Editorial: The Future of Geriatrics

Pitfalls in Oncogeriatrics

An oncogeriatric interdisciplinary activity exists only in a minority of high-income countries, and it is almost absent in those with lower incomes. Considering topics, sessions, and tracks in the main meetings and conferences of the major Oncological Societies in Europe and worldwide, the USA excluded, little attention has thus far been paid to the problem of cancer in the elderly. Again, with the exception of the USA, the major cooperative groups, for example, the EORTC in Europe, have only dedicated marginal attention to the research of cancer in the elderly. Despite major shortcomings, professionals interested in geriatric oncology have taken a number of important initiatives to highlight the benefits of this particular activity, including the organization of an international society (Société Internationale de Oncogeriatrie, or SIOG). In spite of these efforts, the authors believe that the management of cancer in the older population is still encountering several important and generalized pitfalls. The main obstacle is the grossly inadequate number of geriatricians and clinical oncologists necessary to an integrated care of the ever-expanding aging population, but other hurdles have been reported. Additionally, the prejudice of ageism can lead to missing potential resources for the development of a generalized oncogeriatric approach.

Injury Patterns and Associated Demographics of Intimate Partner Violence in Older Adults Presenting to U.S. Emergency Departments

Intimate partner violence (IPV) is a global public health issue and occurs in intimate relationships regardless of age or sexual orientation. Several studies, most of them relying on small-scale samples, have explored the prevalence and risk factors of IPV in older adults. Still, none have focused on the demographics and injury patterns in older adult victims. Using the National Electronic Injury Surveillance System (NEISS) All Injury Program (AIP) data, we performed a retrospective analysis from 2005 through 2015 of the demographics and injuries of older adult IPV patients (>60 years old) presenting to emergency departments (EDs) compared to younger adult IPV patients (<60 years old). IPV accounted for 2,059,441 ED visits (.61%) with 37,534 (1.8%) visits in the older adults. Older adults were more frequently male (36.1% vs 16.8%), White (65.3% vs 52.8%), sustained fewer neck/head injuries (47.6% vs 59.4%), fewer contusions/abrasions (34.6% vs 47.2%), had more trunk fractures (38.4% vs 11.9%), trunk strains/sprains (39.5% vs 15.4%) and more hospital admissions (15.7 vs 4.2%), compared to younger IPV patients. Within the older adult cohort, females were more commonly White (71.2% vs 56.0%) while males were more commonly Black (36.3% vs 19.0%). Injuries in older adult males were more commonly lacerations (40.6% vs 14.2%%) and less commonly contusions/abrasions (33.8% vs 43.5%) compared to elderly females. Older adult females had more internal organ injuries than older adult males (18.9% vs 12.9%) and nearly all involved the head. Knowledge of these injury patterns in older adults can equip the health care providers when to be more suspicious of unexplained or suspicious injuries as the victim's symptoms at the presentation might not be directly related to violence.

The impact of COVID-19 on patients with chronic pain seeking care at a tertiary pain clinic

Empirical data on the health impacts of the COVID-19 pandemic remain scarce, especially among patients with chronic pain. We conducted a cross-sectional study matched by season to examine patient-reported health symptoms among patients with chronic pain pre- and post-COVID-19 pandemic onset. Survey responses were analyzed from 7535 patients during their initial visit at a tertiary pain clinic between April 2017-October 2020. Surveys included measures of pain and pain-related physical, emotional, and social function. The post-COVID-19 onset cohort included 1798 initial evaluations, and the control pre-COVID-19 cohort included 5737 initial evaluations. Patients were majority female, White/Caucasian, and middle-aged. The results indicated that pain ratings remained unchanged among patients after the pandemic onset. However, pain catastrophizing scores were elevated when COVID-19 cases peaked in July 2020. Pain interference, physical function, sleep impairment, and emotional support were improved in the post-COVID-19 cohort. Depression, anxiety, anger, and social isolation remained unchanged. Our findings provide evidence of encouraging resilience among patients seeking treatment for pain conditions in the face of the COVID-19 pandemic. However, our findings that pain catastrophizing increased when COVID-19 cases peaked in July 2020 suggests that future monitoring and consideration of the impacts of the pandemic on patients' pain is warranted.

A pen pal program during COVID-19 pandemic increases student interest for careers in geriatrics

Social isolation and loneliness are serious issues facing older adults that have been intensified during COVID-19. Through a pen pal program, we connected 69 healthcare professional students with 180 older adults in our community to help reduce social isolation and loneliness. Participants were connected through letters, e-mails, and phone calls for three months. At the end of the program, we surveyed students (response rate: 62%). Half of the students reported spending less than 20 minutes per week on the project. Of the survey respondents roughly 91% were white, 74.4% were enrolled in the College of Medicine, and 51.1% were in their first year of their respective program. Students increased their knowledge of social isolation and loneliness (p = .0001), their interest in volunteering (p = .018) and working with older adults (p = .028), and their comfort communicating with older adults (p = .002). Students reported that their wellness improved and that they practiced skills that would be used in their future careers. By providing volunteer experiences to students, we can increase their exposure to the geriatric population, hopefully increasing the number of students who enter geriatrics while simultaneously reducing social isolation and loneliness in older adults.

Computed tomography-based body composition profile as a screening tool for geriatric frailty detection

OBJECTIVE

To assess prevalence of CT imaging-derived sarcopenia, osteoporosis, and visceral obesity in clinically frail and prefrail patients and determine their association with the diagnosis of frailty.

MATERIALS AND METHODS

This cross-sectional study was constructed using our institution's pelvic trauma registry and ambulatory database registry. The study included all elderly pelvic trauma patients and ambulatory outpatients between May 2016 and March 2020 who had a comprehensive geriatric assessment and CT abdomen/pelvis within 1 year from the date of the assessment. Patients were dichotomized in prefrail or frail groups. The study excluded patients with history of metastatic disease or malignancy requiring chemotherapy.

RESULTS

The study cohort consisted of 151 elderly female and 65 male patients. Each gender population was subdivided into frail (114 female [75%], 51 male [78%]) and prefrail (37 female [25%], 14 male [22%]) patients. CT-imaging-derived diagnosis of osteoporosis (odds ratio, 2.5; 95% CI: 1.2-5.5) and sarcopenia (odds ratio, 2.6; 95% CI: 1.2-5.6) were associated with frailty in females, but did not reach statistical significance in males. BMI and subcutaneous adipose tissue at L3 level were statistically lower in the frail male group compared to the prefrail group. BMI showed strong correlation with the subcutaneous area at the L3 level in both genders (Spearman's coefficient of 0.8, p < 0.001). Hypoalbuminemia and visceral obesity were not associated with frailty in either gender.

CONCLUSION

This proof-of-concept study demonstrates the feasibility of using CT-derived body-composition parameters as a screening tool for frailty, which can offer an opportunity for early medical intervention.

Social distanciation through COVID-19: A narrative analysis of Indian Peri-Urban Elderly

The world encountered an emergent issue of great concern, regarding the new pandemic virus termed as ‘Novel Coronavirus (COVID-19)’. This pandemic situation has disconcerted the socio-economic and psychological situations of people and their livelihoods, thus, disturbing societal equilibrium. Social distancing is considered to be an influential weapon to restrict this virus transmission. Like many others, especifically, the elderly people, face pressing difficulties in their daily life-world. Thus, a qualitative study is being considered among the Indian peri-urban elderly (N ​= ​15, >60 years) to identify the experiences of social distancing on their lives and their situation in an everyday living context. The dominant themes are being identified in this study reveal that social relationships are in ‘paradox’ as it binds the proximate familial relations and distantiate the relations with their significant others that is the bonding between their friends and neighbours along with the coping strategies that have been recorded to overcome their immense psychological stress. Moreover, their preparedness to get back to the normal routines of their daily lives in post-COVID-19 is certainly a matter of concern to them. Thus, the study proposes to develop plans and policies towards awareness, counseling, and volunteering services based on local or remote area approach to make coping strategies for them more viable to combat this unforeseen crisis.

Development of a New Application-Based Chewing Efficiency Test (Mini Dental Assessment) and Its Evaluation by Nursing Staff in Geriatric Care: A Pilot Study

The increasing average life expectancy worldwide results in an elderly population with significant health care needs. However, dental care is often not a focus of care. It is well known that oral and overall health are directly related. Therefore, the Mini Dental Assessment (MDA) was developed to provide a simple analysis of oral health status, although it is currently only available in paper form, with all associated drawbacks, from illegible writing to the inability to quickly search the collected forms. This study aimed to develop a digital application (app) for mobile devices that can overcome the problems associated with paper forms. After the digital MDA was developed, its usability was evaluated by nurses, a questionnaire was answered, and it was compared to the analog MDA with patients in a pilot study. The usability of the app (System Usability Scale) was 95.18 ± 4.26, representing a very high usability. Furthermore, this app showed good clinical applicability. The results also showed that the digital MDA was accepted by nurses in their daily routine and was preferred to the analog MDA. A follow-up study with a higher number of subjects is highly recommended.

COVID-19 and cardiovascular complications: an update from the underlying mechanism to consequences and possible clinical intervention

Introduction: The novel coronavirus has caused significant mortality worldwide and is primarily associated with severe acute respiratory distress syndrome (ARDS). Apart from ARDS, clinical reports have shown noticeable cardiovascular complications among the patients of COVID-19. Infection from virus, stimulation of cytokine storm, altered immune response, and damage to myocardial tissue are some of the proposed mechanisms of cardiovascular complications in COVID-19.Areas covered: Based on the clinical reports of CVDs among COVID-19 patients, we have discussed the molecular mechanisms involved in cardiovascular pathogenesis, its prevalence, and association with COVID-19, and various available therapeutic modality for the treatment.Expert opinion: Seeing the cardiovascular complications in COVID-19 patients and its association with the existing drug, risk-benefit ratio of treatment paradigm, as well as the level of cardiac injury biomarkers must be monitored regularly. Additionally, a well-designed clinical trial should be conducted where head to head comparison can be made with anti-COVID-19 drugs and cardioprotective anti-inflammatory drugs. Nevertheless, vaccines are the best-suited approach, but until then, sanitization, social distancing, and active lifestyle are the best ways to beat this global pandemic situation.

Effect of an aged wearing suit on nursing student's knowledge and attitude

Background

The knowledge and attitude of health care providers are important and influential factors in providing care services to the elderly and need to be considered during the training course. Simulation in geriatric nursing education can be an opportunity for learners to experience the restrictions of the elderly. The present study was conducted to determine the effect of training through simulation on the attitude and knowledge of nursing students in elderly care.

Methods

This study was quasi-experimental with two experimental and control groups of pre and post-test, which was conducted on 70 nursing students of the 5th semester (two groups of 35 people). For the experimental group, the elderly simulation suit was worn for two hours, which was designed by the researcher and created sensory, physical, and motor restrictions similar to the elderly for students. Before and after the study, Kogan’s attitudes toward older people scale and Palmore’s “facts on aging quiz” were completed by students. The data were analyzed using an independent t-test and paired t-test using SPSS version 16 software.

Results

The mean scores of students’ knowledge in the experimental and control groups had no significant difference at the beginning of the study (p < 0.05). But the mean scores of knowledge in the experimental group before and after the intervention was (9.2 ± 2.6) and (15.3 ± 3.5), respectively, and in the control group before and after the intervention was (10.4 ± 2.9) and (11.3 ± 2.6), respectively, which had a statistically significant difference (p = 0.0001). The mean scores of students’ attitudes in the experimental and control groups had no significant difference at the beginning of the study (p < 0.05). The mean scores of attitude in the experimental group before and after the intervention was (114.69 ± 8.4) and (157.31 ± 10.7), respectively and in the control group before and after the intervention was (113.34 ± 13.6) and (108.5 ± 16.6), respectively, which was significantly different (p = 0.0001).

Conclusions

Based on the findings, the experience of aging restrictions through simulation has improved the knowledge and attitude of nursing students towards the elderly. Nursing education requires the growth of attitudinal skills, individuals’ beliefs, and creating empathy among them, so creating simulation opportunities can assist nursing students in the educational processes.

Atrial fibrillation in the elderly: a risk factor beyond stroke

Atrial fibrillation (AF) represents the most common arrhythmia worldwide and its prevalence exponentially increases with age. It is related to increased risk of ischemic stroke or systemic embolism, which determines a significant burden of morbidity and mortality, as widely documented in the literature. AF also constitutes a risk factor for other less investigated conditions, such as heart failure, pulmonary embolism, impairment in physical performance, reduced quality of life, development of disability, mood disorders and cognitive impairment up to dementia. In the elderly population, the management of AF and its complications is particularly complex due to the heterogeneity of the ageing process, the lack of specific evidence-based recommendations, as well as the high grade of comorbidity and disability characterizing the over 65 years aged people. In the present review, we aim to summarize the pieces of the most updated evidence on AF complications beyond stoke, mainly focusing on the elderly population.

Changes in Dietary Behaviours during the COVID-19 Outbreak Confinement in the Spanish COVIDiet Study

The aim of this study was to evaluate whether dietary behaviours of the Spanish adult population were changed during the COVID-19 outbreak confinement. For that purpose, an online questionnaire, based on 44 items including socio-demographic data, Mediterranean diet (MedDiet) Adherence Screener (MEDAS) as a reference of a healthy diet, processed foods intake, changes in their usual food choices and weight gain was distributed using social media and snowball sampling. A total of 7514 participants (37% aged below 35 years, 70.6% female, 77.9% university-level education or higher) from all the Spanish territory completed the questionnaire. Results outlined healthier dietary behaviours during the confinement when compared to previous habits. Overall, the MEDAS score (ranging from 0 to 14, whereby higher a scoring reflects greater adherence to the MedDiet) increased significantly from 6.53 ± 2 to 7.34 ± 1.93 during the confinement. Multivariate logistic regression models, adjusted for age, gender, region and other variables, showed a statistically significant higher likelihood of changing the adherence to the MedDiet (towards an increase in adherence) in those persons who decreased the intake of fried foods, snacks, fast foods, red meat, pastries or sweet beverages, but increased MedDiet-related foods such as olive oil, vegetables, fruits or legumes during the confinement. COVID-19 confinement in Spain has led to the adoption of healthier dietary habits/behaviours in the studied population, as reflected by a higher adherence to the MedDiet. This improvement, if sustained in the long-term, could have a positive impact on the prevention of chronic diseases and COVID-19-related complications.