study has illustrated that self-rated frailty is associated with other measures of health and that self-rated frailty predicts mortality over a three-year period. These findings support the utilization of older adult's self-ratings of frailty for new avenues of operationalizing frailty.


Assuntos
Idoso Fragilizado/estatística & dados numéricos , Fragilidade/diagnóstico , Mortalidade/tendências , Idoso , Idoso de 80 Anos ou mais , Seguimentos , Fragilidade/psicologia , Humanos , Vida Independente , Masculino , Manitoba/epidemiologia , Debilidade Muscular , Estudos Prospectivos , Qualidade de Vida
5.
Rev. esp. geriatr. gerontol. (Ed. impr.) ; 55(6): 317-325, nov.-dic. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-192480

RESUMO

ANTECEDENTES Y OBJETIVO: La pandemia por SARS-CoV-2 condiciona elevadas tasas de mortalidad en pacientes mayores hospitalizados. Actualmente, pocos estudios incluyen pacientes octogenarios y ninguno analiza el impacto del estado funcional sobre este resultado de salud. Nuestro objetivo es describir las características de los pacientes mayores de 80 años hospitalizados por coronavirus disease 2019 (COVID-19), determinar la tasa de mortalidad e identificar factores asociados. MATERIALES Y MÉTODOS: Estudio observacional prospectivo realizado en mayores de 80 años ingresados por COVID-19 en un Servicio de Geriatría. Se recogieron variables sociodemográficas, clínicas, funcionales, mentales, analíticas, radiológicas, terapéuticas y asistenciales. Se analizaron mediante análisis bivariante los factores asociados a mortalidad intrahospitalaria. RESULTADOS: Fueron incluidos 58 casos con COVID-19 confirmado por laboratorio, edad media 88,3 ± 5,4 años, 69% mujeres, 65,5% deterioro cognitivo moderado-severo e índice de Barthel previo 40,6 ± 36. Los principales síntomas fueron fiebre (60,3%), disnea (53,4%) y deterioro del estado funcional (50%). Las comorbilidades más frecuentes fueron enfermedad cardiovascular (75,9%), hipertensión arterial (HTA) (74,1%) y enfermedad renal crónica (ERC) (50%). Se detectó una tasa de mortalidad del 41,4%, siendo los factores asociados: dependencia funcional severa (OR = 3,8 [1,2-12,2]), ERC (OR = 3,2 [1,1-9,7]), deterioro cognitivo moderado-severo (OR = 4,9 [1 a 25,4]). CONCLUSIONES: Se objetivan altas tasas de mortalidad en pacientes mayores hospitalizados por COVID-19, con mayor riesgo de fallecer en aquellos con dependencia funcional severa o deterioro cognitivo. Estos hallazgos refuerzan la importancia de la Valoración Geriátrica para elaborar estrategias que permitan adecuar la toma de decisiones diagnósticas y terapéuticas y optimizar la atención al paciente anciano ante un nuevo brote epidémico


OBJECTIVE: The SARS-CoV-2 pandemic conditions high mortality rates in hospitalized elderly. Currently, a few studies include octogenarian patients and none of them analyze the impact of functional status on this health outcome. Our objective is to describe the characteristics of patients older than 80 years hospitalized for coronavirus disease 2019 (COVID-19), to determine the mortality rate and to identify associated factors. MATERIAL AND METHODS: Prospective observational study carried out on patients over 80 years admitted for COVID-19 in a Geriatrics Service. Sociodemographic, clinical, functional, mental, analytical, radiological, therapeutic and healthcare variables were collected. The factors associated with in-hospital lethality were analyzed by bivariate analysis. RESULTS: 58 cases with laboratory-confirmed COVID-19 were included, mean age 88.3 ± 5.4 years, 69% women, 65.5% moderate-severe cognitive impairment and previous Barthel index 40.66 ± 36. The main symptoms were fever (60,3%), dyspnea (53.4%) and deterioration of functional condition (50%). The most frequent comorbidities were cardiovascular disease (75.9%), hypertension (HT) (74.1%) and chronic kidney disease (CKD) (50%). A mortality rate of 41,4% was detected and the associated factors were: severe functional dependence (OR = 3.8 [1.2-12.2]), moderate-severe cognitive impairment (OR = 4.9 [1-25.4]) and CKD (OR = 3.2 [1.1-9.7]). CONCLUSION: High mortality rates are observed in older patients hospitalized for COVID-19, with a higher risk of dying in those with severe functional dependence or cognitive impairment. These findings reinforce the value of Geriatric Assessment to develop strategies to adapt diagnostic and therapeutic decision-making and to optimize care for elderly patients in the event of a new epidemic outbreak


Assuntos
Humanos , Masculino , Feminino , Idoso de 80 Anos ou mais , Infecções por Coronavirus/mortalidade , Mortalidade Hospitalar/tendências , Vírus da SARS/isolamento & purificação , Estudos Prospectivos , Indicadores de Morbimortalidade , Causas de Morte/tendências , Idoso Fragilizado/estatística & dados numéricos
8.
Artigo em Inglês | MEDLINE | ID: mdl-33352735

RESUMO

Frailty in middle-aged and older adults is associated with diabetes-related complications. The impact of and interaction between diabetes and frailty on psychosocial wellbeing and mortality in Ireland for adults aged ≥50 years were assessed using data from the Survey of Health, Ageing and Retirement in Europe. Measures included diabetes status (self-reported), frailty phenotype (≥3/5 criteria), low self-rated health ("fair" or "poor"), depression screening (EURO-D index score ≥4), and low quality of life (QoL) (CASP-12 index score < 35). Among the 970 participants, those with diabetes (n = 87) were more likely to be frail (23% vs. 8%; p < 0.001), have low self-rated health (46% vs. 19%; p < 0.001), depression (25% vs. 17%; p = 0.070), and low QoL (25% vs. 18%, p = 0.085). Adjusting for diabetes, age and sex, frailty independently predicted low self-rated health (OR: 9.79 (5.85-16.36)), depression (9.82 (5.93-16.25)), and low QoL (8.52 (5.19-13.97)). Adjusting for frailty, age and sex, diabetes independently predicted low self-rated health (2.70 (1.63-4.47)). The age-sex adjusted mortality hazard ratio was highest for frailty with diabetes (4.67 (1.08-20.15)), followed by frailty without diabetes (2.86 (1.17-6.99)) and being non-frail with diabetes (1.76 (0.59-5.22)). Frailty independently predicts lower self-reported wellbeing and is associated with reduced survival, underpinning its role as an integral part of holistic diabetes care.


Assuntos
Depressão/epidemiologia , Diabetes Mellitus/epidemiologia , Idoso Fragilizado/psicologia , Fragilidade/epidemiologia , Qualidade de Vida/psicologia , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Estudos Transversais , Depressão/psicologia , Europa (Continente)/epidemiologia , Feminino , Idoso Fragilizado/estatística & dados numéricos , Avaliação Geriátrica , Humanos , Irlanda/epidemiologia , Masculino , Pessoa de Meia-Idade , Princípios Morais , Prevalência , Apoio Social
9.
PLoS One ; 15(12): e0243548, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33326452

RESUMO

As older adults in an early stage (prefrailty) of frailty may return to a healthy state, it is necessary to examine the prevention of prefrailty. In this context, the number and types of social participation activities associated with physical prefrailty in community-dwelling older adults have remained relatively unexplored. This cross-sectional study investigates this issue by analyzing 616 participants living in Okinoshima, Shimane, a rural area of Japan, in 2019. Frailty was assessed using the 5-item frailty phenotype (unintentional weight loss, self-reported exhaustion, weakness, slow walking speed, and low physical activity). Data on social participation were obtained using a questionnaire based on participants' level of involvement with volunteer groups, sports clubs/groups, neighborhood associations, religious organizations/groups, and community elderly salons; their answers were categorized as "yes" if they answered "several times per year or more" and "no" if they answered "never." Binominal logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) of prefrailty by the number or types of social participation activities, adjusted for gender, age, body mass index, smoking, medication-taking, educational attainment, working status, and living arrangement. Of the 616 participants, 273 (44.3%) and 28 (4.5%) had prefrailty and frailty, respectively. The analysis showed that the number of social participation activities was significantly associated with lower odds of prefrailty (OR = 0.83; 95% CI, 0.74-0.94). Regarding the types of social participation, sports clubs/groups were associated with lower odds of prefrailty (OR = 0.47; 95% CI, 0.31-0.73). Participation in neighborhood associations was associated with prefrailty/frailty (OR = 0.57; 95% CI, 0.37-0.86). These results suggest that increasing the number of social participation activities or involvement in sports clubs/groups and neighborhood associations may be important to prevent physical prefrailty in the older population.


Assuntos
Idoso Fragilizado/psicologia , Fragilidade/prevenção & controle , Participação Social/psicologia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Exercício Físico , Fadiga , Feminino , Idoso Fragilizado/estatística & dados numéricos , Fragilidade/fisiopatologia , Humanos , Vida Independente/estatística & dados numéricos , Japão/epidemiologia , Modelos Logísticos , Masculino , Autorrelato , Inquéritos e Questionários , Perda de Peso
10.
Artigo em Inglês | MEDLINE | ID: mdl-33348703

RESUMO

Poor sleep quality and frailty are common problems among aged people. However, the association between sleep quality and frailty in middle-aged and older people is seldom discussed in Asia, especially in Taiwan. This study investigated this association hopefully to provide pertinent knowledge for the prevention of frailty. We conducted a cross-sectional study and enrolled 828 subjects, 237 male and 591 female, aged 50-85 years old, from a community in Northern Taiwan. Poor sleep quality was defined as the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI) > 5. Prefrailty and frailty were defined as fulfillment of one or two and three, respectively, of five phenotypic criteria: exhaustion, weakness, slowness, weight loss, and low physical activity. Our univariate analysis showed that the incidence of prefrailty/frailty in the group of poor sleep quality was higher than that in the group of CPSQI ≤ 5 (p < 0.001). Further multiple logistic regression analysis revealed that poor sleep quality was an independent factor for prefrailty and frailty status (odds ratio = 1.95, 95% confidence interval = 1.38-2.77), after adjustment for confounding factors. We concluded that poor sleep quality is independently associated with prefrailty and frailty status in our study population.


Assuntos
Idoso Fragilizado/estatística & dados numéricos , Fragilidade/epidemiologia , Força da Mão/fisiologia , Sono/fisiologia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Taiwan/epidemiologia
11.
Nutrients ; 12(11)2020 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-33147894

RESUMO

BACKGROUND: The objective of this quasi-experimental study was to determine whether bolus vitamin D supplementation taken either regularly over the preceding year or after the diagnosis of COVID-19 was effective in improving survival among hospitalized frail elderly COVID-19 patients. METHODS: Seventy-seven patients consecutively hospitalized for COVID-19 in a geriatric unit were included. Intervention groups were participants regularly supplemented with vitamin D over the preceding year (Group 1), and those supplemented with vitamin D after COVID-19 diagnosis (Group 2). The comparator group involved participants having received no vitamin D supplements (Group 3). Outcomes were 14-day mortality and highest (worst) score on the ordinal scale for clinical improvement (OSCI) measured during COVID-19 acute phase. Potential confounders were age, gender, functional abilities, undernutrition, cancer, hypertension, cardiomyopathy, glycated hemoglobin, number of acute health issues at admission, hospital use of antibiotics, corticosteroids, and pharmacological treatments of respiratory disorders. RESULTS: The three groups (n = 77; mean ± SD, 88 ± 5years; 49% women) were similar at baseline (except for woman proportion, p = 0.02), as were the treatments used for COVID-19. In Group 1 (n = 29), 93.1% of COVID-19 participants survived at day 14, compared to 81.2% survivors in Group 2 (n = 16) (p = 0.33) and 68.7% survivors in Group 3 (n = 32) (p = 0.02). While considering Group 3 as reference (hazard ratio (HR) = 1), the fully-adjusted HR for 14-day mortality was HR = 0.07 (p = 0.017) for Group 1 and HR = 0.37 (p = 0.28) for Group 2. Group 1 had longer survival time than Group 3 (log-rank p = 0.015), although there was no difference between Groups 2 and 3 (log-rank p = 0.32). Group 1, but not Group 2 (p = 0.40), was associated with lower risk of OSCI score ≥5 compared to Group 3 (odds ratio = 0.08, p= 0.03). CONCLUSIONS: Regular bolus vitamin D supplementation was associated with less severe COVID-19 and better survival in frail elderly.


Assuntos
Infecções por Coronavirus/mortalidade , Suplementos Nutricionais , Fragilidade/mortalidade , Pneumonia Viral/mortalidade , Vitamina D/uso terapêutico , Vitaminas/uso terapêutico , Idoso de 80 Anos ou mais , Betacoronavirus , Infecções por Coronavirus/sangue , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/terapia , Feminino , Idoso Fragilizado/estatística & dados numéricos , Fragilidade/sangue , Fragilidade/virologia , Hospitalização , Humanos , Masculino , Ensaios Clínicos Controlados não Aleatórios como Assunto , Pandemias , Pneumonia Viral/sangue , Pneumonia Viral/terapia , Taxa de Sobrevida
12.
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
13.
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
14.
J Am Med Dir Assoc ; 21(10): 1378-1383.e1, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32981664

RESUMO

OBJECTIVE: To describe clinical characteristics and risk factors associated with coronavirus disease 2019 (COVID-19) in long-stay nursing home residents. DESIGN AND PARTICIPANTS: Retrospective cohort study (March 16, 2020 to May 8, 2020). SETTING: Academic long-term chronic care facility (Boston, MA). PARTICIPANTS: Long-term care residents. METHODS: Patient characteristics and clinical symptoms were obtained via electronic medical records and Minimum Data Set. Staff residence was inferred by zip codes. COVID-19 infection was confirmed by polymerase chain reaction testing using nasopharyngeal swabs. Residents were followed until discharge from facility, death, or up to 21 days. Risks of COVID-19 infection were modeled by generalized estimating equation to estimate the relative risk (RR) and 95% confidence intervals (CI) of patient characteristics and staff community of residence. RESULTS: Overall 146 of 389 (37.5%) long-stay residents tested positive for COVID-19. At the time of positive test, 66 of 146 (45.5%) residents were asymptomatic. In the subsequent illness course, the most common symptom was anorexia (70.8%), followed by delirium (57.6%). During follow-up, 44 (30.1%) of residents with COVID-19 died. Mortality increased with frailty (16.7% in pre-frail, 22.2% in moderately frail, and 50.0% in frail; P < .001). The proportion of residents infected with COVID-19 varied across the long-term care units (range: 0%‒90.5%). In adjusted models, male sex (RR 1.80, 95% CI 1.07, 3.05), bowel incontinence (RR 1.97, 95% CI 1.10, 3.52), and staff residence remained significant predictors of COVID-19. For every 10% increase in the proportion of staff living in a high prevalence community, the risk of testing positive increased by 6% (95% CI 1.04, 1.08). CONCLUSIONS AND IMPLICATIONS: Among long-term care residents diagnosed with COVID-19, nearly one-half were asymptomatic at the time of diagnosis. Predictors of COVID-19 infection included male sex, bowel incontinence, and staff residence in a community with a high burden of COVID-19. Universal testing of patients and staff in communities with high COVID-19 rates is essential to mitigate outbreaks.


Assuntos
Betacoronavirus , Técnicas de Laboratório Clínico , Infecções por Coronavirus/mortalidade , Idoso Fragilizado/estatística & dados numéricos , Assistência de Longa Duração/organização & administração , Casas de Saúde/organização & administração , Pneumonia Viral/mortalidade , Fatores Etários , Idoso , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Feminino , Humanos , Masculino , Pandemias , Pneumonia Viral/terapia , Estudos Retrospectivos , Fatores de Risco
15.
Geriatr Gerontol Int ; 20(10): 974-979, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32881240

RESUMO

AIM: Heart diseases and social factors are associated with physical frailty, but there are few studies of older people living in the community. Consequently, the aim of this study was to examine the association between heart diseases, social factors and physical frailty in community-dwelling older populations including the oldest-old people. METHODS: The cross-sectional study included 1882 participants of community-dwelling older and oldest-old people. The survey site assessed questionnaires on medical history, social factors, blood samples and physical examination. Physical frailty was based on slow gait speed or weak grip strength. Associations were analyzed using multiple logistic regression with adjustments for covariate factors. RESULTS: Subjects with heart disease had a higher prevalence of physical frailty than those without heart disease. After adjusting the covariate factors, heart diseases were associated with a slow gait speed (odds ratio [OR] = 1.62; 95% confidence interval [CI]: 1.13-2.32, P = 0.009). Frequency of going outdoors and direct interaction with relatives or friends were associated with a slow gait speed (OR = 0.83, 95% CI 0.75-0.91, P ≤ 0.001 and OR = 0.87, 95% CI 0.81-0.94, P < 0.001), and associated with physical frailty (OR = 0.80, 95% CI 0.72-0.89, P ≤ 0.001 and OR = 0.88, 95% CI 0.82-0.95, P = 0.002). Living alone and frequency of direct interaction with relatives or friends were associated with physical frailty in subjects with heart disease. CONCLUSIONS: Our findings indicate that in community-dwelling older people, heart diseases and social factors were associated with physical frailty. Older people with heart disease, those living alone and the frequency of direct interaction with relatives or friends were associated with physical frailty. Geriatr Gerontol Int 2020; 20: 974-979.


Assuntos
Idoso Fragilizado/estatística & dados numéricos , Fragilidade/epidemiologia , Cardiopatias/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Avaliação Geriátrica , Humanos , Vida Independente , Relações Interpessoais , Masculino , Razão de Chances , Prevalência , Apoio Social , Inquéritos e Questionários , Velocidade de Caminhada
16.
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
17.
JMIR Mhealth Uhealth ; 8(9): e21845, 2020 09 18.
Artigo em Inglês | MEDLINE | ID: mdl-32896832

RESUMO

BACKGROUND: Technological communication methods such as telephone calls and video calls can help prevent social isolation and loneliness in frail older adults during confinement. OBJECTIVE: Our objectives were to determine which virtual communication method (ie, telephone call or video call) was preferred by confined older hospital patients and nursing home residents and the variables influencing this preference. METHODS: The TOVID (Telephony Or Videophony for Isolated elDerly) study was a cross-sectional study that was designed to examine the preference between telephone calls and video calls among frail older adults who were either hospitalized in a geriatric acute care unit or institutionalized in a long-term care and nursing home during the COVID-19 confinement period. RESULTS: A total of 132 older people were surveyed between March 25 and May 11, 2020 (mean age 88.2 years, SD 6.2); 79 (59.8%) were women. Patients hospitalized in the geriatric acute care unit were more able to establish communication independently than residents institutionalized in the long-term care and nursing home (P=.03) and were more satisfied with their communication experiences (P=.02). Overall, older people tended to favor telephone calls (73/132, 55.3%) over video calls (59/132, 44.7%); however, their satisfaction degree was similar regardless of the chosen method (P=.1), with no effect of age (P=.97) or gender (P=.2). In the geriatric acute care unit, the satisfaction degrees were similar for telephone calls (40/41, 98%) and video calls (33/38, 87%) in older patients (P=.10). Conversely, in the long-term care and nursing home, residents were more satisfied with the use of video calls to communicate with their relatives (14/15, 93%) versus the use of telephone calls (6/12, 50%; P=.02). CONCLUSIONS: Older people confined to health care settings were able to complete telephone calls more independently than video calls, and they tended to use telephone calls more often than video calls. The satisfaction degrees were similar with both modalities and even greater with video calls among long-term care and nursing home residents when they were given assistance to establish communication. TRIAL REGISTRATION: ClinicalTrials.gov NCT04333849: https://www.clinicaltrials.gov/ct2/show/NCT04333849.


Assuntos
Comportamento do Consumidor/estatística & dados numéricos , Infecções por Coronavirus/prevenção & controle , Idoso Fragilizado/psicologia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Isolamento Social , Telefone , Comunicação por Videoconferência , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/epidemiologia , Estudos Transversais , Feminino , Idoso Fragilizado/estatística & dados numéricos , Hospitalização , Humanos , Solidão , Masculino , Casas de Saúde , Pneumonia Viral/epidemiologia
18.
Med J Aust ; 213(7): 321-326, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32776351

RESUMO

OBJECTIVES: To develop and validate a frailty index, derived from aged care eligibility assessment data. DESIGN: Retrospective cohort study; analysis of the historical national cohort of the Registry of Senior Australians (ROSA). PARTICIPANTS: 903 996 non-Indigenous Australians aged 65 years or more, living in the community and assessed for subsidised aged care eligibility during 2003-2013. MAIN OUTCOME MEASURES: 44-item frailty index; summary statistics for frailty index score distribution; predictive validity with respect to mortality and entry into permanent residential aged care during the five years after assessment. RESULTS: The mean frailty index score during 2003-2013 was 0.20 (SD, 0.07; range, 0-0.41); the proportion of assessed older people with scores exceeding 0.20 increased from 32.1% in 2003-2005 to 75.0% in 2012-2013. The risks of death and entry into permanent residential aged care at one, three and five years increased with frailty index score level (at one year, high [over 0.35] v low scores [under 0.05]: hazard ratio for death, 5.99; 95% CI, 5.69-6.31; for entry into permanent residential aged care, 8.70; 95% CI, 8.32-9.11). The predictive validity (area under the receiver operating characteristic curve) of Cox proportional hazard models including age, sex, and frailty index score was 0.64 (95% CI, 0.63-0.64) for death and 0.63 (95% CI, 0.62-0.63) for entry into permanent residential aged care within one year of assessment. CONCLUSIONS: We used Australian aged care eligibility assessment program data to construct and validate a frailty index. It can be employed in aged care research in Australia, but its application to aged care planning requires further investigation.


Assuntos
Idoso Fragilizado/estatística & dados numéricos , Fragilidade/diagnóstico , Avaliação Geriátrica/métodos , Indicadores Básicos de Saúde , Idoso , Idoso de 80 Anos ou mais , Austrália , Feminino , Serviços de Saúde para Idosos , Humanos , Masculino , Valor Preditivo dos Testes , Avaliação de Programas e Projetos de Saúde , Modelos de Riscos Proporcionais , Curva ROC , Reprodutibilidade dos Testes , Fatores de Risco
19.
Age Ageing ; 49(6): 915-922, 2020 10 23.
Artigo em Inglês | MEDLINE | ID: mdl-32778870

RESUMO

BACKGROUND: COVID-19 has disproportionately affected older people. OBJECTIVE: The objective of this paper to investigate whether frailty is associated with all-cause mortality in older hospital inpatients, with COVID-19. DESIGN: Cohort study. SETTING: Secondary care acute hospital. PARTICIPANTS: Participants included are 677 consecutive inpatients aged 65 years and over. METHODS: Cox proportional hazards models were used to examine the association of frailty with mortality. Frailty was assessed at baseline, according to the Clinical Frailty Scale (CFS), where higher categories indicate worse frailty. Analyses were adjusted for age, sex, deprivation, ethnicity, previous admissions and acute illness severity. RESULTS: Six hundred and sixty-four patients were classified according to CFS. Two hundred and seventy-one died, during a mean follow-up of 34.3 days. Worse frailty at baseline was associated with increased mortality risk, even after full adjustment (P = 0.004). Patients with CFS 4 and CFS 5 had non-significant increased mortality risks, compared to those with CFS 1-3. Patients with CFS 6 had a 2.13-fold (95% CI 1.34-3.38) and those with CFS 7-9 had a 1.79-fold (95% CI 1.12-2.88) increased mortality risk, compared to those with CFS 1-3 (P = 0.001 and 0.016, respectively). Older age, male sex and acute illness severity were also associated with increased mortality risk. CONCLUSIONS: Frailty is associated with all-cause mortality risk in older inpatients with COVID-19.


Assuntos
Betacoronavirus , Infecções por Coronavirus/mortalidade , Idoso Fragilizado/estatística & dados numéricos , Fragilidade/epidemiologia , Avaliação Geriátrica/métodos , Pacientes Internados/estatística & dados numéricos , Pneumonia Viral/mortalidade , Idoso , Idoso de 80 Anos ou mais , Feminino , Mortalidade Hospitalar/tendências , Humanos , Masculino , Pandemias , Taxa de Sobrevida/tendências , Reino Unido/epidemiologia
20.
PLoS One ; 15(8): e0236111, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32790685

RESUMO

A relationship between chronic pain and frailty has been reported. The early detection and prevention of frailty are recommended, in part because community-dwelling older adults in a pre-frailty state may return to a healthy state. The relationship between chronic pain and pre-frailty is not known. Toward the goal of promoting a reversible return to health from pre-frailty, we investigated the relationship between chronic pain and pre-frailty among community-dwelling older adults. We assessed the frailty and chronic pain of 107 older adults who were participating in community health checks. The status of physical frailty was based on the five components described by Fried (2001): muscle weakness shown by handgrip strength, slowness of gait speed, weight loss, low physical activity, and exhaustion. Chronic pain was assessed based on pain intensity, the Pain Catastrophizing Scale (PCS), the Japanese version of the Geriatric Depression Scale-15 (GDS-15), and the Central Sensitization Inventory (CSI). The prevalence of chronic pain with pre-frailty was 40.2%. A hierarchical analysis revealed that PCS-measured helplessness (odds ratio [OR]: 0.88) and the CSI (OR: 0.87) were significant factors associated with the presence of chronic pain with pre-frailty. The prevalence of chronic pain with pre-frailty was high, and chronic pain and pre-frailty were strongly related. New intervention or prevention programs that take into account both chronic pain and pre-frailty must be created as soon as possible.


Assuntos
Catastrofização/epidemiologia , Dor Crônica/epidemiologia , Fragilidade/prevenção & controle , Vida Independente , Debilidade Muscular/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Catastrofização/psicologia , Dor Crônica/complicações , Dor Crônica/diagnóstico , Dor Crônica/psicologia , Estudos Transversais , Feminino , Idoso Fragilizado/psicologia , Idoso Fragilizado/estatística & dados numéricos , Fragilidade/diagnóstico , Fragilidade/etiologia , Avaliação Geriátrica , Força da Mão , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/diagnóstico , Debilidade Muscular/etiologia , Medição da Dor , Prevalência
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