COVID-19 and Intrinsic Capacity

The Global Research Trends on Intrinsic Capacity of Older Adults: A Bibliometric and Visual Analysis of Papers Published During 2015-2023

Objective

The concept of intrinsic capacity (IC) revolves around healthy aging and active aging. Since the Introduction of the concept by the World Health Organization in 2015, a series of studies have been conducted by scholars from multiple fields. However, no bibliometric analysis has systematically investigated this issue. We aim to identify the current landscape and frontier trends of scientific achievements on IC in older adults through bibliometric approaches.

Methods

Quantitative analysis of publications relating to IC in older adults from 2015 to 2023 was interpreted and graphed through the Web of Science Core Collection database on December 5, 2023. A variety of quantitative variables was analyzed, including publication and citation counts, H-index, and journal citation reports. Co-authorship, citation, co-citation, and co-occurrence analyses were performed for countries/regions, institutions, authors, and keywords using the VOSviewer and CiteSpace.

Results

A total of 952 original and review articles in English were identified. The European countries possessed an absolute advantage in this field. The most contributive institution was the University of São Paulo. The most productive author is Cesari Matteo from France, followed by Qaisar Rizwan from the United Arab Emirates. However, a relatively low level of research cooperation existed between institutions and authors. Important topics mainly include the connotations, theoretical framework models, evaluation, screening tools, and application scenarios of IC. Among the promising hotspots, "biological aging", "ICOPE", "Covid-19", "prevention", "inflammation", "caf22", "prevalence", and "randomized controlled trial" displayed relatively latest average appearing year.

Conclusion

Global trends indicate a growing scientific output on IC in older adults, and developed countries are leading the way. There is still room for improvement in research team collaboration. The focus gradually shifts from theoretical research to empirical research. It is recommended to pay attention to the latest hot spots, such as "biological aging", "ICOPE implementation", "post-COVID-19 syndrome", and "biomarkers".

Factors Associated with the Deterioration of Intrinsic Capacity among Older Adults in Mexico and Colombia

BACKGROUND

Intrinsic capacity (IC) is defined as "all the physical and mental attributes possessed by the older person." This concept has gained momentum in recent years because it provides insights into the changes in the functional capacity of individuals during their life. This study examined common factors associated with IC decline among older adults in Mexico and Colombia.

METHODS

This cross-sectional, correlational study included 348 community-dwelling older adults. Sociodemographic, clinical, and family conditions were assessed as possible associated factors, and IC was analyzed across five domains: cognitive, locomotor, psychological, vitality (malnutrition through deficiency and excess), and sensory (visual and auditory). Parametric and non-parametric statistical analyses were performed.

RESULTS

The common factors associated with impairment according to domain were family dysfunctionality (cognitive domain); myocardial infarction, family dysfunctionality, age >80 years, home occupation, and not having a partner (locomotor domain); dysfunctional family and risk of falls (psychological domain); age >80 years and not having a partner (malnutrition by deficiency domain); age 60-79 years, walking <7,500 steps/day, and peripheral vascular disease (malnutrition by excess domain); risk of falling and being female (visual sensory domain); risk of falling (auditory sensory domain); and dysfunctional family and risk of falling (total intrinsic capacity).

CONCLUSION

Both populations had common sociodemographic, clinical, and familial factors that directly affected total IC stocks and their domains.

Impact of COVID-19 on Physical Activity, Fatigue, and Frailty in Community-Dwelling Older Adults: A Cross-Sectional Study

This study aimed to describe the level of physical activity and its relation to fatigue and frailty during the COVID-19 pandemic in community-dwelling older adults aged 80 years and over. Three hundred and ninety-one older adults (aged 86.5 ± 3.00) completed a survey including physical activity, the Mobility Tiredness scale, and the FRAIL scale. Linear regression analysis was conducted to assess whether the variables age, sex, and physical activity (independent factors) were significantly related to fatigue and frailty. Respectively, 30.5% and 24.7% of the participants reported a decrease in walking and in energy-intensive activities; 25.4% reported increased sedentary behavior. A lower level of physical activity was associated with higher levels of fatigue and increased frailty risk (p < .05), independently from psychological symptoms. These results are important because participants with lower levels of physical activity and more sedentary behavior are more likely to feel fatigued and have higher risk to be frail.

Quality of life and intrinsic capacity in patients with post-acute COVID-19 syndrome is in relation to frailty and resilience phenotypes

The objective of this study was to characterize frailty and resilience in people evaluated for Post-Acute COVID-19 Syndrome (PACS), in relation to quality of life (QoL) and Intrinsic Capacity (IC). This cross-sectional, observational, study included consecutive people previously hospitalized for severe COVID-19 pneumonia attending Modena (Italy) PACS Clinic from July 2020 to April 2021. Four frailty-resilience phenotypes were built: "fit/resilient", "fit/non-resilient", "frail/resilient" and "frail/non-resilient". Frailty and resilience were defined according to frailty phenotype and Connor Davidson resilience scale (CD-RISC-25) respectively. Study outcomes were: QoL assessed by means of Symptoms Short form health survey (SF-36) and health-related quality of life (EQ-5D-5L) and IC by means of a dedicated questionnaire. Their predictors including frailty-resilience phenotypes were explored in logistic regressions. 232 patients were evaluated, median age was 58.0 years. PACS was diagnosed in 173 (74.6%) patients. Scarce resilience was documented in 114 (49.1%) and frailty in 72 (31.0%) individuals. Predictors for SF-36 score < 61.60 were the phenotypes "frail/non-resilient" (OR = 4.69, CI 2.08-10.55), "fit/non-resilient" (OR = 2.79, CI 1.00-7.73). Predictors for EQ-5D-5L < 89.7% were the phenotypes "frail/non-resilient" (OR = 5.93, CI 2.64-13.33) and "frail/resilient" (OR = 5.66, CI 1.93-16.54). Predictors of impaired IC (below the mean score value) were "frail/non-resilient" (OR = 7.39, CI 3.20-17.07), and "fit/non-resilient" (OR = 4.34, CI 2.16-8.71) phenotypes. Resilience and frailty phenotypes may have a different impact on wellness and QoL and may be evaluated in people with PACS to identify vulnerable individuals that require suitable interventions.

How does social support interact with intrinsic capacity to affect the trajectory of functional ability among older adults? Findings of a population-based longitudinal study

BACKGROUND

The ecological model of health and ageing has proposed that functional ability (FA) is determined by the interaction between intrinsic capacity (IC) and environmental characteristics. This study empirically examined how social support, as an important social environmental resource, interacts with IC to affect FA trajectories among older adults.

METHODS

This was a prospective three-wave cohort study with a sample of 775 community-dwelling older adults. Social support, IC and FA were assessed using the Social Support Rating Scale, the revised Integrated Care for Older People screening tool and the Lawton Instrumental Activities of Daily Living Scale, respectively. Latent growth curve models (LGCM) were implemented to test their relationships.

RESULTS

FA significantly declined over 3 years, and the detrimental effect of impaired IC on the deterioration rate of FA was buffered by subjective support but was aggravated by support utilization and was not changed by objective support. FA decline among older adults with impaired IC was observed in those with low subjective support or with high support utilization but not in those with high subjective support or with low support utilization. Among older adults with intact IC, FA decline was observed in those with low support utilization but not in those with high support utilization or with low or high subjective support.

CONCLUSIONS

Subjective support may prevent FA decline among older adults with impaired IC, while support utilization may benefit older adults with intact IC but may be detrimental for those with impaired IC. Social support interventions to optimize FA trajectories should improve older adults' perceptions of support and bridge the gap in support utilization among older adults with impaired IC.

Measurements of Intrinsic Capacity in Older Adults: A Scoping Review and Quality Assessment

OBJECTIVES

This review summarizes the measurements of intrinsic capacity in 5 domains across different studies and evaluates the quality of research papers.

DESIGN

Scoping review of papers written in English and Chinese published in peer-reviewed journals.

SETTING AND PARTICIPANTS

The intrinsic capacity of older adults was assessed using the multidomain structure (Cognition, Locomotion, Psychological, Sensory and Vitality) proposed by the World Health Organization.

METHODS

We searched PubMed, MEDLINE, and Web of Science for papers in English, and CNKI, CBM for papers written in Chinese published until September 13, 2022. Both cross-sectional and cohort studies of multidomain measurements of intrinsic capacity were included. Three independent reviewers appraised the quality of studies, and Cohen's kappa was calculated to determine interrater reliability. Data were listed by author, year, setting, country, age range and number of participants, measurement and calculation of intrinsic capacity, and data acquisition method.

RESULTS

We included 53 studies. Twenty-one studies were of high quality, 31 studies were of moderate quality, and 1 study was of low quality. Measurements of intrinsic capacity and derivation of the summative index score were heterogeneous. Intrinsic capacity was usually assessed in 4 or 5 domains. Sensory was the most frequently overlooked domain or subdivided into vision and hearing in some studies. Indicators of vitality were the most heterogeneous. We also found consistency in heterogeneous measurements. The most common measurements of cognition, locomotion, and psychological capacity were the Mini-Mental State Examination, Short Physical Performance Battery, and Geriatric Depression Scale respectively. Self-reported questionnaires were commonly adopted in sensory domain. The Mini-Nutritional Assessment and grip strength were the most measured indicators of vitality.

CONCLUSIONS AND IMPLICATIONS

The focus on capacity and disease should be balanced to better promote healthy aging in older adults. Heterogeneity of intrinsic capacity measurements underscores the need for consensus about standardized measurements and calculation procedures.

WHO working definition of vitality capacity for healthy longevity monitoring

Intrinsic capacity, a crucial concept in healthy ageing, is defined by WHO as "the composite of all the physical and mental capacities that an individual can draw on at any point in time". Vitality capacity is considered the underlying physiological determinant of intrinsic capacity. To advance the measurement and monitoring of vitality capacity, a working group of WHO staff members and twenty experts representing six WHO regions was convened to discuss and clarify the attributes of vitality capacity and to develop a clear working definition of the concept. Potential biomarkers to measure vitality capacity were identified, and the following consensual working definition was developed: vitality capacity is a physiological state (due to normal or accelerated biological ageing processes) resulting from the interaction between multiple physiological systems, reflected in (the level of) energy and metabolism, neuromuscular function, and immune and stress response functions of the body.

Exploring the conceptual framework and measurement model of intrinsic capacity defined by the World Health Organization: A scoping review

WHO has defined intrinsic capacity (IC) as the composite of all physical and mental capacities of an individual covering five subdomains: cognition, locomotion, sensory, vitality, and psychological. Despite this well accepted definition, the conceptual and measurement model of IC remains unclear, which hampers a standardized operationalization of the construct. We performed a scoping review to give a comprehensive overview of the extent to which the current literature of IC addresses and assumes the conceptual framework and measurement model of IC as reflective or formative. For inclusion, we considered all types of articles that were published in peer-reviewed journals except for protocol articles. A systematic search of 6 databases from different disciplines led to the inclusion of 31 papers. We found inconsistency and gaps in the descriptions of IC. Most of the papers did not define the measurement model. In the conceptual background and validation articles, we identified descriptions of both reflective and formative measurement models while in empirical studies applying IC measurements the underlying assumptions remained mainly unclear. Defining a measurement model is not merely a theoretical matter but influences the operationalization and validation processes of the construct. This study raised questions about the most fundamental features of the IC construct and discusses whether IC should be considered as an underlying latent trait of all capacities (reflective construct) or an aggregate summary measure of the subdomain capacities (formative construct).

Correlates to psychological distress in frail older community-dwellers undergoing lockdown during the COVID-19 pandemic

Background

This study identifies correlates of the lockdown’s psychological distress in frail older community-dwellers (Catalonia, Spain).

Methods

Participants from a community frailty intervention program, with a comprehensive geriatric assessment within the 12-months pre-lockdown and COVID-19 free during the first pandemic wave (March–May 2020), underwent a phone assessment past the lockdown to assess COVID-19-related emotional distress (DME) as well as other sociodemograhic, clinical and psychosocial factors.

Results

Of the 94 frail older adults (age = 82,34 ± 6,12 years; 68,1% women; 38,3% living alone), 84,9% were at risk of experiencing moderate-to-high psychological distress, according to the backward stepwise logistic regression model obtained (χ2 = 47,007, p < 0,001, Nagelkerke R² = 0,528), based on the following factors: absence of depressive symptoms before lockdown (OR = 0,12, p = 0,014, 95%CI[0,023–0,647]), not carrying out leisure activities during lockdown (OR = 0,257, p = 0,023, 95%CI[0,079–0,832]) and currently experiencing high malaise due to COVID-19 situation (OR = 1,504, p < 0,001, 95%CI[1,241–1,822]).

Discussion

These findings suggest that it is necessary to favour a prior overall health status and to empower frail older community-dwellers in the use of a broad repertoire of coping strategies in the face of adversity to foster mental health and keep at bay the potential emotional impact of the situation generated by the COVID pandemic.

Intrinsic capacity of older people in the community using WHO Integrated Care for Older People (ICOPE) framework: a cross-sectional study

BACKGROUND

The World Health Organization (WHO) published the Integrated Care for Older People (ICOPE) framework to guide assessing and promoting intrinsic capacity of older adults. This study, adopting the WHO ICOPE framework, assessed the intrinsic capacity impairment and investigated the relationship among intrinsic capacity, social engagement, and self-care capacity on performing activities of daily living. It also assessed the sensitivity of the initial brief screening and the detailed full assessment.

METHODS

This is a cross-sectional study conducted in 11 community centers in Hong Kong. Intrinsic capacity was assessed in two steps identical to WHO ICOPE handbook: using WHO ICOPE brief screening tool (step 1) and detailed full assessment (step 2) to assess the intrinsic capacity domains of locomotion, cognition, vitality, psychological well-being, and sensory capacity (hearing and vision). Structural equational modeling analysis was used to examine the relationship among intrinsic capacity, social engagement, and self-care capacity, and the mediating role of intrinsic capacity in the relationships.

RESULTS

A total of 304 older adults with a mean age 76.73 (SD = 7.25) years participated in WHO ICOPE Step 1 brief screening, and 221 participants (72.7%) showed intrinsic capacity impairment. After completing Step 2 full assessment, 202 participants (66.4%) had one or more impaired intrinsic capacity domains. The overall sensitivity and specificity of the screening tool were 95% and 57.6% respectively, whereas the sensitivity of each domain ranged from 74.7% to 100%. The percentage of impairment in locomotion (117, 39.8%), cognition (75, 25.5%), psychological well-being (34, 11.6%), vision (75, 24.7%), hearing capacity (82, 27.9%), and vitality (8, 2.7%). People in younger old age (β = -0.29, p < 0.001), with more education (β = 0.26, p < 0.001), and absence of hypertension (β = -0.11, p < 0.05) were more likely to have better intrinsic capacity. Intrinsic capacity was positively associated with self-care capacity in performing activities of daily living (β = 0.21, p < 0.001) and social engagement (β = 0.31, p < 0.001).

CONCLUSIONS

The ICOPE screening tool is a sensitive instrument to detect intrinsic capacity impairment among community-dwelling older adults and it does not demand substantial workforce; its use is worthy to be supported. The intrinsic capacity impairment in community-dwelling older adults are prevalent, in particular, in locomotor and cognitive capacity. Actions should be taken to slow or prevent the impairment, support self-care and social engagement in old age.

The association of social frailty with intrinsic capacity in community-dwelling older adults: a prospective cohort study

Background

Social frailty is associated with poor health outcomes; however, its effects on healthy aging indicators have not been adequately investigated. This study assessed the longitudinal association between social frailty and the intrinsic capacity of community-dwelling older adults.

Methods

A total of 663 participants (56.7% women) aged ≥60 years from in Nagoya, Japan, were included in the study. The first measurement occurred in 2014, and annual follow-ups occurred until 2017. Social frailty was determined based on four items: financial difficulty, household status, social activity, and regular contact with others. A deficit score of 0 represented social robustness, 1 represented social prefrailty, and ≥ 2 represented social frailty. Intrinsic capacity was evaluated by the locomotion, cognition, psychological function, vitality, and sensory function domains. The longitudinal association was analyzed using generalized estimating equations.

Results

The prevalence of social prefrailty and social frailty at baseline was 31.2 and 6.3%, respectively. The social prefrailty group (β = − 0.132, P < 0.001) and social frailty group (β = − 0.258, P < 0.001) were associated with a greater reduction in the composite intrinsic capacity scores than the social robustness group, especially in the cognition, psychological function, and vitality domains. Men with social prefrailty/social frailty demonstrated a greater decrease in the psychological function domain score (− 0.512 vs. − 0.278) than women. Additionally, the cognition domain score only decreased in men in the social prefrailty/social frailty group (β = − 0.122, P = 0.016).

Conclusions

Social frailty was associated with intrinsic capacity and its subdomains longitudinally. Men with social frailty were more vulnerable than women to a decline in their psychological function and cognition domains. Therefore, the advanced management of social frailty is necessary to facilitate healthy aging.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02466-6.

Management of frailty under COVID-19 pandemic in Japan

Frailty prevention is a cornerstone for the extension of healthy life expectancy. It is a multi-dimensional construct that includes physical, mental, and social aspects. Frailty is reversible and can be attenuated by intervention; therefore, its early detection is important in primary and community care. The mainstream of disability prevention in Japan, which comprises the Japanese and local governments as well as healthcare workers, was a high-risk approach until 2014. Given the revision on Japan's long-term care insurance law, current ageing health policies have shifted to more population centric approach. Implements group activities called "Kayoi-no-ba" has been valued in Japan as disability prevention initiative. The Kihon Checklist - a 25-item questionnaire - has been broadly used by health experts and researchers to assess frailty in Japan. However, a new 15-item questionnaire has been newly developed to identify frailty and other health-related problems in older people of 75 years and above. This will enable providing the necessary support to frail individuals at any healthcare facility in local communities. The increase in frailty prevalence in older people has been concern during the COVID-19 pandemic. Home-based physical exercise programs are expected to be effective for frailty prevention. Utilization of information and communication technologies, social network services, and video calls has attracted attention for being effective tools to facilitate communication for older people during the pandemic. Further, life course approaches are needed to clarify the midlife risk of frailty development in later life.

Adaptive Metabolic and Inflammatory Responses Identified Using Accelerated Aging Metrics Are Linked to Adverse Outcomes in Severe SARS-CoV-2 Infection

Background

Chronological age (CA) is a predictor of adverse COVID-19 outcomes; however, CA alone does not capture individual responses to SARS-CoV-2 infection. Here, we evaluated the influence of aging metrics PhenoAge and PhenoAgeAccel to predict adverse COVID-19 outcomes. Furthermore, we sought to model adaptive metabolic and inflammatory responses to severe SARS-CoV-2 infection using individual PhenoAge components.

Methods

In this retrospective cohort study, we assessed cases admitted to a COVID-19 reference center in Mexico City. PhenoAge and PhenoAgeAccel were estimated using laboratory values at admission. Cox proportional hazards models were fitted to estimate risk for COVID-19 lethality and adverse outcomes (ICU admission, intubation, or death). To explore reproducible patterns which model adaptive responses to SARS-CoV-2 infection, we used k-means clustering using PhenoAge components.

Results

We included 1068 subjects of whom 222 presented critical illness and 218 died. PhenoAge was a better predictor of adverse outcomes and lethality compared to CA and SpO₂ and its predictive capacity was sustained for all age groups. Patients with responses associated to PhenoAgeAccel>0 had higher risk of death and critical illness compared to those with lower values (log-rank p<0.001). Using unsupervised clustering we identified four adaptive responses to SARS-CoV-2 infection: 1) Inflammaging associated with CA, 2) metabolic dysfunction associated with cardio-metabolic comorbidities, 3) unfavorable hematological response, and 4) response associated with favorable outcomes.

Conclusions

Adaptive responses related to accelerated aging metrics are linked to adverse COVID-19 outcomes and have unique and distinguishable features. PhenoAge is a better predictor of adverse outcomes compared to CA.

[Update 2021: Coronavirus pandemic - challenges for geriatrics]

Nobody supposed that after one year of the pandemia, the SARS-CoV-2 Virus and its emerging mutants dominates the press, our lives and the health system as a whole. As for Geriatric Medicine, many things have also changed: The majority of COVID-19 patients are no more the (oldest) old and mortality is less observed in multimorbid persons, as most of them have been vaccinated. (Oldest) old persons are still especially vulnerable to die due to a COVD-19 infection. In longterm care, a significant higher mortality was seen in the former waves, but now, some longterm care facilities have more places that they can fill. This is a situation that many European countries would never have anticipated.Ressource allocationin stormy times is now more openly discussed, especially who should be admitted to intensive care units. This has led to more detailed and new guidelines which may help even when the pandemia is over. Here, some thoughts regarding the care of older adults in times of the pandemia are discussed.

A Multi-Domain Group-Based Intervention to Promote Physical Activity, Healthy Nutrition, and Psychological Wellbeing in Older People with Losses in Intrinsic Capacity: AMICOPE Development Study

The World Health Organization has developed the Integrated Care of Older People (ICOPE) strategy, a program based on the measurement of intrinsic capacity (IC) as "the composite of all physical and mental attributes on which an individual can draw". Multicomponent interventions appear to be the most effective approach to enhance IC and to prevent frailty and disability since adapted physical activity is the preventive intervention that has shown the most evidence in the treatment of frailty and risk of falls. Our paper describes the development of a multi-domain group-based intervention addressed to older people living in the community, aimed at improving and/or maintaining intrinsic capacity by means of promoting physical activity, healthy nutrition, and psychological wellbeing in older people. The process of intervention development is described following the Guidance for reporting intervention development studies in health research (GUIDED). The result of this study is the AMICOPE intervention (Aptitude Multi-domain group-based intervention to improve and/or maintain IC in Older PEople) built upon the ICOPE framework and described following the Template for Intervention Description and Replication (TIDieR) guidelines. The intervention consists of 12 face-to-face sessions held weekly for 2.5 h over three months and facilitated by a pair of health and social care professionals. This study represents the first stage of the UK Medical Research Council framework for developing and evaluating a complex intervention. The next step should be carrying out a feasibility study for the AMICOPE intervention and, at a later stage, assessing the effectiveness in a randomized controlled trial.

The need for adaptable global guidance in health systems strengthening for musculoskeletal health: a qualitative study of international key informants

BACKGROUND

Musculoskeletal (MSK) conditions, MSK pain and MSK injury/trauma are the largest contributors to the global burden of disability, yet global guidance to arrest the rising disability burden is lacking. We aimed to explore contemporary context, challenges and opportunities at a global level and relevant to health systems strengthening for MSK health, as identified by international key informants (KIs) to inform a global MSK health strategic response.

METHODS

An in-depth qualitative study was undertaken with international KIs, purposively sampled across high-income and low and middle-income countries (LMICs). KIs identified as representatives of peak global and international organisations (clinical/professional, advocacy, national government and the World Health Organization), thought leaders, and people with lived experience in advocacy roles. Verbatim transcripts of individual semi-structured interviews were analysed inductively using a grounded theory method. Data were organised into categories describing 1) contemporary context; 2) goals; 3) guiding principles; 4) accelerators for action; and 5) strategic priority areas (pillars), to build a data-driven logic model. Here, we report on categories 1-4 of the logic model.

RESULTS

Thirty-one KIs from 20 countries (40% LMICs) affiliated with 25 organisations participated. Six themes described contemporary context (category 1): 1) MSK health is afforded relatively lower priority status compared with other health conditions and is poorly legitimised; 2) improving MSK health is more than just healthcare; 3) global guidance for country-level system strengthening is needed; 4) impact of COVID-19 on MSK health; 5) multiple inequities associated with MSK health; and 6) complexity in health service delivery for MSK health. Five guiding principles (category 3) focussed on adaptability; inclusiveness through co-design; prevention and reducing disability; a lifecourse approach; and equity and value-based care. Goals (category 2) and seven accelerators for action (category 4) were also derived.

CONCLUSION

KIs strongly supported the creation of an adaptable global strategy to catalyse and steward country-level health systems strengthening responses for MSK health. The data-driven logic model provides a blueprint for global agencies and countries to initiate appropriate whole-of-health system reforms to improve population-level prevention and management of MSK health. Contextual considerations about MSK health and accelerators for action should be considered in reform activities.

Intrinsic Capacity Assessment by a Mobile Geriatric Team During the Covid-19 Pandemic

In the autumn of 2020, the second wave of the COVID-19 pandemic hit Europe. In this context, because of the insufficient number of beds in geriatric COVID units, non-geriatric wards were confronted with a significant number of admissions of geriatric patients. In this perspective article, we describe the role of a mobile geriatric team in the framework of the COVID-19 pandemic and specifically how it assisted other specialists in the management of hospitalized geriatric patients by implementing a new approach: the systematic assessment and optimization of Intrinsic Capacity functions. For each patient, assessed by this consultative team, an individualized care plan, including an anticipated end-of-life decision-making process, was established. Intensity of care was most often not stated by considering chronological age but rather the comorbidity burden, the frailty status, and the patient's wishes. Further studies are needed to determine if this mobile geriatric team approach was beneficial in terms of mortality, length of stay, or functional, psychological, and cognitive outcomes in COVID-19 geriatric patients.

A Review of the Current Status of Clinical Management of COVID-19 in the Elderly

The high infectivity and severity of SARS-CoV-2 infection (COVID-19), and our limited understanding of the biology of the novel coronavirus, as well as the lack of an effective treatment for COVID-19, have created a global pandemic. Those most likely to become seriously ill with COVID-19 are adults, especially the elderly and those who are already weak or sick. At present, a specific drug for treatment of COVID-19 has not been developed. This, combined with the typical coexistence of a variety of chronic diseases in elderly patients, makes treatment challenging at present. In addition, for elderly patients, COVID-19 isolation measures during the epidemic can easily lead to psychological problems. Thus, how to manage elderly patients has become a focus of social attention in the current circumstances. This article reviews the effects of COVID-19 and makes management suggestions for elderly patients during this epidemic period. In addition to the elderly, critically ill people are also highly susceptible to this novel coronavirus. For elderly COVID-19 patients, antiviral therapy, immune regulation, and even auxiliary respiratory therapy can be given after a comprehensive evaluation of the disease. With the approval and use of COVID-19 vaccines, it is reasonable to expect that we can conquer SARS-CoV-2.

Cross-sectional study examining the status of intrinsic capacity decline in community-dwelling older adults in China: prevalence, associated factors and implications for clinical care

OBJECTIVES

Intrinsic capacity (IC) was proposed by the WHO as a new concept for capturing an individual's functional capacities across their lifetime. We aimed to investigate the prevalence and factors associated with IC decline and examine associations between IC and adverse outcomes among community-dwelling older adults in China.

DESIGN

A cross-sectional study.

SETTING

Community, China.

PARTICIPANTS

Data were derived from the China Comprehensive Geriatric Assessment Study, a population-based nationally representative sample. IC comprises of five domains: locomotion, cognition, vitality, sensory and psychology. Participants were deemed to have IC decline if they showed a decline in any of the five domains. Sociodemographic characteristics, chronic diseases, geriatric syndromes and adverse outcomes were also examined.

RESULTS

Of the 5823 community-dwelling participants aged 60-98 years, 2506 had IC decline (weighted 39.9%): 57.7% in western, 38.3% in northern, 33.7% in northwest, 36.1% in middle, 16.9% in eastern and 19.8% in northeast China. The number of participants with decline in the locomotion, cognition, vitality, sensory and psychological domains were 1039 (17.8%), 646 (11.1%), 735 (12.6%), 824 (14.2%) and 713 (12.2%), respectively. Age, northern residence, low education, being unmarried, low income, less exercise, less meat intake, insomnia, memory loss, urinary incontinence, constipation, slowness, chronic obstructive pulmonary disease and osteoarthritis were related to IC decline. After adjusting for age, sex, area, district, marriage, education, waist-hip ratio, smoking, alcohol consumption, exercise, income and chronic diseases, IC decline was independently associated with risk of frailty, disability, falls, fractures and immobility.

CONCLUSION

The prevalence of IC decline in China is high. IC decline was significantly associated with adverse outcomes, after adjustment for related variables. Efforts promoting IC to delay functional dependence should focus on modifiable factors, including negative social factors, poor lifestyle, chronic diseases and geriatric syndromes.

Tweets by People With Arthritis During the COVID-19 Pandemic: Content and Sentiment Analysis

BACKGROUND

Emerging evidence suggests that people with arthritis are reporting increased physical pain and psychological distress during the COVID-19 pandemic. At the same time, Twitter's daily usage has surged by 23% throughout the pandemic period, presenting a unique opportunity to assess the content and sentiment of tweets. Individuals with arthritis use Twitter to communicate with peers, and to receive up-to-date information from health professionals and services about novel therapies and management techniques.

OBJECTIVE

The aim of this research was to identify proxy topics of importance for individuals with arthritis during the COVID-19 pandemic, and to explore the emotional context of tweets by people with arthritis during the early phase of the pandemic.

METHODS

From March 20 to April 20, 2020, publicly available tweets posted in English and with hashtag combinations related to arthritis and COVID-19 were extracted retrospectively from Twitter. Content analysis was used to identify common themes within tweets, and sentiment analysis was used to examine positive and negative emotions in themes to understand the COVID-19 experiences of people with arthritis.

RESULTS

In total, 149 tweets were analyzed. The majority of tweeters were female and were from the United States. Tweeters reported a range of arthritis conditions, including rheumatoid arthritis, systemic lupus erythematosus, and psoriatic arthritis. Seven themes were identified: health care experiences, personal stories, links to relevant blogs, discussion of arthritis-related symptoms, advice sharing, messages of positivity, and stay-at-home messaging. Sentiment analysis demonstrated marked anxiety around medication shortages, increased physical symptom burden, and strong desire for trustworthy information and emotional connection.

CONCLUSIONS

Tweets by people with arthritis highlight the multitude of concurrent concerns during the COVID-19 pandemic. Understanding these concerns, which include heightened physical and psychological symptoms in the context of treatment misinformation, may assist clinicians to provide person-centered care during this time of great health uncertainty.