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Hammel IS, Tosi DM, Tang F, Pott H, Ruiz JG. Frailty as a risk factor for post-acute sequelae of COVID-19 among US veterans during the Delta and Omicron waves. J Am Geriatr Soc 2023; 71:3826-3835. [PMID: 37725480 DOI: 10.1111/jgs.18584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/17/2023] [Accepted: 08/14/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Older populations have suffered the highest rates of SARS-CoV-2 infection and associated complications, including Post-Acute Sequelae of SARS-CoV-2 infection (PASC). Frailty is a geriatric syndrome that often coexists with COVID-19 infection. The vulnerability to stressors caused by multisystemic dysfunction that characterizes frailty may predispose older adults to develop PASC. METHODS Retrospective cohort study using the VA COVID-19 Shared Data Resource to identify US veterans testing positive for SARS-CoV-2 between July 2021 and February 2022, without prior positive tests and who were alive 30 days after infection. Frailty was calculated using a 31-item VA Frailty Index generated from electronic health records. We categorized Veterans into robust (FI ≤ 0.10), prefrail (FI: >0.10- < 0.21), and frail (FI ≥ 0.21). We assessed the association between frailty and PASC and vaccination and PASC using Cox survival model, adjusting for covariates. RESULTS We identified 245,857 COVID-19-positive veterans surviving 30 days after infection. The mean age was 57.5 ± 16.5 years; 87.2% were males, 68.1% were white, and 9.0% were Hispanic. Almost half of the sample (48.9%) were classified as robust, while 28.3% were pre-frail and 22.7% were frail; 99,886 (40.6%) were fully vaccinated, and 33,516 (13.6%) received booster doses. Over a median follow-up of 143 days (IQR = 101), 23,890 (9.7%) patients developed PASC. Within 6 months after infection, frailty and pre-frailty were associated with a 41% (adjusted HR [aHR]:1.40 (95% CI: 1.35-1.47) and 15% (aHR: 1.17 (95% CI: 1.11-1.19) increase in the risk of PASC compared with the robust, respectively. Vaccination and booster doses before infection were associated with a 27% (aHR: 0.73 (95% CI: 0.71-0.75) and 33% (aHR: 0.66 (95% CI: 0.63-0.69) reduction in the risk of developing PASC, respectively. CONCLUSIONS Frailty was associated with an increased risk of developing PASC. Vaccination was associated with a decreased risk of PASC, further reduced by booster doses. Early recognition of frailty in patients with COVID-19 may assist in the early identification and management of PASC.
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Affiliation(s)
- Iriana S Hammel
- Geriatric Research Education and Clinical Center, Miami VA Healthcare System, Miami, Florida, USA
- Division of Geriatrics and Palliative Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Dominique M Tosi
- Geriatric Research Education and Clinical Center, Miami VA Healthcare System, Miami, Florida, USA
- Division of Geriatrics and Palliative Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Fei Tang
- Geriatric Research Education and Clinical Center, Miami VA Healthcare System, Miami, Florida, USA
| | - Henrique Pott
- Department of Medicine, Universidade Federal de São Carlos, São Carlos, São Paulo, Brazil
| | - Jorge G Ruiz
- Geriatric Research Education and Clinical Center, Miami VA Healthcare System, Miami, Florida, USA
- Division of Geriatric Medicine, Memorial Healthcare System, Hollywood, Florida, USA
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Nair SP, Quigley AL, Moa A, Chughtai AA, Macintyre CR. Monitoring the burden of COVID-19 and impact of hospital transfer policies on Australian aged-care residents in residential aged-care facilities in 2020. BMC Geriatr 2023; 23:507. [PMID: 37608356 PMCID: PMC10463348 DOI: 10.1186/s12877-023-04154-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 07/05/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Residential aged-care facilities in Australia emerged as the high-risk setting the COVID-19 outbreaks due to community transmission. The vulnerable aged-care residents of these facilities suffered due to low hospital transfers and high mortality and morbidity rates. This study aimed to monitor and report the burden of COVID-19 in residential aged-care facilities across Australia and the impact of hospital transfer policies on resident hospitalisation during the first year of the pandemic. METHODS We conducted a retrospective cohort study by collecting data from weekly aged-care outbreak reports published by open sources and official government sources between 1st March and 20th November 2020. A comprehensive line list of outbreaks was created using open-source data. The line list included the name of the facility, location, COVID-19 cases among residents, & staff, resident hospitalisations, mode of transmission, number of resident deaths, and state policies involving resident hospitalisation. We also searched the websites of these facilities to collect data on their COVID-19 policies for the residents, staff, and visitors. Statistical analyses were performed on the data obtained. RESULTS 126 aged-care COVID-19 outbreaks were identified in Australia during the study period. The incidence rate of COVID-19 infections among aged-care residents in Australia was (1118.5 per 100,000 resident population) which is 10 times higher than the general population (107.6 per 100,000 population). The hospitalisation rate for aged-care residents in Australia was 0.93 per 100,000 population. The hospitalisation rate of aged-care residents in Victoria was 3.14 per 100,000 population despite having the highest COVID-19 cases. Excluding South Australia, all states followed ad-hoc case-by-case hospital transfer policies for aged-care residents. CONCLUSION This study documented a higher risk of COVID-19 infection for aged-care residents and workers but found low hospitalisation rates among residents across Australia. The hospitalisation rates in Victoria were higher than the national average but low when considering the COVID-19 infection rates in the state. The hospitalisation rates could have been impacted due to the state hospital transfer policies at that time. Immediate transfer of infected residents to hospitals may improve their survival and reduce the risk of infection to the other residents, as healthcare settings have more advanced infection control measures and are well-equipped with trained staff and resources.
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Affiliation(s)
- Shruti Premshankar Nair
- Ingham Institute, SWSLHD, Liverpool, Sydney, NSW 2170 Australia
- Biosecurity Research Program, The Kirby Institute, UNSW, Wallace Wurth Building, High St, Kensington Campus, Kensington, NSW 2052 Australia
| | - Ashley L Quigley
- Biosecurity Research Program, The Kirby Institute, UNSW, Wallace Wurth Building, High St, Kensington Campus, Kensington, NSW 2052 Australia
| | - Aye Moa
- Biosecurity Research Program, The Kirby Institute, UNSW, Wallace Wurth Building, High St, Kensington Campus, Kensington, NSW 2052 Australia
| | - Abrar Ahmad Chughtai
- School of Population Health, UNSW Medicine, Samuel’s building, Kensington, Sydney, NSW 2052 Australia
| | - Chandini Raina Macintyre
- Biosecurity Research Program, The Kirby Institute, UNSW, Wallace Wurth Building, High St, Kensington Campus, Kensington, NSW 2052 Australia
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Bulut EA, Ozden G, Isik AT. An atypical presentation of COVID-19: Hidden risk for seniors to misdiagnose. North Clin Istanb 2023; 10:521-523. [PMID: 37719254 PMCID: PMC10500241 DOI: 10.14744/nci.2022.35336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/04/2022] [Indexed: 11/20/2022] Open
Abstract
The outbreak of coronavirus disease (COVID-19) was announced as a pandemic by the World Health Organization in March 2020. Clinical manifestations include cough, fever, dyspnea, myalgia, and loss of sense of smell and taste. Less common extrapulmonary signs and symptoms such as cutaneous manifestations, diarrhea, confusion, functional decline have been reported in the literature. Older patients with multiple comorbidities are at a greater risk for severe disease and death and are vulnerable to atypical presentations due to changes in organ systems, multimorbidity, cognitive impairment, and sensory disturbances. In this case, a 77-year-old patient diagnosed with COVID-19 pneumonia presented with atypically acute urticaria with angioedema was reported. Although there were no typical signs of the disease, such as cough or shortness of breath, the patient's laboratory values, and chest imaging were compatible with COVID-19. Therefore, the diagnosis of COVID-19 should be considered in older patients presenting with subtle signs or cutaneous manifestations.
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Affiliation(s)
- Esra Ates Bulut
- Department of Geriatric Medicine, Adana City Training and Research Hospital, Adana, Turkiye
| | - Guzin Ozden
- Department of Allergy and Immunology, Adana City Training and Research Hospital, Adana, Turkiye
| | - Ahmet Turan Isik
- Department of Geriatric Medicine, Dokuz Eylul University Faculty of Medicine, Izmir, Turkiye
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Tajmirriahi M, Sami R, Mansourian M, Khademi N, Hosseini NS, Dehghan M, Soltaninejad F. The clinical manifestation and outcome of COVID-19 in patients with a history of ischemic heart disease; a retrospective case-control study. BMC Cardiovasc Disord 2023; 23:241. [PMID: 37149583 PMCID: PMC10163857 DOI: 10.1186/s12872-023-03256-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 04/21/2023] [Indexed: 05/08/2023] Open
Abstract
INTRODUCTION Coronary artery disease (CAD) is considered an independent risk factor for COVID-19. However, no study has specifically examined the clinical manifestations and outcomes of COVID-19 in patients with ischemic heart disease (IHD). METHODS In a retrospective case-control study between 20 March 2020 to 20 May 2020, the medical record of 1611 patients with laboratory-confirmed SARS-CoV-2 infection was reviewed. IHD was defined as a history of an abnormal coronary angiography, coronary angioplasty, coronary artery bypass graft (CABG), or chronic stable angina. Demographic data, past medical history, drug history, symptoms, vital signs, laboratory findings, outcome, and death were investigated from medical records. RESULTS 1518 Patients (882 men (58.1%)) with a mean age of 59.3 ± 15.5 years were included in the study. Patients with IHD (n = 300) were significantly less likely to have fever (OR: 0.170, 95% CI: 0.34-0.81, P < 0.001), and chills (OR: 0.74, 95% CI: 0.45-0.91, P < 0.001). Patients with IHD were 1.57 times more likely to have hypoxia (83.3% vs. 76%, OR: 1.57, 95% CI: 1.13-2.19, P = 0.007). There was no significant difference in terms of WBC, platelets, lymphocytes, LDH, AST, ALT, and CRP between the two groups (P > 0.05). After adjusting for demographic characteristics, comorbidities and vital signs, the risk factors for mortality of these patients were older age (OR: 1.04 and 1.07) and cancer (OR: 1.03, and 1.11) in both groups. In addition, in the patients without IHD, diabetes mellitus (OR: 1.50), CKD (OR: 1.21) and chronic respiratory diseases (OR: 1.48) have increased the odds of mortality. In addition, the use of anticoagulants (OR: 2.77) and calcium channel blockers (OR: 2.00) has increased the odds of mortality in two groups. CONCLUSION In comparison with non-IHD, the symptoms of SARS-CoV-2 infection such as fever, chills and diarrhea were less common among patients with a history of IHD. Also, older age, and comorbidities (including cancer, diabetes mellitus, CKD and chronic obstructive respiratory diseases) have been associated with a higher risk of mortality in patients with IHD. In addition, the use of anticoagulants and calcium channel blockers has increased the chance of death in two groups without and with IHD.
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Affiliation(s)
- Marzieh Tajmirriahi
- Hypertension Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ramin Sami
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marjan Mansourian
- Department of Biology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Niloufar Khademi
- Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Mehrneagar Dehghan
- Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Forogh Soltaninejad
- Bamdad Respiratory and Sleep Research Center, Pulmonary ward, Isfahan University of Medical Sciences, Isfahan, Iran.
- Khorshid Hospital, Ostandari St, Isfahan, Iran.
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Sendagire H, Kiwuwa S, Dhamani A, Akugizibwe R, Lwasa Y, Bukenya A, Mukasa HK, Kakeeto P, Nankinga Z, Bbosa G, Babirye J, Nankabirwa H, Nabadda S. Staging of COVID-19 disease; using selected laboratory profiles for prediction, prevention and management of severe SARS-CoV-2 infection in Africa-review. Afr Health Sci 2023; 23:1-15. [PMID: 37545952 PMCID: PMC10398495 DOI: 10.4314/ahs.v23i1.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
There are many uncertainties on the future management of the coronavirus disease 19 (COVID-19) in Africa. By July 2021, Africa had lagged behind the rest of the world in Covid-19 vaccines uptake, accounting for just 1.6% of doses administered globally. During that time COVID 19 was causing an average death rate of 2.6% in Africa, surpassing the then global average of 2.2%. There were no clear therapeutic guidelines, yet inappropriate and unnecessary treatments may have led to unwanted adverse events such as worsening of hyperglycemia and precipitating of ketoacidosis in administration of steroid therapy. in order to provide evidence-based policy guidelines, we examined peer-reviewed published articles in PubMed on COVID 19, or up-to date data, we focused our search on publications from 1st May 2020 to 15th July, 2021. For each of the studies, we extracted data on pathophysiology, selected clinical chemistry and immunological tests, clinical staging and treatment. Our review reports a gross unmet need for vaccination, inadequate laboratory capacity for immunological tests and the assessment of individual immune status, clinical staging and prediction of disease severity. We recommend selected laboratory tools in the assessment of individual immune status, prediction of disease severity and determination of the exact timing for suitable therapy, especially in individuals with co-morbidities.
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Affiliation(s)
- Hakim Sendagire
- College of Health Sciences, Makerere University, Kampala, Uganda
- Faculty of Health Sciences, Islamic University in Uganda
- National Health Laboratory and Diagnostics Services, Ministry of Health, Uganda
| | - Steven Kiwuwa
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Ali Dhamani
- College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Yasin Lwasa
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Andrew Bukenya
- College of Health Sciences, Makerere University, Kampala, Uganda
| | | | | | | | - Godfrey Bbosa
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Juliet Babirye
- College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Susan Nabadda
- National Health Laboratory and Diagnostics Services, Ministry of Health, Uganda
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Risk factors and outcomes of delirium in hospitalized older adults with COVID-19: A systematic review and meta-analysis. AGING AND HEALTH RESEARCH 2023; 3:100125. [PMID: 36778764 PMCID: PMC9894681 DOI: 10.1016/j.ahr.2023.100125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 02/05/2023] Open
Abstract
Background Older adults with COVID-19 are more likely to present with atypical symptoms, notably delirium. The main objective of this meta-analysis is to identify risk factors for delirium and outcomes of delirium in hospitalized older adults (65 years or above) with COVID-19. Methods Comprehensive literature search of Embase, CINAHIL, Medline and Web of Science was performed for published literature until 31st August 2021. Two independent researchers evaluated study eligibility and assessed study quality using the Newcastle Ottawa Scale (NOS) for cohort studies and Joanna Briggs Institute (JBI) critical appraisal tools for case series. The association of various predisposing factors with delirium in this cohort was reported as odds ratio (OR) and its 95% confidence interval (CI). Results A total of 31 studies from 11 countries were included in this review. Most of the included studies investigated patients from non-ICU settings (n = 24; 77.4%). Frailty (OR 3.52, 95% CI: 1.96-6.31, p<0.0001, I2=71.63%), cognitive impairment including dementia (OR 6.17, 95% CI: 2.92-13.07, p<0.00001, I2=88.63%) and being nursing home residents (OR 1.72, 95% CI: 1.31-2.24, p<0.0001, I2=0) were significantly associated with increased likelihood of developing delirium in older adults with COVID-19. The presence of delirium also significantly increases mortality risk in hospitalized older adults with COVID-19 (OR 2.51, 95% CI: 1.51-4.17, p<0.0001, I2=89.3%). Conclusion Our review identifies key factors associated with increased risk of developing delirium in hospitalized older adults with COVID-19. Identification of patients at risk of delirium and attention to these factors early during admission may improve outcomes for this vulnerable cohort.
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Fong TG, Albaum JA, Anderson ML, Cohen SG, Johnson S, Supiano MA, Vlisides PE, Wade HL, Weinberg L, Wierman HR, Zachary W, Inouye SK. The Modified and Extended Hospital Elder Life Program: A remote model of care to expand delirium prevention. J Am Geriatr Soc 2023; 71:935-945. [PMID: 36637405 PMCID: PMC10023347 DOI: 10.1111/jgs.18212] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/06/2022] [Accepted: 12/08/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Delirium is a common complication of hospitalization and is associated with poor outcomes. Multicomponent delirium prevention strategies such as the Hospital Elder Life Program (HELP) have proven effective but rely on face-to-face intervention protocols and volunteer staff, which was not possible due to restrictions during the COVID-19 pandemic. We developed the Modified and Extended Hospital Elder Life Program (HELP-ME), an innovative adaptation of HELP for remote and/or physically distanced applications. METHODS HELP-ME protocols were adapted from well-established multicomponent delirium prevention strategies and were implemented at four expert HELP sites. Each site contributed to the protocol modifications and compilation of a HELP-ME Operations Manual with standardized protocols and training instructions during three expert panel working groups. Implementation was overseen and monitored during seven learning sessions plus four coaching sessions from January 8, 2021, through September 24, 2021. Feasibility of implementing HELP-ME was measured by protocol adherence rates. Focus groups were conducted to evaluate the acceptability, provide feedback, and identify facilitators and barriers to implementation. RESULTS A total of 106 patients were enrolled across four sites, and data were collected for 214 patient-days. Overall adherence was 82% (1473 completed protocols/1798 patient-days), achieving our feasibility target of >75% overall adherence. Individual adherence rates ranged from 55% to 96% across sites for the individual protocols. Protocols with high adherence rates included the nursing delirium protocol (96%), nursing medication review (96%), vision (89%), hearing (87%), and orientation (88%), whereas lower adherence occurred with fluid repletion (64%) and range-of-motion exercises (55%). Focus group feedback was generally positive for acceptability, with recommendations that an optimal approach would be hybrid, balancing in-person and remote interventions for potency and long-term sustainability. CONCLUSIONS HELP-ME was fully implemented at four HELP sites, demonstrating feasibility and acceptability. Testing hybrid approaches and evaluating effectiveness is recommended for future work.
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Affiliation(s)
- Tamara G. Fong
- Departments of Neurology and Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, MA
| | | | | | - Sara G. Cohen
- California Pacific Medical Center, Sutter Health, San Francisco, CA
| | - Shauni Johnson
- Division of Geriatrics, Primary Care Institute, Allegheny Health Network, Pittsburgh, PA
| | - Mark A. Supiano
- Geriatrics Division, University of Utah School of Medicine and University of Utah Center on Aging, Salt Lake City, Utah
| | - Philip E. Vlisides
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI
- Center for Consciousness Science, University of Michigan, Ann Arbor, MI
| | - Harley L. Wade
- Division of Geriatrics, Maine Medical Center, Portland, ME
| | - Lyn Weinberg
- Division of Geriatrics, Primary Care Institute, Allegheny Health Network, Pittsburgh, PA
| | | | - Wendy Zachary
- California Pacific Medical Center, Sutter Health, San Francisco, CA
| | - Sharon K. Inouye
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, MA
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van Son JE, Kahn ECP, van der Bol JM, Barten DG, Blomaard LC, van Dam C, Ellerbroek J, Jansen SWM, Lekx A, van der Linden CMJ, Looman R, Maas HAAM, Mattace-Raso FUS, Mooijaart SP, van Munster BC, Peters A, Polinder-Bos HA, Smits RAL, Spies PE, Wassenburg A, Wassenburg N, Willems HC, Schouten HJ, Robben SHM. Atypical presentation of COVID-19 in older patients is associated with frailty but not with adverse outcomes. Eur Geriatr Med 2023; 14:333-343. [PMID: 36749454 PMCID: PMC9902812 DOI: 10.1007/s41999-022-00736-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/24/2022] [Indexed: 02/08/2023]
Abstract
PURPOSE Older patients with COVID-19 can present with atypical complaints, such as falls or delirium. In other diseases, such an atypical presentation is associated with worse clinical outcomes. However, it is not known whether this extends to COVID-19. We aimed to study the association between atypical presentation of COVID-19, frailty and adverse outcomes, as well as the incidence of atypical presentation. METHODS We conducted a retrospective observational multi-center cohort study in eight hospitals in the Netherlands. We included patients aged ≥ 70 years hospitalized with COVID-19 between February 2020 until May 2020. Atypical presentation of COVID-19 was defined as presentation without fever, cough and/or dyspnea. We collected data concerning symptoms on admission, demographics and frailty parameters [e.g., Charlson Comorbidity Index (CCI) and Clinical Frailty Scale (CFS)]. Outcome data included Intensive Care Unit (ICU) admission, discharge destination and 30-day mortality. RESULTS We included 780 patients, 9.5% (n = 74) of those patients had an atypical presentation. Patients with an atypical presentation were older (80 years, IQR 76-86 years; versus 79 years, IQR 74-84, p = 0.044) and were more often classified as severely frail (CFS 6-9) compared to patients with a typical presentation (47.6% vs 28.7%, p = 0.004). Overall, there was no significant difference in 30-day mortality between the two groups in univariate analysis (32.4% vs 41.5%; p = 0.173) or in multivariate analysis [OR 0.59 (95% CI 0.34-1.0); p = 0.058]. CONCLUSIONS In this study, patients with an atypical presentation of COVID-19 were more frail compared to patients with a typical presentation. Contrary to our expectations, an atypical presentation was not associated with worse outcomes.
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Affiliation(s)
- Joy E. van Son
- Department of Geriatric Medicine, Elisabeth-TweeSteden Hospital, Location ETZ Elisabeth, Post Office Box 90151, 5000 LC Tilburg, The Netherlands
| | - Elisabeth C. P. Kahn
- Department of Geriatric Medicine and Centre of Excellence for Old Age Medicine, Gelre Hospitals, Apeldoorn and Zutphen, The Netherlands
| | | | - Dennis G. Barten
- Department of Emergency Medicine, VieCuri Medical Centre, Venlo, The Netherlands
| | - Laura C. Blomaard
- Section Geriatrics, Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - Carmen van Dam
- Division of Geriatric Medicine, Department of Internal Medicine, Zaans Medisch Centrum, Zaandam, The Netherlands
| | - Jacobien Ellerbroek
- Department of Internal Medicine, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Steffy W. M. Jansen
- Department of Geriatric Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - Anita Lekx
- Department of Emergency Medicine, VieCuri Medical Centre, Venlo, The Netherlands
| | | | - Roy Looman
- Division of Geriatric Medicine, Department of Internal Medicine, Zaans Medisch Centrum, Zaandam, The Netherlands
| | - Huub A. A. M. Maas
- Department of Geriatric Medicine, Elisabeth-TweeSteden Hospital, Location ETZ Elisabeth, Post Office Box 90151, 5000 LC Tilburg, The Netherlands
| | - Francesco U. S. Mattace-Raso
- Department of Internal Medicine, Division of Geriatric Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Simon P. Mooijaart
- Section Geriatrics, Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - Barbara C. van Munster
- Department of Internal Medicine and Geriatrics, University Medical Centre Groningen, Groningen, The Netherlands
| | - Annefleur Peters
- Department of Emergency Medicine, VieCuri Medical Centre, Venlo, The Netherlands
| | - Harmke A. Polinder-Bos
- Department of Internal Medicine, Division of Geriatric Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Rosalinde A. L. Smits
- Section Geriatrics, Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - Petra E. Spies
- Department of Geriatric Medicine and Centre of Excellence for Old Age Medicine, Gelre Hospitals, Apeldoorn and Zutphen, The Netherlands
| | - Anna Wassenburg
- Department of Geriatric Medicine, Alrijne Hospital, Leiderdorp, The Netherlands
| | - Nora Wassenburg
- Department of Geriatric Medicine, Alrijne Hospital, Leiderdorp, The Netherlands
| | - Hanna C. Willems
- Section Geriatrics, Department of Internal Medicine, Amsterdam University Medical Centre, Location AMC, Amsterdam, The Netherlands
| | - Henrike J. Schouten
- Department of Geriatric Medicine and Centre of Excellence for Old Age Medicine, Gelre Hospitals, Apeldoorn and Zutphen, The Netherlands
| | - Sarah H. M. Robben
- Department of Geriatric Medicine, Elisabeth-TweeSteden Hospital, Location ETZ Elisabeth, Post Office Box 90151, 5000 LC Tilburg, The Netherlands
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High severe acute respiratory coronavirus virus 2 (SARS-CoV-2) seroconversion rate among geriatric staff from Strasbourg University Hospitals. Infect Control Hosp Epidemiol 2022; 43:1980-1981. [PMID: 34486510 PMCID: PMC8458838 DOI: 10.1017/ice.2021.402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Duffy T, Seaton RA, McKeown A, Keeley P, Sanzone N, Quate L, Farmer E, Stubbs H. Hospital Specialist Palliative Care Team Influence on End-of-Life Care in Coronavirus Disease 2019? A Retrospective Observational Cohort Study. Palliat Med Rep 2022; 3:235-243. [PMCID: PMC9629908 DOI: 10.1089/pmr.2022.0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2022] [Indexed: 11/05/2022] Open
Abstract
Objectives: The coronavirus 19 disease (COVID-19) pandemic has led to a renewed focus on end-of-life care. The majority of COVID-19 deaths occur in hospital, with patients cared for by generalists and hospital specialist palliative care teams (HSPCTs). This project aims at exploring the potential influences of HSPCTs on end-of-life care in COVID-19. Methods: A retrospective observational study was carried out by exploring four end-of-life care themes in a Scottish hospital population who died from COVID-19. Comparison was made between cohorts seen by HSPCTs versus generalist clinicians. Results: Analysis of 119 patients across NHS Greater Glasgow and Clyde (NHSGGC) health board demonstrated that COVID-19 patients seen by HSPCTs were more likely to be younger (median 77 vs. 81 years; p = 0.02), have a cancer diagnosis (21.7% vs. 5.4%; p = 0.01), die sooner after admission (median four vs. six days; p < 0.01), and be commenced on a syringe driver (89.1% vs. 42.5%; p < 0.01). Differences detected across four end-of-life care themes comparing HSPCTs with generalist teams were minimal with documentation and prescribing in keeping with available guidance. Conclusion: Consistencies in end-of-life care observed across NHSGGC cohorts draw attention to the potential wider impact of HSPCT roles, including education, guideline development, and mentoring. Understanding such diverse effects is important to support funding and development of HSPCTs. Further research is required to better quantify the impact and heterogenous influences of HSPCTs in general.
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Affiliation(s)
- Tony Duffy
- St Columba's Hospice Care, Edinburgh, United Kingdom.,*Address correspondence to: Tony Duffy, MBChB (hons), MSc, MRCP, St. Columba's Hospice Care, Edinburgh EH5 3RW, United Kingdom;
| | - R. Andrew Seaton
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Alistair McKeown
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Paul Keeley
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | | | - Leza Quate
- Inverclyde Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Eoghan Farmer
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Harrison Stubbs
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
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11
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Jirjees F, Barakat M, Shubbar Q, Othman B, Alzubaidi H, Al-Obaidi H. Perceptions of COVID-19 symptoms, prevention, and treatment strategies among people in seven Arab countries: A cross-sectional study. J Infect Public Health 2022; 15:1108-1117. [PMID: 36137360 PMCID: PMC9462932 DOI: 10.1016/j.jiph.2022.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 08/13/2022] [Accepted: 08/29/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUP the widespread COVID-19 infection worldwide has resulted in the inability of healthcare facilities to receive all infected patients; therefore, most are treated at home. In addition, factors such as high mortality, types and severity of symptoms, and the prevalence of unreliable information have prompted patients to resort to self-treatment. OBJECTIVES To assess prevention, treatment, degree of symptoms, and sources of information among patients with COVID-19 in Arab countries METHOD: A cross-sectional study was conducted in seven Arab countries: Algeria, Egypt, Iraq, Lebanon, Libya, Tunisia, and the United Arab of Emirates. People who have recovered from COVID-19 completed the study questionnaire. Score of symptoms during and after COVID-19 infection has been calculated by giving the participants a list of 13 symptoms. RESULTS A total of 3519 participants completed the survey. Mostly females (68.3%), and aged between 18 and 40 years old (59.4%). Prophylaxis treatments, including vaccines and antibiotics, have been used in around 40% of the participants. The total average score of symptoms during the infection period was found 7.31 ± 3.66 out of 13. However, the symptoms score upon recovery was low (0.48 ± 1.11 score). The significant associations with increased incidence of symptoms during infection were reported with older people, married, divorced or widowed, people with chronic diseases, and obese. Moreover, significant associations with decreased symptoms were reported with those who worked in the health sector, non- or ex-smokers, and vaccinated people. CONCLUSION The use of medication and other treatments to prevent infection with COVID-19 was common among the participants in the seven countries. Taking the vaccine was the only effect on the number of symptoms experienced by patients. Although nearly two years have passed since the onset of the disease, there is still a need to raise treatment awareness among patients at home.
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Affiliation(s)
| | - Muna Barakat
- School of Pharmacy, Applied Science Private University, Jordan
| | | | - Bayan Othman
- School of Pharmacy, Applied Science Private University, Jordan
| | | | - Hala Al-Obaidi
- College of Pharmacy and Health Sciences, Ajman University, UAE
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12
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Tang F, Hammel IS, Andrew MK, Ruiz JG. COVID-19 mRNA vaccine effectiveness against hospitalisation and death in veterans according to frailty status during the SARS-CoV-2 delta (B.1.617.2) variant surge in the USA: a retrospective cohort study. THE LANCET. HEALTHY LONGEVITY 2022; 3:e589-e598. [PMID: 35935474 PMCID: PMC9342932 DOI: 10.1016/s2666-7568(22)00166-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background Studies have shown that COVID-19 vaccination is effective at preventing infection and death in older populations. However, whether vaccination effectiveness is reduced in patients with frailty is unclear. We aimed to compare vaccine effectiveness against hospitalisation and death after COVID-19 during the surge of the delta (B.1.617.2) variant of SARS-CoV-2 according to patients' frailty status. Methods In this retrospective cohort study, we used data derived from the US Veterans Health Administration (VHA) facilities and the US Department of Veterans Affairs (VA) COVID-19 Shared Data Resource, which contains information from the VA National Surveillance Tool, death certificates, and National Cemetery Administration. We included veterans aged 19 years or older who tested positive for SARS-CoV-2 using RT-PCR or antigen tests between July 25 and Sept 30, 2021, with no record of a previous positive test. Deaths were identified through VHA facilities, death certificates, and National Cemetery Administration data available from VA databases. We also retrieved data including sociodemographic characteristics, medical conditions diagnosed at baseline, frailty score, and vaccination information. The primary outcomes were COVID-19-associated hospitalisations and all-cause deaths at 30 days from testing positive for SARS-CoV-2. The odds ratio (OR) for COVID-19-associated hospitalisation and hazard ratio (HR) for death of vaccinated patients compared with the unvaccinated patients were estimated according to frailty categories of robust, pre-frail, or frail. Vaccine effectiveness was estimated as 1 minus the OR for COVID-19-associated hospitalisation, and 1 minus the HR for death. Findings We identified 57 784 veterans (mean age 57·5 years [SD 16·7], 50 642 [87·6%] males, and 40 743 [70·5%] White people), of whom 28 497 (49·3%) were categorised as robust, 16 737 (29·0%) as pre-frail, and 12 550 (21·7%) as frail. There were 2577 all-cause deaths (676 [26·2%] in the vaccinated group and 1901 [73·8%] in the unvaccinated group), and 7857 COVID-19-associated hospitalisations (2749 [35·0%] in the vaccinated group and 5108 [65·0%] in the unvaccinated group) within 30 days of a positive SARS-CoV-2 test. Vaccine effectiveness against COVID-19-associated hospitalisation within 30 days of a positive SARS-CoV-2 test was 65% (95% CI 61-69) in the robust group, 54% (48-58) in the pre-frail group, and 36% (30-42) in the frail group. By 30 days of a positive SARS-CoV-2 test, the vaccine effectiveness for all-cause death was 79% (95% CI 74-84) in the robust group, 79% (75-83) in the pre-frail group, and 68% (63-71) in the frail group. Interpretation Compared with non-frail patients (pre-frail and robust), those with frailty had lower levels of vaccination protection against COVID-19-associated hospitalisation and all-cause death. Future studies investigating COVID-19 vaccine effectiveness should incorporate frailty assessments and actively recruit older adults with frailty. Funding Miami VA Healthcare System Geriatric Research Education and Clinical Center.
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Affiliation(s)
- Fei Tang
- Geriatric Research Education and Clinical Center, Miami VA Healthcare System, Miami, FL, USA
| | - Iriana S Hammel
- Geriatric Research Education and Clinical Center, Miami VA Healthcare System, Miami, FL, USA
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Melissa K Andrew
- Department of Medicine (Geriatrics) and Canadian Center for Vaccinology, Dalhousie University, Halifax, NS, Canada
| | - Jorge G Ruiz
- Geriatric Research Education and Clinical Center, Miami VA Healthcare System, Miami, FL, USA
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
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13
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Delgado-Parada E, Alonso-Sánchez M, Ayuso-Mateos JL, Robles-Camacho M, Izquierdo A. Liaison psychiatry before and after the COVID-19 pandemic. Psychiatry Res 2022; 314:114651. [PMID: 35640325 PMCID: PMC9124364 DOI: 10.1016/j.psychres.2022.114651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 05/20/2022] [Accepted: 05/21/2022] [Indexed: 01/13/2023]
Abstract
INTRODUCTION the COVID-19 pandemic had an impact on hospital admissions. The clinical profiles of patients referred to liaison psychiatry teams (LPT) remained stable over the last few decades. We postulate changes in patient profiles due to the COVID-19 pandemic. MATERIALS AND METHODS a total of 384 patients admitted to a tertiary care University Hospital in Madrid (Spain) and referred to LPTs were recruited. Patients referred 5 months before and after the first admission for COVID-19 were included. Clinical and sociodemographic characteristics were collected, and non-parametric hypothesis contrast tests were used to study possible differences between both periods. RESULTS patients referred during the pandemic were significantly older (U = 2.006; p = .045), most of them were admitted to medical hospitalization units (χ2 (2) = 5.962; p = 015), and with a different reason for admission. There was an increase in the rate of adjustment disorders (χ2 (1) =7.893; p = 005) and delirium (χ2 (1) =9.413; p = 002), as well as psychiatric comorbidity (χ2 (2) = 9.930; p = .007), and a reduction in the proportion of patients treated for substance misuse (χ2 (5) = 19.152; p = .002). The number of deaths increased significantly (χ2 (1) = 6.611; p = .010). In persons over 65 years inappropriate prescription was significantly lower (χ2 (1) = 8.200; p = .004). CONCLUSIONS the pandemic had an impact on the activity of the LPTs due to the change in the clinical profile and evolution of referred patients, maintaining standards of care that are reflected through prescription.
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Affiliation(s)
- E Delgado-Parada
- Department of Psychiatry, Hospital Universitario de La Princesa, c/ Diego de León, 62, (28006) Madrid, Spain; Instituto de Investigación Sanitaria Hospital Universitario de la Princesa (IIS-Princesa), c/ Diego de León, 62, (28006) Madrid, Spain
| | - M Alonso-Sánchez
- Department of Psychiatry, Hospital Universitario de La Princesa, c/ Diego de León, 62, (28006) Madrid, Spain.
| | - J L Ayuso-Mateos
- Department of Psychiatry, Hospital Universitario de La Princesa, c/ Diego de León, 62, (28006) Madrid, Spain; Instituto de Investigación Sanitaria Hospital Universitario de la Princesa (IIS-Princesa), c/ Diego de León, 62, (28006) Madrid, Spain; Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Av/ Monforte de Lemos, 3-5. Pabellón 11. Planta 0 (28029) Madrid, Spain; Departament of Psychiatry, Universidad Autónoma de Madrid, c/ Arzobispo Morcillo, 4, (28029) Madrid, Spain
| | - M Robles-Camacho
- Department of Psychiatry, Hospital Universitario de La Princesa, c/ Diego de León, 62, (28006) Madrid, Spain
| | - A Izquierdo
- Department of Psychiatry, Hospital Universitario de La Princesa, c/ Diego de León, 62, (28006) Madrid, Spain; Instituto de Investigación Sanitaria Hospital Universitario de la Princesa (IIS-Princesa), c/ Diego de León, 62, (28006) Madrid, Spain; Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Av/ Monforte de Lemos, 3-5. Pabellón 11. Planta 0 (28029) Madrid, Spain; Departament of Psychiatry, Universidad Autónoma de Madrid, c/ Arzobispo Morcillo, 4, (28029) Madrid, Spain
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14
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Szklarzewska S, Vande Walle J, De Breucker S, Schoevaerdts D. A comparison of clinical characteristics between old and oldest-old patients hospitalised for SARS-COV2. Acta Clin Belg 2022; 78:192-199. [PMID: 35894148 DOI: 10.1080/17843286.2022.2102115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
OBJECTIVES Oldest-old patients may have an unusual SARS-COV2 presentation that can jeopardise diagnosis and management. The aim of this study was to compare the clinical characteristics and outcomes of oldest-old (≥85 years) and old patients (75-85 years) admitted with COVID-19 to Belgian hospitals during the first wave of the pandemic. METHODS We conducted a multicentre, retrospective, observational study in ten Belgian hospitals. We reviewed the electronic clinical records of patients ≥75 years hospitalised with COVID-19 from March to June 2020. RESULTS A total of 986 patients were placed on the register (old group: n = 507; oldest-old group: n = 479). Before hospitalisation, the oldest-old (OO) group presented with more geriatric syndromes including comorbidities, frailty, falls, cognitive impairment, and incontinence. At admission, the OO group presented with less cough, less headache, and less fever but significantly more delirium than old (O) group. Members of the OO group were admitted less frequently to intensive care units (ICUs). A geriatrician was consulted to help in the decision-making process more often for the OO group. The global mortality of the cohort was 47%, with no difference between the two groups. Patients in the OO group were more often institutionalised after hospitalisation and less often referred for rehabilitation. CONCLUSIONS The OO patients presented with more geriatric syndromes that make them vulnerable to dependence and institutionalisation after a hospital stay, without having a higher mortality rate than O patients. Geriatrician expertise is necessary in the management of frail older patients.
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Affiliation(s)
- Sylwia Szklarzewska
- Department of Geriatric Medicine, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Justine Vande Walle
- Department of Geriatric Medicine, CHU UCL Namur Hospital, Godinne site, Université Catholique de Louvain, Brussels, Belgium
| | - Sandra De Breucker
- Department of Geriatric Medicine, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Didier Schoevaerdts
- Department of Geriatric Medicine, CHU UCL Namur Hospital, Godinne site, Université Catholique de Louvain, Brussels, Belgium
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15
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Goldberg EM, Southerland LT, Meltzer AC, Pagenhardt J, Hoopes R, Camargo CA, Kline JA. Age-related differences in symptoms in older emergency department patients with COVID-19: Prevalence and outcomes in a multicenter cohort. J Am Geriatr Soc 2022; 70:1918-1930. [PMID: 35460268 PMCID: PMC9115070 DOI: 10.1111/jgs.17816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/24/2022] [Accepted: 04/02/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Older adults represent a disproportionate share of severe COVID-19 presentations and fatalities, but we have limited understanding of the differences in presentation by age and the association between less typical emergency department (ED) presentations and clinical outcomes. METHODS This retrospective cohort study used the RECOVER Network registry, a research collaboration of 86 EDs in 27 U.S. states. We focused on encounters with a positive nasopharyngeal swab for SARS-CoV-2, and described their demographics, clinical presentation, and outcomes. Sequential multivariable logistic regressions examined the strength of association between age cohort and outcomes. RESULTS Of 4536 encounters, median patient age was 55 years, 49% were women, and 34% were non-Hispanic Black persons. Cough was the most common presenting complaint across age groups (18-64, 65-74, and 75+): 71%, 67%, and 59%, respectively (p < 0.001). Neurological symptoms, particularly altered mental status, were more common in older adults (2%, 11%, 26%; p < 0.001). Patients 75+ had the greatest odds of ED index visit admission of all age groups (adjusted odds ratio [aOR] 6.66; 95% CI 5.23-8.56), 30-day hospitalization (aOR 7.44; 95% CI 5.63-9.99), and severe COVID-19 (aOR 4.26; 95% CI 3.45-5.27). Compared to individuals with alternate presentations and adjusting for age, patients with typical symptoms (fever, cough and/or shortness of breath) had similar odds of ED index visit admission (aOR 1.01; 95% CI 0.81-1.24), potentially higher odds of 30-day hospitalization (aOR 1.23; 95% CI 1.00-1.53), and greater odds of severe COVID-19 (aOR 1.46; 95% CI 1.12-1.90). CONCLUSIONS Older patients with COVID-19 are more likely to have presentations without the most common symptoms. However, alternate presentations of COVID-19 in older ED patients are not associated with greater odds of mechanical ventilation and/or death. Our data highlights the importance of a liberal COVID-19 testing strategy among older ED patients to facilitate accurate diagnoses and timely treatment and prophylaxis.
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Affiliation(s)
| | | | - Andrew C. Meltzer
- Department of Emergency MedicineGeorge Washington School of Medicine & Health ServicesWashingtonDistrict of ColumbiaUSA
| | - Justine Pagenhardt
- Department of Emergency MedicineWest Virginia UniversityMorgantownWest VirginiaUSA
| | - Ryan Hoopes
- Warren Alpert School of MedicineBrown UniversityProvidenceRhode IslandUSA
| | - Carlos A. Camargo
- Department of Emergency Medicine, Massachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Jeffrey A. Kline
- Department of Emergency MedicineWayne State UniversityDetroitMichiganUSA
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Clinical Characteristics and Predictors of Mortality in Elderly Patients Hospitalized with COVID-19 in Bangladesh: A Multicenter, Retrospective Study. Interdiscip Perspect Infect Dis 2022; 2022:5904332. [PMID: 35698592 PMCID: PMC9188299 DOI: 10.1155/2022/5904332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/24/2022] [Indexed: 01/08/2023] Open
Abstract
Purpose Elderly patients are at high risk of fatality from COVID-19. The present work aims to describe the clinical characteristics of elderly inpatients with COVID-19 and identify the predictors of in-hospital mortality at admission. Materials and Methods In this retrospective, multicenter cohort study, we included elderly COVID-19 inpatients (n = 245) from four hospitals in Sylhet, Bangladesh, who had been discharged between October 2020 and February 2021. Demographic, clinical, and laboratory data were extracted from hospital records and compared between survivors and nonsurvivors. We used univariable and multivariable logistic regression analysis to explore the risk factors associated with in-hospital death. Principal Results. Of the included patients, 202 (82.44%) were discharged and 43 (17.55%) died in hospital. Except hypertension, other comorbidities like diabetes, chronic kidney disease, ischemic heart disease, and chronic obstructive pulmonary disease were more prevalent in nonsurvivors. Nonsurvivors had a higher prevalence of leukocytosis (51.2 versus 30.7; p=0.01), lymphopenia (72.1 versus 55; p=0.05), and thrombocytopenia (20.9 versus 9.9; p=0.07). Multivariable regression analysis showed an increasing odds ratio of in-hospital death associated with older age (odds ratio 1.05, 95% CI 1.01–1.10, per year increase; p=0.009), thrombocytopenia (OR = 3.56; 95% CI 1.22–10.33, p=0.019), and admission SpO2 (OR 0.91, 95% CI 0.88–0.95; p=0.001). Conclusions Higher age, thrombocytopenia, and lower initial level of SpO2 at admission are predictors of in-hospital mortality in elderly patients with COVID-19.
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Rodrigues NG, Han CQY, Su Y, Klainin‐Yobas P, Wu XV. Psychological impacts and online interventions of social isolation amongst older adults during COVID-19 pandemic: A scoping review. J Adv Nurs 2022; 78:609-644. [PMID: 34625997 PMCID: PMC8661520 DOI: 10.1111/jan.15063] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 08/10/2021] [Accepted: 09/26/2021] [Indexed: 01/09/2023]
Abstract
AIM To summarise the psychological impacts of social isolation amongst older adults during COVID-19 and review the benefits and limitations of online interventions used to combat social isolation. DESIGN A scoping review was performed. DATA SOURCES A systematic search was performed from October 2020 to January 2021 in seven electronic databases: China National Knowledge Infrastructure (CNKI), PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Cochrane Library and Web of Science. A hand search of the reference lists of included papers and WHO publications was performed. Grey literature search was carried out from Scopus, ProQuest Dissertation and Google Scholar. REVIEW METHODS Studies were screened, appraised and extracted independently by two reviewers. Thematic analysis was used to synthesise data, which were presented in a descriptive manner and organised into categories and themes. RESULTS Totally, 33 studies were included. Four themes and eight sub-themes emerged: (1) negative impacts and experiences of older adults during social isolation, (2) adopting coping behaviours in the midst of COVID-19, (3) online interventions to combat the consequences of social isolation, (4) barriers to online intervention. CONCLUSION The COVID-19 pandemic has taken an emotional toll on older adults' psychological wellbeing and has highlighted the untapped strengths of older adults facing isolation. Online interventions, which could be a new normal in the COVID era, were beneficial in combating social isolation. Strategies by various stakeholders were recommended to tackle the barriers of online interventions. IMPACT With the COVID-19 pandemic still in progress, this review provides insights on the psychological impacts of social isolation amongst older adults. Nurses in the community and long-term care facilities could adopt strategies and online intervention to better support the older adults, contribute to a stronger COVID-19 response and support system, and an overall better road to recovery from this crisis.
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Affiliation(s)
- Natalie Grace Rodrigues
- Alice Lee Centre for Nursing StudiesYong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
| | - Claudia Qin Yun Han
- Alice Lee Centre for Nursing StudiesYong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
| | - Ya Su
- Faculty of Health SciencesHokkaido UniversitySapporoJapan
| | - Piyanee Klainin‐Yobas
- Alice Lee Centre for Nursing StudiesYong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
| | - Xi Vivien Wu
- Alice Lee Centre for Nursing StudiesYong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
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18
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Leonard A, Murray B, Prior AR, Srinivasan R, Kane A, Boran G. Survey of laboratory medicine's national response to the Covid-19 pandemic in the Republic of Ireland. Ir J Med Sci 2022; 191:65-69. [PMID: 33665780 PMCID: PMC7932685 DOI: 10.1007/s11845-021-02578-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/26/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND The global SARS-CoV-2 pandemic placed Irish Laboratory Medicine services under sustained and massive strain. Rapid reconfiguration was required to introduce new assays at high capacity for diagnosis and monitoring of COVID-19, while maintaining existing services. AIM The aim of this national survey was to capture Laboratory Medicine's response across the Republic of Ireland during the first wave of the COVID-19 pandemic. METHODS An electronic survey developed using Microsoft Forms® was emailed on 5 October 2020 to 53 local representatives of the PeriAnalytic and Laboratory Medicine Society (PALMSoc), reaching 38 separate pathology departments in the country. RESULTS A total of 45 responses from 38 laboratories were received (72% response rate) representing a range of departments and disciplines. Most laboratories (63%) introduced new tests, and in a time frame of less than 6 weeks (80%). Point-of-care testing (POCT) played a significant role in the response to COVID-19, with almost half of respondents (47%) reporting that additional equipment was introduced. Maintenance of the Quality Management System (QMS) proved challenging, with 60% of respondents indicating that not all aspects were sustained. When asked about changes to staff rostering, 98% of respondents reported that changes were made. All adjustments were made despite staffing challenges; only 18% of respondents described the staffing levels in their department as 100% prior to the onset of the first wave. CONCLUSIONS This study confirms an agile and resilient response to the COVID-19 pandemic from Ireland's Laboratory Medicine services despite many economic and staffing challenges.
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Affiliation(s)
- Ann Leonard
- Department of Laboratory Medicine, Tallaght University Hospital, Dublin 24, Ireland.
- School of Medicine, Trinity College Dublin, Dublin, Ireland.
| | - Brian Murray
- Department of Laboratory Medicine, Tallaght University Hospital, Dublin 24, Ireland
| | - Anna Rose Prior
- Department of Clinical Microbiology, Tallaght University Hospital, Dublin 24, Ireland
| | - Rama Srinivasan
- Department of Chemical Pathology, Blackrock Clinic, Co., Dublin, Ireland
| | - Anne Kane
- Irish External Quality Assessment Scheme (IEQAS), Dublin 14, Ireland
| | - Gerard Boran
- Department of Laboratory Medicine, Tallaght University Hospital, Dublin 24, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
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Wong EKC, Watt J, Zou H, Chandraraj A, Wenyue Zhang A, Brookes J, Verduyn A, Berall A, Norman R, Piggott KL, Izukawa T, Straus SE, Liu BA. The association of typical and atypical symptoms with in-hospital mortality in older adults with COVID-19: a multicentre cohort study. Facets (Ott) 2022. [DOI: 10.1139/facets-2022-0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Atypical disease presentations are common in older adults with COVID-19. The objective of this study was to determine the prevalence of atypical and typical symptoms in older adults with COVID-19 through progressive pandemic waves and the association of these symptoms with in-hospital mortality. This retrospective cohort study included consecutive adults aged over 65 years with confirmed COVID-19 infection who were admitted to seven hospitals in Toronto, Canada, from 1 March 2020 to 30 June 2021. The median age for the 1786 patients was 78.0 years and 847 (47.5%) were female. Atypical symptoms (as defined by geriatric syndromes) occurred in 1187 patients (66.5%), but rarely occurred in the absence of other symptoms ( n = 106; 6.2%). The most common atypical symptoms were anorexia ( n = 598; 33.5%), weakness ( n = 519; 23.9%), and delirium ( n = 449; 25.1%). Dyspnea (adjusted odds ratio [aOR] 2.05; 95% confidence interval [CI] 1.62–2.62), tachycardia (aOR 1.87; 95% CI 1.14–3.04), and delirium (aOR 1.52; 95% CI 1.18–1.96) were independently associated with in-hospital mortality. In a cohort of older adults hospitalized with COVID-19 infection, atypical presentations frequently overlapped with typical symptoms. Further research should be directed at understanding the cause and clinical significance of atypical presentations in older adults.
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Affiliation(s)
- Eric Kai-Chung Wong
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, M5B 1T8, Canada
- Division of Geriatric Medicine, Department of Medicine, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, M5B 1T8, Canada
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, ON, M5S 3H2, Canada
| | - Jennifer Watt
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, M5B 1T8, Canada
- Division of Geriatric Medicine, Department of Medicine, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, M5B 1T8, Canada
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, ON, M5S 3H2, Canada
| | - Hanyan Zou
- Division of Geriatric Medicine, Department of Medicine, Sinai Health and University Health Network, Toronto, ON, M5G 1X5, Canada
| | - Arthana Chandraraj
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, M5B 1T8, Canada
| | - Alissa Wenyue Zhang
- Division of Geriatric Medicine, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, M4N 3M5, Canada
| | - Jahnel Brookes
- Kunin-Lunenfeld Centre for Applied Research & Evaluation, Rotman Research Institute, Baycrest Health Sciences Centre, Toronto, ON, M6A 2E1, Canada
| | - Ashley Verduyn
- Providence Healthcare and Houses of Providence, Unity Health Toronto, Toronto, ON, M1L 1W1, Canada
| | - Anna Berall
- Kunin-Lunenfeld Centre for Applied Research & Evaluation, Rotman Research Institute, Baycrest Health Sciences Centre, Toronto, ON, M6A 2E1, Canada
| | - Richard Norman
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, ON, M5S 3H2, Canada
- Division of Geriatric Medicine, Department of Medicine, Sinai Health and University Health Network, Toronto, ON, M5G 1X5, Canada
| | - Katrina Lynn Piggott
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, ON, M5S 3H2, Canada
- Division of Geriatric Medicine, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, M4N 3M5, Canada
| | - Terumi Izukawa
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, ON, M5S 3H2, Canada
- Kunin-Lunenfeld Centre for Applied Research & Evaluation, Rotman Research Institute, Baycrest Health Sciences Centre, Toronto, ON, M6A 2E1, Canada
- Division of Geriatric Medicine, Department of Medicine, Baycrest Health Sciences Centre, Toronto, ON, M6A 2E1, Canada
| | - Sharon E. Straus
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, M5B 1T8, Canada
- Division of Geriatric Medicine, Department of Medicine, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, M5B 1T8, Canada
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, ON, M5S 3H2, Canada
| | - Barbara Arlena Liu
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, ON, M5S 3H2, Canada
- Division of Geriatric Medicine, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, M4N 3M5, Canada
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20
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Lou B, Guo J, Liu Y, Xiong C, Shi J, Zhou C. Prevalence, classification, risk factors and outcome impact of delirium in patients with COVID-19: a meta-analysis protocol for systematic review. BMJ Open 2021; 11:e048323. [PMID: 34903533 PMCID: PMC8671850 DOI: 10.1136/bmjopen-2020-048323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Previous studies have shown mixed results that delirium may result in a high risk of adverse clinical outcomes in patients with COVID-19. The aim of this meta-analysis is to summarise the evidence of prevalence, classification, risk factors and outcomes impact of delirium in adult patients with COVID-19. METHODS A systematic search will be performed in PubMed, EMBase, ISI Knowledge via Web of Science and preprint databases (MedRxiv and BioRxiv) (from inception until June 2021) to identify all cohort studies concerning delirium in adult patients with COVID-19. The primary outcome will be the prevalence of delirium with different classifications (hyperactive, hypoactive or mixed type). The secondary outcomes will include the association of risk factors and the association with all-cause mortality during hospitalisation. Univariable or multivariable meta-regression and subgroup analyses will be conducted for the study design and patient characteristics. Sensitivity analyses were used to assess the robustness of our results by removing each included study at one time to obtain and evaluate the remaining overall estimates of primary and secondary outcomes. ETHICS AND DISSEMINATION Ethical approval is not an essential element for the systematic review protocol in accordance with the Institutional Review Board /Independent Ethics Committee of Beijing Hospital. This meta-analysis will be disseminated through a peer-reviewed journal for publication. PROSPERO REGISTRATION NUMBER CRD42020224871.
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Affiliation(s)
- Baohui Lou
- Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jingfei Guo
- Anestheisiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue Liu
- Anestheisiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chao Xiong
- Anestheisiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jia Shi
- Anestheisiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chenghui Zhou
- Anestheisiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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21
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Seong GM, Baek AR, Baek MS, Kim WY, Kim JH, Lee BY, Na YS, Lee SI. Comparison of Clinical Characteristics and Outcomes of Younger and Elderly Patients with Severe COVID-19 in Korea: A Retrospective Multicenter Study. J Pers Med 2021; 11:jpm11121258. [PMID: 34945730 PMCID: PMC8708855 DOI: 10.3390/jpm11121258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 12/19/2022] Open
Abstract
Old age is associated with disease severity and poor prognosis among coronavirus disease 2019 (COVID-19) cases; however, characteristics of elderly patients with severe COVID-19 are limited. We aimed to assess the clinical characteristics and outcomes of patients hospitalized with severe COVID-19 at tertiary care centers in South Korea. This retrospective multicenter study included patients with severe COVID-19 who were admitted at seven hospitals in South Korea from 2 February 2020 to 28 February 2021. The Cox regression analyses were performed to assess factors associated with the in-hospital mortality. Of 488 patients with severe COVID-19, 318 (65.2%) were elderly (≥65 years). The older patient group had more underlying diseases and a higher severity score than the younger patient group. The older patient group had a higher in-hospital mortality rate than the younger patient group (25.5% versus 4.7%, p-value < 0.001). The in-hospital mortality risk factors among patients with severe COVID-19 included age, acute physiology and chronic health evaluation II score, presence of diabetes and chronic obstructive lung disease, high white blood cell count, low neutrophil-lymphocyte ratio and platelet count, do-not-resuscitate order, and treatment with invasive mechanical ventilation. In addition to old age, disease severity and examination results must be considered in treatment decision-making.
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Affiliation(s)
- Gil Myeong Seong
- Department of Internal Medicine, Jeju National University, Jeju 63243, Korea;
| | - Ae-Rin Baek
- Department of Internal Medicine, Division of Allergy and Pulmonology, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Korea;
| | - Moon Seong Baek
- Department of Internal Medicine, College of Medicine, Chung-Ang University, Seoul 06973, Korea; (M.S.B.); (W.-Y.K.)
| | - Won-Young Kim
- Department of Internal Medicine, College of Medicine, Chung-Ang University, Seoul 06973, Korea; (M.S.B.); (W.-Y.K.)
| | - Jin Hyoung Kim
- Department of Internal Medicine, Division of Respiratory and Critical Care Medicine, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan 44033, Korea;
| | - Bo Young Lee
- Division of Allergy and Respiratory Diseases, Soonchunhyang University Seoul Hospital, Seoul 04401, Korea;
| | - Yong Sub Na
- Department of Pulmonology and Critical Care Medicine, Chosun University Hospital, Gwangju 61453, Korea;
| | - Song-I Lee
- Department of Pulmonary and Critical Care Medicine, Chungnam National University Hospital, Daejeon 35015, Korea
- Correspondence: ; Tel.: +82-42-280-6816
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22
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Baktash V, Hosack T, Rule R, Patel N, Kho J, Sekhar R, Mandal AKJ, Missouris CG. Development, evaluation and validation of machine learning algorithms to detect atypical and asymptomatic presentations of Covid-19 in hospital practice. QJM 2021; 114:496-501. [PMID: 34156436 DOI: 10.1093/qjmed/hcab172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 06/12/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Diagnostic methods for Covid-19 have improved, both in speed and availability. Because of atypical and asymptomatic carriage of the virus and nosocomial spread within institutions, timely diagnosis remains a challenge. Machine learning models trained on blood test results have shown promise in identifying cases of Covid-19. AIMS To train and validate a machine learning model capable of differentiating Covid-19 positive from negative patients using routine blood tests and assess the model's accuracy against atypical and asymptomatic presentations. DESIGN AND METHODS We conducted a retrospective analysis of medical admissions to our institution during March and April 2020. Participants were categorized into Covid-19 positive or negative groups based on clinical, radiological features or nasopharyngeal swab. A machine learning model was trained on laboratory parameters and validated for accuracy, sensitivity and specificity and externally validated at an unconnected establishment. RESULTS An Ensemble Bagged Tree model was trained on data collected from 405 patients (212 Covid-19 positive) producing an accuracy of 81.79% (95% confidence interval (CI) 77.53-85.55%), the sensitivity of 85.85% (CI 80.42-90.24%) and specificity of 76.65% (CI 69.49-82.84%). Accuracy was preserved for atypical and asymptomatic subgroups. Using an external data set for 226 patients (141 Covid-19 positive) accuracy of 76.82% (CI 70.87-82.08%), sensitivity of 78.38% (CI 70.87-84.72%) and specificity of 74.12% (CI 63.48-83.01%) was achieved. CONCLUSION A machine learning model using routine laboratory parameters can detect atypical and asymptomatic presentations of Covid-19 and might be an adjunct to existing screening measures.
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Affiliation(s)
- V Baktash
- Department of Medicine, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Wexham Street, Slough, Berkshire, SL2 4HL, UK
| | - T Hosack
- Department of Medicine, Stoke Mandeville Hospital, Mandeville Rd, Aylesbury, Buckinghamshire, HP21 8AL, UK
| | - R Rule
- Department of Medicine, Stoke Mandeville Hospital, Mandeville Rd, Aylesbury, Buckinghamshire, HP21 8AL, UK
| | - N Patel
- Department of Medicine, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Wexham Street, Slough, Berkshire, SL2 4HL, UK
| | - J Kho
- Department of Medicine, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Wexham Street, Slough, Berkshire, SL2 4HL, UK
| | - R Sekhar
- Department of Medicine, Stoke Mandeville Hospital, Mandeville Rd, Aylesbury, Buckinghamshire, HP21 8AL, UK
| | - A K J Mandal
- Department of Medicine, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Wexham Street, Slough, Berkshire, SL2 4HL, UK
| | - C G Missouris
- Department of Medicine, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Wexham Street, Slough, Berkshire, SL2 4HL, UK
- Department of Clinical Cardiology, University of Nicosia Medical School, 93 Agiou Nikolaou Street, Engomi 2408 Nicosia, Cyprus
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23
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Ramos-Rincón JM, Bernabeu-Whittel M, Fiteni-Mera I, López-Sampalo A, López-Ríos C, García-Andreu MDM, Mancebo-Sevilla JJ, Jiménez-Juan C, Matía-Sanz M, López-Quirantes P, Rubio-Rivas M, Paredes-Ruiz D, González-San-Narciso C, González-Vega R, Sanz-Espinosa P, Hernández-Milián A, Gonzalez-Noya A, Gil-Sánchez R, Boixeda R, Alcalá-Pedrajas JN, Palop-Cervera M, Cortés-Rodríguez B, Guisado-Espartero ME, Mella-Pérez C, Gómez-Huelgas R. Clinical features and risk factors for mortality among long-term care facility residents hospitalized due to COVID-19 in Spain. J Gerontol A Biol Sci Med Sci 2021; 77:e138-e147. [PMID: 34626477 DOI: 10.1093/gerona/glab305] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND COVID-19 severely impacted older adults and long-term care facility (LTCF) residents. Our primary aim was to describe differences in clinical and epidemiological variables, in-hospital management, and outcomes between LTCF residents and community-dwelling older adults hospitalized with COVID-19. The secondary aim was to identify risk factors for mortality due to COVID-19 in hospitalized LTCF residents. METHODS This is a cross-sectional analysis within a retrospective cohort of hospitalized patients≥75 years with confirmed COVID-19 admitted to 160 Spanish hospitals. Differences between groups and factors associated with mortality among LTCF residents were assessed through comparisons and logistic regression analysis. RESULTS Of 6,189 patients≥75 years, 1,185 (19.1%) were LTCF residents and 4,548 (73.5%) were community-dwelling. LTCF residents were older (median: 87.4 vs. 82.1 years), mostly female (61.6% vs. 43.2%), had more severe functional dependence (47.0% vs 7.8%), more comorbidities (Charlson Comorbidity Index: 6 vs 5), had dementia more often (59.1% vs. 14.4%), and had shorter duration of symptoms (median: 3 vs 6 days) than community-dwelling patients (all, p<.001). Mortality risk factors in LTCF residents were severe functional dependence (aOR:1.79;95%CI:1.13-2.83;p=.012), dyspnea (1.66;1.16-2.39;p=.004), SatO2<94% (1.73;1.27-2.37;p=.001), temperature≥37.8ºC (1.62;1.11-2.38; p=.013); qSOFA index≥2 (1.62;1.11-2.38;p=.013), bilateral infiltrates (1.98;1.24-2.98;p<.001), and high C-reactive protein (1.005;1.003-1.007;p<.001). In-hospital mortality was initially higher among LTCF residents (43.3% vs 39.7%), but lower after adjusting for sex, age, functional dependence, and comorbidities (aOR:0.74,95%CI:0.62-0.87;p<.001). CONCLUSION Basal functional status and COVID-19 severity are risk factors of mortality in LTCF residents. The lower adjusted mortality rate in LTCF residents may be explained by earlier identification, treatment, and hospitalization for COVID-19.
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Affiliation(s)
| | - Máximo Bernabeu-Whittel
- Internal Medicine Department. Virgen del Rocío University Hospital, Seville, Spain.,Medicine Department, University of Seville, Sevilla, Spain
| | | | - Almudena López-Sampalo
- Internal Medicine Department. Málaga Regional University Hospital- Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain
| | - Carmen López-Ríos
- Internal Medicine Department. Virgen del Rocío University Hospital, Seville, Spain
| | | | - Juan-José Mancebo-Sevilla
- Internal Medicine Department. Málaga Regional University Hospital- Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain
| | - Carlos Jiménez-Juan
- Internal Medicine Department. Virgen del Rocío University Hospital, Seville, Spain
| | - Marta Matía-Sanz
- Internal Medicine Department, Royo Villanova Hospital, Zaragoza, Spain
| | - Pablo López-Quirantes
- Internal Medicine Department. Málaga Regional University Hospital- Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain
| | - Manuel Rubio-Rivas
- Internal Medicine Department. Bellvitge University Hospital- -IDIBELL, L'Hospitalet de Llobregat (Barcelona), Spain
| | - Diana Paredes-Ruiz
- Internal Medicine Department. 12 Octubre University Hospital, Madrid, Spain
| | | | - Rocío González-Vega
- Internal Medicine Department, Costa del Sol Hospital, Marbella (Malaga), Spain
| | - Pablo Sanz-Espinosa
- Internal Medicine Department. Rio Hortega University Hospital, Valladolid, Spain
| | | | - Amara Gonzalez-Noya
- Internal Medicine Department, Ourense University Hospital Complex, Ourense, Spain
| | | | - Ramon Boixeda
- Internal Medicine Department. Mataró Hospital, Mataró (Barcelona), Spain
| | | | - Marta Palop-Cervera
- Internal Medicine Department. Sagunto University Hospital, Sagunto (Valencia), Spain
| | | | | | - Carmen Mella-Pérez
- Internal Medicine Department, Ferrol University Hospital Complex, (Ferrol) A Coruna, Spain
| | - Ricardo Gómez-Huelgas
- Internal Medicine Department. Málaga Regional University Hospital- Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain.,Medicine Department, University of Malaga, Malaga, Spain
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24
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Iftikhar H, Najam M, Rehman MU. Mesenteric Lymphadenitis Due to COVID-19 in an Adult. Cureus 2021; 13:e15897. [PMID: 34336415 PMCID: PMC8312771 DOI: 10.7759/cureus.15897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2021] [Indexed: 12/13/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is an infectious disease that can present with a wide range of symptoms. Abdominal pain is less common than other symptoms but is more frequent among patients with severe disease. Various abdominal imaging findings are described in the literature for children and adults with COVID-19 infection. Mesenteric lymphadenopathy is reported in pediatric patients with COVID-19 gastrointestinal infection. It is very rarely reported in the adult population. We report a case of an adult male with multiple risk factors, who presented with severe abdominal pain and tenderness in the right inguinal fossa. He was evaluated for differential diagnosis of acute appendicitis, renal colic, diabetic ketoacidosis (DKA), and COVID-19. His investigations showed normal laboratory tests and a normal chest radiograph. His CT abdomen showed a normal appendix and multiple prominent mesenteric lymph nodes. His COVID-19 PCR was positive. He was discharged after pain relief with home isolation instructions and symptomatic management. Our case represents an atypical clinical presentation of COVID-19 infection in many ways. His laboratory investigations were not suggestive of COVID-19. Our patient’s abdominal imaging findings represent a rare association of COVID-19 with mesenteric lymphadenitis in adults. The clinical course of our patient was smooth after discharge and he did not develop any complications of COVID-19 despite multiple risk factors. Our case reminds the significance of keeping broad diagnostic differentials in the emergency department. Although mesenteric lymphadenitis is often a self-limiting condition affecting children and young adults, it is the most frequent alternative diagnosis of acute appendicitis and intussusception. Mesenteric lymphadenitis can be the sole atypical presentation of COVID-19 in adults. Atypical presentations are not uncommon due to the scarcity of data on this evolving disease.
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Affiliation(s)
- Haris Iftikhar
- Emergency Medicine, Hamad Medical Corporation, Doha, QAT
| | - Mavia Najam
- Medicine, Nishtar Medical University, Multan, PAK
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25
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Marziliano A, Burns E, Chauhan L, Liu Y, Makhnevich A, Zhang M, Carney MT, Dbeis Y, Lindvall C, Qiu M, Diefenbach MA, Sinvani L. Patient Factors and Hospital Outcomes Associated With Atypical Presentation in Hospitalized Older Adults With COVID-19 During the First Surge of the Pandemic. J Gerontol A Biol Sci Med Sci 2021; 77:e124-e132. [PMID: 34279628 PMCID: PMC8344548 DOI: 10.1093/gerona/glab171] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Indexed: 12/15/2022] Open
Abstract
Background Literature indicates an atypical presentation of COVID-19 among older adults (OAs). Our purpose is to identify the frequency of atypical presentation and compare demographic and clinical factors, and short-term outcomes, between typical versus atypical presentations in OAs hospitalized with COVID-19 during the first surge of the pandemic. Methods Data from the inpatient electronic health record were extracted for patients aged 65 and older, admitted to our health systems’ hospitals with COVID-19 between March 1 and April 20, 2020. Presentation as reported by the OA or his/her representative is documented by the admitting professional and includes both symptoms and signs. Natural language processing was used to code the presence/absence of each symptom or sign. Typical presentation was defined as words indicating fever, cough, or shortness of breath; atypical presentation was defined as words indicating functional decline or altered mental status. Results Of 4 961 unique OAs, atypical presentation characterized by functional decline or altered mental status was present in 24.9% and 11.3%, respectively. Atypical presentation was associated with older age, female gender, Black race, non-Hispanic ethnicity, higher comorbidity index, and the presence of dementia and diabetes mellitus. Those who presented typically were 1.39 times more likely than those who presented atypically to receive intensive care unit–level care. Hospital outcomes of mortality, length of stay, and 30-day readmission were similar between OAs with typical versus atypical presentations. Conclusion Although atypical presentation in OAs is not associated with the same need for acute intervention as respiratory distress, it must not be dismissed.
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Affiliation(s)
- Allison Marziliano
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA.,Department of Medicine at the Donald and Barbara Zucker School of Medicine at Hofstra, Northwell, Manhasset, NY, USA
| | - Edith Burns
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA.,Department of Medicine at the Donald and Barbara Zucker School of Medicine at Hofstra, Northwell, Manhasset, NY, USA
| | - Lakshpaul Chauhan
- Department of Medicine at the Donald and Barbara Zucker School of Medicine at Hofstra, Northwell, Manhasset, NY, USA
| | - Yan Liu
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Alex Makhnevich
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA.,Department of Medicine at the Donald and Barbara Zucker School of Medicine at Hofstra, Northwell, Manhasset, NY, USA
| | - Meng Zhang
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Maria T Carney
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA.,Department of Medicine at the Donald and Barbara Zucker School of Medicine at Hofstra, Northwell, Manhasset, NY, USA
| | - Yasser Dbeis
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Charlotta Lindvall
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Michael Qiu
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Michael A Diefenbach
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA.,Department of Medicine at the Donald and Barbara Zucker School of Medicine at Hofstra, Northwell, Manhasset, NY, USA
| | - Liron Sinvani
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA.,Department of Medicine at the Donald and Barbara Zucker School of Medicine at Hofstra, Northwell, Manhasset, NY, USA
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26
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A retrospective cohort study of risk factors and outcomes in older patients admitted to an inner-city geriatric unit in London during first peak of COVID-19 pandemic. Ir J Med Sci 2021; 191:1037-1045. [PMID: 34228265 PMCID: PMC8258277 DOI: 10.1007/s11845-021-02679-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/09/2021] [Indexed: 12/12/2022]
Abstract
Purpose Compared to younger patients, coronavirus disease 2019 (COVID-19) clinical presentation in older people can be more heterogeneous and fatal. We aim to describe a cohort of older adults admitted in an inner-city London hospital during the first peak of the pandemic. Methods A retrospective observational study that enrolled older adults consecutively admitted into two geriatric wards with suspected or confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We collected socio-demographic data, comorbidities, symptoms at presentation and/or during admission, biochemical and radiological data and outcomes at 28 days. Results One hundred twenty-four patients were included, and 75% were > 80 years old. 19.5% of COVID-19 cases were judged to be hospital-acquired. More than half presented or developed typical symptoms, respiratory failure or fatigue. 46.8% were diagnosed with delirium, 24.2% with falls and dysphagia was present in 13.7%. The mortality rate was 29.8% and was higher among males, those > 80 years, patients with a higher grade of frailty, a history of dementia or chronic kidney disease, as well as those diagnosed with respiratory failure, acute kidney injury or hypernatremia. Independent predictors of mortality were male sex, age > 80 years, respiratory failure and hypernatremia. Conclusion We have described a cohort of patients with SARS-CoV-2 infection in the first UK peak of the global pandemic. We found that these patients had significant frailty with multiple comorbidities. There was a high mortality and increased dependency and greater social care need in survivors. Supplementary information The online version contains supplementary material available at 10.1007/s11845-021-02679-z.
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27
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Forget MF, Del Degan S, Leblanc J, Tannous R, Desjardins M, Durand M, Vu TTM, Nguyen QD, Desmarais P. Delirium and Inflammation in Older Adults Hospitalized for COVID-19: A Cohort Study. Clin Interv Aging 2021; 16:1223-1230. [PMID: 34234422 PMCID: PMC8242147 DOI: 10.2147/cia.s315405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/10/2021] [Indexed: 01/08/2023] Open
Abstract
Purpose The occurrence and predictors of delirium in older adults hospitalized for coronavirus disease 2019 (COVID-19) have not been well described. Highlighting the association with inflammatory markers may be useful for identifying delirium. This study aimed to determine the prevalence and incidence of delirium and explore its association with the C-reactive protein (CRP). Patients and Methods This cohort study of adults aged 65 and older with a COVID-19 diagnosis took place at an academic healthcare institution between April and May 2020. COVID-19 was diagnosed by positive nasopharyngeal swab. Serum levels of CRP were collected as a marker of systemic inflammation. The primary outcome was the prevalence and incidence of delirium. Delirium was diagnosed primarily during a patient's stay in hospital based on the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5). To ensure that no delirium diagnosis was missed during hospital stay, clinical records were reviewed by clinicians with geriatric medicine training for retrospective diagnoses. Results A total of 127 patients aged 65 and older were hospitalized with a diagnosis of COVID-19. The median age was 82 years (IQR: 74–88), with 54 (43%) females. Overall, delirium was present in 62 (49%) patients: manifestations of delirium were present on the first day of hospitalization in 53 of these cases (86%), while 9 cases (14%) developed delirium during hospitalization. After controlling for age and sex, the mean CRP value over the first 3 days since arrival was associated with a higher risk of delirium (OR 1.35; 95% CI: 1.01–1.85) for every 50 mg/L increase. Conclusion In this cohort of older adults hospitalized for COVID-19, delirium was highly prevalent. An early increase in CRP levels should raise suspicion about the occurrence of delirium and could improve its diagnosis.
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Affiliation(s)
- Marie-France Forget
- Department of Medicine, Division of Geriatrics, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Sophie Del Degan
- Department of Medicine, Division of Geriatrics, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Julie Leblanc
- Department of Medicine, Division of Geriatrics, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Rita Tannous
- Department of Medicine, Division of Geriatrics, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Michaël Desjardins
- Department of Medicine, Division of Infectious Disease, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Madeleine Durand
- Department of Medicine, Division of Internal Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.,Innovation Hub, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Thien Tuong Minh Vu
- Department of Medicine, Division of Geriatrics, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.,Department of Neurosciences, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Quoc Dinh Nguyen
- Department of Medicine, Division of Geriatrics, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.,Innovation Hub, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Philippe Desmarais
- Department of Medicine, Division of Geriatrics, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.,Department of Neurosciences, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
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28
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Blain H, Gamon L, Tuaillon E, Pisoni A, Giacosa N, Albrand M, Miot S, Rolland Y, Picot MC, Bousquet J. Atypical symptoms, SARS-CoV-2 test results and immunisation rates in 456 residents from eight nursing homes facing a COVID-19 outbreak. Age Ageing 2021; 50:641-648. [PMID: 33620381 PMCID: PMC7929417 DOI: 10.1093/ageing/afab050] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Indexed: 12/13/2022] Open
Abstract
Background Frail older persons may have an atypical presentation of COVID-19. The value of rRT-PCR testing for identifying SARS-CoV-2 nursing homes (NH) residents is not known. Objective To determine whether (i) atypical symptoms may predict rRT-PCR results and (ii) rRT-PCR results may predict immunization against SARS-CoV-2 in NH residents. Design A retrospective longitudinal study. Setting eight NHs with at least ten rRT-PCR-positive residents. Subjects 456 residents. Methods Typical and atypical symptoms recorded in residents’ files during the 14 days before and after rRT-PCR testing were analyzed. Residents underwent blood testing for IgG-SARS-CoV-2 nucleocapsid protein 6 to 8 weeks after testing. Univariate and multivariate analyses compared symptoms and immunization rates in rRT-PCR-positive and negative residents. Results 161 residents had a positive rRT-PCR (35.3%), 17.4% of whom were asymptomatic before testing. Temperature > 37.8°C, oxygen saturation < 90%, unexplained anorexia, behavioural change, exhaustion, malaise, and falls before testing were independent predictors of a further positive rRT-PCR. Among the rRT-PCR-positive residents, 95.2% developed SARS-CoV-2 antibodies vs 7.6% in the rRT-PCR-negative residents. Among the residents with a negative rRT-PCR, those who developed SARS-CoV-2 antibodies more often had typical or atypical symptoms (p = 0.02 and < 0.01, respectively). Conclusion This study supports a strategy based on (i) testing residents with typical or unexplained atypical symptoms for an early identification of the first SARS-CoV-2 cases, (ii) rT-PCR testing for identifying COVID-19 residents, (iii) repeated wide-facility testing (including asymptomatic cases) as soon as a resident is tested positive for SARS-CoV-2, and (iv) implementing SARS-CoV-2 infection control measures in rRT-PCR-negative residents when they have unexplained typical or atypical symptoms.
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Affiliation(s)
- Hubert Blain
- Department of Geriatrics, Montpellier University Hospital, Montpellier University, France
| | - Lucie Gamon
- Department of Medical Information, University Hospital of Montpellier, University of Montpellier, France
| | - Edouard Tuaillon
- Department of Virology, Montpellier University Hospital, INSERM 1058, Montpellier University, France
| | - Amandine Pisoni
- Department of Virology, Montpellier University Hospital, INSERM 1058, Montpellier University, France
| | - Nadia Giacosa
- Department of Geriatrics, Montpellier University Hospital, Montpellier University, France
| | - Mylène Albrand
- Department of Geriatrics, Montpellier University Hospital, Montpellier University, France
| | - Stéphanie Miot
- Department of Geriatrics, Montpellier University Hospital, Montpellier University, France
- CESP, INSERM U1178, Centre de recherche en Epidemiologie et Santé des Populations, Paris, France
| | - Yves Rolland
- Gérontopôle de Toulouse, INSERM 1027; 31059 Toulouse, France
| | - Marie-Christine Picot
- Department of Medical Information, University Hospital of Montpellier, University of Montpellier, France
| | - Jean Bousquet
- Charité, Univeersitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Comprehensive Allergy Center, Department of Dermatology and Allergy, Berlin, Germany
- MACVIA-France, Montpellier, France
- University Hospital, Montpellier, France
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Andrew MK, Schmader KE, Rockwood K, Clarke B, McElhaney JE. Considering Frailty in SARS-CoV-2 Vaccine Development: How Geriatricians Can Assist. Clin Interv Aging 2021; 16:731-738. [PMID: 33953551 PMCID: PMC8088982 DOI: 10.2147/cia.s295522] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/02/2021] [Indexed: 12/15/2022] Open
Abstract
The COVID-19 pandemic has disproportionately impacted frail older adults, especially residents of long-term care (LTC) facilities. This has appropriately led to prioritization of frail older adults and LTC residents, and those who care for them, in the vaccination effort against COVID-19. Older adults have distinct immunological, clinical, and practical complexity, which can be understood through a lens of frailty. Even so, frailty has not been considered in studies of COVID-19 vaccines to date, leading to concerns that the vaccines have not been optimally tailored for and evaluated in this population even as vaccination programs are being implemented. This is an example of how vaccines are often not tested in Phase 1/2/3 clinical trials in the people most in need of protection. We argue that geriatricians, as frailty specialists, have much to contribute to the development, testing and implementation of COVID-19 vaccines in older adults. We discuss roles for geriatricians in ten stages of the vaccine development process, covering vaccine design, trial design, trial recruitment, establishment and interpretation of illness definitions, safety monitoring, consideration of relevant health measures such as frailty and function, analysis methods to account for frailty and differential vulnerability, contributions in regulatory and advisory roles, post-marketing surveillance, and program implementation and public health messaging. In presenting key recommendations pertinent to each stage, we hope to contribute to a dialogue on how to push the field of vaccinology to embrace the complexity of frailty. Making vaccines that can benefit frail older adults will benefit everyone in the fight against COVID-19.
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Affiliation(s)
- Melissa K Andrew
- Department of Medicine, Division of Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Canadian Center for Vaccinology, Halifax, Nova Scotia, Canada
| | - Kenneth E Schmader
- Division of Geriatrics, Duke University Medical Center and GRECC, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
| | - Kenneth Rockwood
- Department of Medicine, Division of Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Barry Clarke
- Department of Family Medicine, Dalhousie University, Halifax, Canada
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Nilsson L, Andersson C, Sjödahl R. COVID-19 as the sole cause of death is uncommon in frail home healthcare individuals: a population-based study. BMC Geriatr 2021; 21:262. [PMID: 33879078 PMCID: PMC8057661 DOI: 10.1186/s12877-021-02176-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/22/2021] [Indexed: 12/05/2022] Open
Abstract
Background During the first pandemic wave, Sweden experienced a high mortality rate. Home healthcare reflects a group of people especially vulnerable to coronavirus disease 2019 (COVID-19). We aimed to evaluate the pattern of comorbidity and frailty in a group of individuals having fatal outcomes in home healthcare during the COVID-19 pandemic March to September 2020, and to assess the contribution of COVID-19 in the fatal outcomes. Methods A cohort of adults with confirmed COVID-19 diagnosis that deceased in home healthcare between March and September 2020 were analysed in a retrospective study comprising home healthcare in 136 facilities in one Swedish county. Main outcome measures were comorbidity and frailty. Results One hundred fifty-five individuals (88 women, 67 men) aged 57–106 (median 88) years were included in the analysis. Nine had considerable frailty (ability to perform various activities of daily living but confined to bed or chair on occasion) and the remaining 146 had severe frailty (unable to perform activities of daily living and/or confined to bed or chair; dementia necessitating care). Three or more diagnoses besides COVID-19 were present in 142 individuals and another eight had two diagnoses in addition to COVID-19. In 20 (13%) individuals, COVID-19 was assessed as the principal cause of death, in 100 (64.5%) a contributing cause, and for the remaining 35 (22.5%) death was probably caused by another comorbidity. This seemed to change over the course of the COVID − 19 pandemic, with its contributing role decreasing from the middle of the summer. Conclusions Death in home healthcare during the first wave of the pandemic mostly affected individuals with severe frailty and comorbidity at very advanced ages. One fifth of the individuals who died in home health care had another cause than Covid-19. Trial registration Clinical Trials.gov NCT04642196 date 24/11/2020.
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Affiliation(s)
- Lena Nilsson
- Department of Anesthesiology and Intensive Care and Department of Biomedical and Clinical Sciences, Linköping University, S-58185, Linköping, Sweden.
| | - Christer Andersson
- Department of Orthopedics, Linköping University Hospital, Linköping, Sweden
| | - Rune Sjödahl
- Department of Surgery and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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Van Son CR, Eti DU. Screening for COVID-19 in Older Adults: Pulse Oximeter vs. Temperature. Front Med (Lausanne) 2021; 8:660886. [PMID: 33937297 PMCID: PMC8079646 DOI: 10.3389/fmed.2021.660886] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/23/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Catherine R. Van Son
- College of Nursing, Washington State University-Vancouver, Vancouver, WA, United States
| | - Deborah U. Eti
- College of Nursing, Washington State University-Spokane, Spokane, WA, United States
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Clinical pathways for patients with giant cell arteritis during the COVID-19 pandemic: an international perspective. THE LANCET. RHEUMATOLOGY 2021; 3:e71-e82. [PMID: 33521671 PMCID: PMC7834492 DOI: 10.1016/s2665-9913(20)30386-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Giant cell arteritis, a common primary systemic vasculitis affecting older people, presents acutely as a medical emergency and requires rapid specialist assessment and treatment to prevent irreversible vision loss. Disruption of the health-care system caused by the COVID-19 pandemic exposed weak points in clinical pathways for diagnosis and treatment of giant cell arteritis, but has also permitted innovative solutions. The essential roles played by all professionals, including general practitioners and surgeons, in treating these patients have become evident. Patients must also be involved in the reshaping of clinical services. As an international group of authors involved in the care of patients with giant cell arteritis, we reflect in this Viewpoint on rapid service adaptations during the first peak of COVID-19, evaluate challenges, and consider implications for the future.
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Simeone PG, Crosta F, Stanziani D, Colameco F, Sanrocco C, Desideri G, Santilli F, Savini V, Scurti R, Parruti G. Could ischemic colitis be the first manifestation of COVID-19? A case report. JOURNAL OF GERONTOLOGY AND GERIATRICS 2020. [DOI: 10.36150/2499-6564-258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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