Improving the care of older patients during the COVID-19 pandemic

Inappropriate polypharmacy during the COVID-19 pandemic: impact, challenges, and solutions - a narrative review

The COVID-19 pandemic has brought unprecedented challenges to healthcare systems worldwide, impacting various aspects of patient care. Polypharmacy, the concurrent use of multiple medications by a single patient, is a significant concern exacerbated by the pandemic. The dual threat of COVID-19 infection and polypharmacy for the same vulnerable group - the elderly and those with pre-existing multimorbidity - is particularly problematic, as polypharmacy has been shown to lead to suboptimal treatment outcomes in many chronic diseases. This comprehensive review explores the multifaceted issues surrounding polypharmacy during the COVID-19 pandemic, addressing its causes, consequences, and potential solutions.

Impact of COVID-19 Infection and Related Social Concerns on Depressive Symptoms: Mediating Effects of Negative Changes in Daily Life and Moderating Effects of Age and Gender

OBJECTIVE

This study examined the mediating effect of negative changes in daily life due to the coronavirus disease-2019 (COVID-19) pandemic on depressive symptoms, considering COVID-19 infection and related social concerns. Additionally, comparisons of path coefficients between the groups were conducted based on age and gender.

METHODS

A cross-sectional study design used data from the 2020 Korean Community Health Survey consisting of 229,269 individuals. This study used a self-reported questionnaire, including the Patient Health Questionnaire-9 and three items addressing social concerns related to COVID-19 infection. A single question assessed whether individuals had experienced COVID-19 infection within the last 3 months, and scores of negative changes in daily life due to the COVID-19 pandemic. Correlation analysis was performed on the variables. Structural equation model analysis was conducted to identify the mediating role of negative changes in daily life. Chi-square tests were also performed to compare the path coefficients based on age and gender.

RESULTS

The structural equation models revealed that COVID-19 infection and related social concerns had both significant direct effects on depressive symptoms and indirect effects through negative changes in daily life. When comparing the path coefficients by age and gender, the coefficients related to depressive symptoms were highest in those under 65 years and in females.

CONCLUSION

Negative changes in daily life due to the COVID-19 pandemic serve as a partial mediator of the impact of COVID-19 infection and related social concerns on depressive symptoms. Special attention should be paid to depressive symptoms in those under 65 years of age and in females.

Health and social home services among community-dwelling older people during COVID-19: Results from the cross-sectional LOST in Lombardia project

BACKGROUND

Few studies have focused on changes in health and social services access due to the COVID-19 pandemic. We aimed to describe changes in the use of selected health and social home services due to the pandemic and to investigate potential associated factors, including socio-demographic characteristics, number of chronic diseases and mental health indicators, among older Italian individuals.

METHODS

We analysed data from the LOST in Lombardia cross-sectional study conducted in November 2020 on a large representative sample of 4400 individuals aged ⩾65 years. To identify potential factors associated with the increased use of three selected health and social home services, we estimated odds ratios (OR) and confidence intervals (CI) using multivariable logistic regression models.

RESULTS

Compared to the year before, 5.0% of older adults increased help from domestic workers (vs. 6.9% reducing) during the pandemic, 4.4% increased help from non-familiar caregivers (vs. 1.3% decreasing) and 4.7% increased medical home visits (vs. 1.0% decreasing). An increase in the use of these services was more frequent among participants with co-morbidities (p for trend <0.001), especially with diabetes (for caregivers: OR=12.2, 95% CI 6.0-24.8), and worse mental health (for caregivers and for those with a GAD-2 score ⩾3 vs. <3: OR=10.6, 95% CI 5.8-19.4). Conversely, people living in more crowded households less frequently increased health and social services use during the pandemic.

CONCLUSIONS

Our results should inform targeted interventions for the identified vulnerable groups to close the gap in health and social inequities.

Understanding the experiences of PHC nurses in caring for older patients in the post-fifth wave of the COVID-19 pandemic: an exploratory qualitative study

Objective

To ensure the best possible care, the perspective of PHC nurse work experience during the COVID-19 pandemic should be considered when developing nursing care protocols for older patients who receive PHC services.

Method

This exploratory qualitative study was conducted with 18 nurses working continuously in PHC between the first and fifth waves of the pandemic. Semi-structured thematic interviews were undertaken. Qualitative thematic content analysis was conducted to identify and group the themes that emerged from the discourse. Interviews were transcribed and analyzed using thematic analysis.

Results

The first topic describes the nurses' experiences of physical and mental suffering in caring for older patients in response to the pandemic. The second topic covers the experience of reorganizing PHC work. The third topic focuses on the difficulties of caring for older patients. The final topic includes issues of support needs for nurses in PHC work.

Conclusion

The experience and understanding of PHC nurses in caring for older people during the COVID pandemic should lead to significant changes in the system of nursing care for geriatric patients and in the cooperative role within geriatric care specialist teams. Drawing on the experience of COVID-19, it is necessary to work on the weak points of PHC exposed by the pandemic in order to improve the quality of care and life for geriatric patients.

Medical School Curriculum Relating to Clinical Ethical Decision Making During a Pandemic: A Scoping Review

Background

The COVID-19 pandemic has demonstrated the need for medical students to be prepared to make adequate decisions during unique challenges presented during pandemics.

Objective

This review aims to provide a comprehensive look into the current global literature that discusses medical curricula on clinical ethical issues during a pandemic.

Methods

The scoping review methodology was divided into three stages. Phase 1, planning, involved identifying key terms, selecting databases, creating a search criterion, and deciding on inclusion and exclusion criteria. Phase 2, study selection and data extraction, included screening the title and abstract, reviewing the complete text, and extracting data. Phase 3, analysis and write-up, comprised analyzing the extracted information and composing the review.

Results

10 studies were included and underwent data extraction as part of the review. The studies varied by country, study design, institution, education setting, and course titles. Ethical issues identified while reviewing the curriculums were resource allocation, healthcare worker obligations, personal protective equipment, disease control, communication, management protocols, and patient care.

Conclusion

This review revealed a lack of literature regarding the curriculum for medical students on ethical issues during a pandemic. This indicates a need for reform in medical education to cover pandemic preparedness and ethical concerns during a pandemic. If medical schools do not address this gap, future physicians may encounter the same issues healthcare workers faced during the COVID-19 pandemic.

Delirium in the Era of COVID-19

BACKGROUND

Delirium has been associated with poor outcomes in hospitalized older adults. Rates of delirium have increased in the context of coronavirus disease 2019 (COVID-19).

PURPOSE

To explore the prevalence of delirium in older adult patients hospitalized with COVID-19 as well as correlations with age, gender, length of stay (LOS), occurrence of an intensive care unit admission or transfer, and in-hospital mortality in 2 hospitals in the southeast United States.

METHODS

A retrospective study of 1502 patients admitted between 2020 and 2021 was completed.

RESULTS

Older adult patients hospitalized with delirium and COVID-19 demonstrated significantly prolonged LOS (14.1 days vs 7.1 days, P < .0001) and higher rates of in-hospital mortality (33.5% vs 12.8%, P < .0001).

CONCLUSIONS

Findings of this study add to the growing literature on delirium in hospitalized patients and support the need for future initiatives to create protocols for monitoring and nursing care management of delirium to improve care delivery.

Tracking the digital health gap in elderly: A study in Italian remote areas

The Covid-19 pandemic has provided a major innovative thrust to public services regarding their digitization to continue providing an effective response to the population's needs and to reduce management costs. However, there has been a partial lack of those welfare policies that can provide an adequate response to the elderly segment of the population, which is most affected by the introduction of new technologies into the public sphere. This study analyses the digital gap in health in the elderly living in remote areas of Italy and investigates the use of digital devices for health purposes. It compares the use of digital solutions for health with people's common digital competencies and their willingness to use them. A descriptive analysis of the sample was constructed to verify the different responses of the elderly by age, gender, educational qualification, and geographic area. Furthermore, regression analyses have been conducted to test whether there is any dependent effect among the elderly's characteristics or geographic areas. The results highlight the existence of a potential digital health gap among the elderly in remote areas of Italy both due to infrastructural issues and the lack of digital skills. The latter are positively correlated with educational qualification, such that it is also possible to highlight differences between age groups analysed and shape future welfare policies to reduce digital inequality.

Understanding actions and challenges in protecting older people during covid-19 pandemic in indonesia: A qualitative study with female caregivers

COVID-19 has rapidly impacted societies on a global scale, with older people among the most affected. To care for older people living in their own homes, female family caregivers play a pivotal role. The current study aimed to explore the actions of female family caregivers and the challenges they faced in taking care of older people living at homes during the COVID-19 pandemic in Belu district, Indonesia. This qualitative study involved twenty female family caregivers, who were recruited using a combination of purposive and snowball sampling techniques. Findings were grouped into two main categories: (i) actions of female family caregivers in taking care of older adults during the COVID-19 pandemic. These included limiting both visitations of extended family members and older adults' activities outside homes; explaining the virus to older adults and controlling their access to news, social media and smartphones; providing nutrition, supplement and maintaining daily diets; and (ii) challenges they faced in taking care of older adults included excessive fear of contracting COVID-19 and possibility of transmitting it to older people; feeling stressed; tired and overburdened. The study highlights the significant role family caregivers played to protect older people living at home. The findings can inform government to develop intervention programs that address and support the needs of both family caregivers and older people living at home.

Residential Aged Care Facilities During the COVID-19 Pandemic: A Staff Survey on Impact and Resources

The current study explored the impact of the coronavirus disease 2019 (COVID-19) pandemic on staff in residential aged care facilities (RACFs). A hardcopy, voluntary, anonymous survey was circulated to local RACFs (June-July 2020), exploring challenges, staffing effects, mood within RACFs, and staff perceptions of supports. Overall, 105 staff members responded, which were mainly nursing personnel (67.6%) and owners/managers (10.5%). Seventy percent believed they were equipped to handle patients with COVID-19. One quarter reported personal protective equipment shortages. Respondents reported pressures to accept patients with COVID-19 from hospitals and/or keep residents in the RACF. One third reported staff "calling in sick" related to COVID-19/quarantine. Common compensatory strategies included increasing part-time workers' hours. Reported mood was largely positive. Most (86.4%) respondents felt supported by general practitioner and local geriatric outreach services. Opportunities to best support RACF staff require further research and dialogue. [Journal of Gerontological Nursing, 49(3), 13-17.].

Home health care professionals' experiences of working in integrated teams during the COVID-19 pandemic: a qualitative thematic study

BACKGROUND

Since COVID-19 emerged, over 514 million COVID-19 cases and 6 million COVID-19-related deaths have been reported worldwide. Older persons receiving home health care often have co-morbidities that require advanced medical care, and are at risk of becoming severely ill or dying from COVID-19. In Sweden, over 10,000 COVID-19-related deaths have been reported among persons receiving municipal home health and social care. Home health care professionals have been working with the patients most at risk if infected. Most research has focused on the experiences of professionals in hospitals and assistant nurses in a home care setting. It is therefore valuable to study the experiences of the registered nurses and physicians working in home health care during the COVID-19 pandemic to learn lessons to inform future work.

METHOD

A thematic qualitative study design using a semi-structured interview guide.

RESULTS

The health care professionals experienced being forced into changed ways of working, which disrupted building and maintaining relationships with other health care professionals, and interrupted home health care. The health care professionals described being forced into digital and phone communication instead of in-person meetings, which negatively influenced the quality of care. The COVID-19 pandemic brought worry about illness for the health care professionals, including worrying about infecting patients, co-workers, and themselves, as well as worry about upholding the provision of health care because of increasing sick leave. The health care professionals felt powerless in the face of their patients' declining health. They also faced worry and guilt from the patients' next of kin.

CONCLUSION

Home health care professionals have faced the COVID-19 pandemic while working across organizational borders, caring for older patients who have been isolated during the pandemic and trying to prevent declining health and feelings of isolation. Due to the forced use of digital and phone communication instead of in-person visits, the home health care professionals experienced a reduction in the patients' quality of care and difficulty maintaining good communication between the professions.

The importance of elderly people knowing basic first-aid measures

BACKGROUND

In the event of a sudden illness or injury, elderly individuals are often dependent on self-help and mutual assistance from partners. With poor access to medical services during natural and other disasters, the importance of first aid knowledge of elderly individuals increases even more. We assessed the opinions of different generations of Slovenian population regarding the importance of knowing the basic first aid measures. In addition, we aimed to examine the knowledge of first aid in the most common emergencies that threaten elderly people's health and lives, focusing on the knowledge of elderly.

METHODS

A structured questionnaire was conducted with a representative Slovenian adult population (n = 1079). Statistically significant differences in average ratings of the importance of first aid knowledge were compared among different age groups with one-way ANOVA followed by a post hoc test. Significant differences in percentages of correct answers in particular cases of health conditions between different age groups were determined using the χ 2 test followed by post hoc tests.

RESULTS

Slovenes are well aware of the importance of first aid knowledge and feel personally responsible for acquiring this knowledge. The general opinion is that older retirees need less first aid knowledge than individuals in younger populations. We found a high level of knowledge about symptoms and first aid measures for some of the most common health conditions that occur in old age. The level of knowledge in the group of the oldest respondents was comparable with that of younger age groups. However, their recognition of health conditions was also somewhat worse, especially when recognising the symptoms and signs of hypoglycaemia and heart attack. Most of the tested knowledge did not depend on a person's age but on the time since that person was last educated in first aid.

CONCLUSIONS

The knowledge of people older than 80 years is somewhat poorer than that in the younger population, mainly because too much time has passed since they were last educated in first aid. Public awareness of first aid needs to be increased and appropriate guidelines should be given with a focus on the elderly population.

Health status of persons with dementia and caregivers' burden during the second wave of COVID-19 pandemic: an Indian study

Due to the disruption of normal flow of treatment during the restrictions related to the coronavirus disease 2019 (COVID-19) pandemic, the health status of persons with dementia (PwD) and their caregivers' burden might worsen.

Objective

The article aims to find out the health status of PwD and caregivers' burden during the peak of second wave of COVID-19 and make a comparison with the preceding trough phase.

Methods

The study was conducted with 53 PwD and their caregivers in two phases. On their visit to the hospital during the unlock phase (phase 1), data were collected for CDR from PwD, and NPI-Q and ZBI from their caregivers. During the peak of second wave (phase 2), data were collected for NPI-Q, ZBI, and DASS-21 through telephonic communication, and statistical analyses were performed on the collected data.

Results

Significantly higher caregiver burden (p=0.001) and neuropsychiatric symptoms (NPSs) [both in severity (p=0.019) and distress (p=0.013)] were observed among the respondents during the peak of second wave of the pandemic as compared to the preceding trough phase. Positive correlations were observed between the caregiver burden and depression, anxiety, and stress of the caregivers (p<0.001) and between the severity of dementia in PwD and caregiver burden (p<0.001) for both the first and second phases. Positive correlation was also observed between the severity of dementia in PwD and depression (p=0.042) and stress (p=0.023) of caregivers.

Conclusions

Significant increase in the burden and distress was observed among caregivers due to increased NPSs of PwD during the second wave of COVID-19 pandemic.

Quality of the Healthcare Services During COVID-19 Pandemic in Selected European Countries

Background

There are several definitions of the quality of healthcare services. It may be defined as a level of value provided by any health care resource, as determined by some measurement. Scientists use a variety of quality measures to attempt to determine health care quality. They use special indicators or based on a patients' or healthcare professional's perception. This article aims to provide a short review of the available data on the quality of healthcare services in selected European countries during the COVID-19 pandemic.

Methodology

The research was done by the use of online databases such as PubMed, Google Scholar, and Science Direct. All the studies focused on the quality of healthcare services, yet the studies used different methods to measure this quality. In addition, the results of the authors' survey on the assessment of the quality of healthcare services before and during the COVID-19 pandemic were presented.

Results

Among twelve studies, four were from the United Kingdom and one each of Catalonia, Italy, Sweden, Poland, Netherlands, France, Germany, Belgium. Patients in the United Kingdom felt that the quality of services was good during the pandemic, whereas the quality declined in the other studies cited. The results of our research also revealed a decrease in the quality of healthcare services provided.

Conclusions

Nevertheless the development of telemedicine has had a positive impact on the quality of healthcare services. The COVID-19 pandemic has undoubtedly affected most European countries' quality of healthcare services.

Before the COVID-Vaccine-Vulnerable Elderly in Homecare

BACKGROUND

At the beginning of 2020, the COVID-19 virus was spreading all over the world. Frail elderly were at risk for illness and death. Isolation seemed to be the best solution. The aim of this paper was to describe how the lockdown affected elderly homecare patients.

METHODS

We used an international self-reported screening instrument built on well-documented risk factors adapted to COVID-19. We considered ethical, legal, and practical concerns. The research included telephone interviews with 30 homecare patients.

RESULTS

Seventy percent lived alone. Seventy-three percent of the sample suffered from major comorbidity. Cardiovascular disorder was the most frequent diagnosis. Nineteen (63.3%) needed help for personal care. Several of the participants were lonely and depressed. The homecare teams struggled to give proper care. The health authorities encouraged the population to reduce their outside physical activities to a minimum. The restrictions due to COVID-19 affected daily life and several respondents expressed uncertainties about the future.

CONCLUSIONS

It is important to describe the patients' experiences in a homecare setting at the initiation of lockdowns due to COVID-19. The isolation protected them from the virus, but they struggled with loneliness and the lack of physical contact with their loved ones. In the future, we need to understand and address the unmet needs of elderly homecare patients in lockdown.

Caregiving of Older Persons during the COVID-19 Pandemic in the Russian Arctic Province: Challenges and Practice

Older people and their families were particularly affected during the COVID-19 pandemic in 2020, but not much is known about the context of the Arctic regions of Russia. In this study, we identified the changes in family care before and during the pandemic using a questionnaire for the informal caregivers of older people. We investigated how and to what extent the pandemic has affected the relationships between caregiver and older person, and how the mental and physical health of older people and caregivers were affected by self-isolation in the Arkhangelsk region of Russia. The pandemic has changed the contribution of care from various actors: the share of care by charities, churches, and other aid agencies increased, while that of municipal services decreased. Sixteen percent of female and forty percent of male caregivers informed the study that COVID-19-related restrictions led to deterioration in the health of older people cared for at home. Family caregivers' own health worsened, especially mental health: 28% of caregivers reported aggravated stress during the COVID-19 pandemic and expressed various fears. Our data show that the main resources in overcoming the period of self-isolation have been telephone communication, personal contact, reading/music, friends, as well as the help of social services and maintaining a positive attitude.

Social Health among German Nursing Home Residents with Dementia during the COVID-19 Pandemic, and the Role of Technology to Promote Social Participation

The COVID-19 pandemic severely impacted the social health of nursing home residents with dementia due to social isolation. Consequently, the frequency of Behavioral and Psychological Symptoms in Dementia (BPSD) might increase. Technological solutions might help safeguard the social health of nursing home residents with dementia. This study investigates the impacts of the COVID-19 pandemic on clinical outcomes and the availability of social activities and technology to promote social participation in nursing home residents with dementia. The study analyzed cross-sectional data from a follow-up questionnaire nested in a larger national survey of care facilities in Germany. A mixed-methods approach integrated statistical analyses of closed-ended responses and thematic analysis of free-text responses. A total of 417 valid individual responses were received, showing an overall increase in observed BPSD-with anxiety and depression most frequently occurring. Many nursing homes canceled all social activities for residents with dementia, though a few had established procedures to facilitate social participation using technology. Requirements to promote social participation in this population using technology were identified at the micro-, meso-, and macro levels. Technology requirements permeated all three levels. During and beyond the COVID-19 pandemic, technology-driven solutions to promote social health among nursing home residents with dementia should be integrated into caregiving procedures.

COVID-19 confinement impact on weight gain and physical activity in the older adult population: data from the LOST in Lombardia study

Background & aims

COVID-19 containment measures significantly impacted lifestyle of the general population, including physical activity. Although the older adults are particularly susceptible to the potential consequences of sedentary lifestyle and inactivity, few studies investigated pandemic effects in this segment of the population. We aimed to evaluate COVID-19 pandemic effects on weight gain and physical activity in the Italian older adults, and assess the impact of possible changes in physical activity on mental health wellbeing.

Methods

In November 2020, a cross-sectional survey was conducted on a representative sample of 4400 older adults (aged 65 or more) from the Lombardy region, Northern Italy. Changes in body mass index (BMI) and physical activity were assessed, compared to the previous year. Using unconditional multiple logistic models, we estimated the odds ratios (OR) and the corresponding 95% confidence intervals (CI) of a decrease in physical activity during COVID-19 pandemic and we evaluated if decreased physical activity was a determinant of a worsening in psychological wellbeing.

Results

Neither weight gain nor increase in obesity prevalence occurred during the pandemic. Mean time spent in physical activity significantly decreased, with 43.8% of participants reporting a decrease of 1 h/week or more during COVID-19 pandemic. A decreased physical activity was determinant of a worsening of selected mental health outcomes, such as: sleep quality (OR = 2.45; 95% CI: 1.91–3.15) and quantity (OR = 1.54; 95% CI: 1.18–2.02), anxiety (OR = 1.31; 95% CI: 1.14–1.52) and depressive symptoms (OR = 1.61; 95% CI: 1.38–1.88).

Conclusion

During the COVID-19 pandemic, while no major changes in BMI were observed, physical activity significantly declined in the older adults. In this population, the lack of physical activity might have contributed to the observed worsening in mental health. During emergency periods, encouraging physical activity might be effective also to preserve psychological wellbeing.

Strategies and actions to enable meaningful family connections in nursing homes during the COVID-19: A Scoping Review

OBJECTIVES

To better understand the impact of visitor restrictions on nursing home residents and their families as well as strategies and actions that were conducted in nursing homes during the COVID-19 pandemic.

METHODS

A scoping review was carried out in October 2020. Several electronic databases were used: Cochrane Plus, Scopus, Web of Sciences and PubMed. 725 results were identified. We included 10 articles.

RESULTS

Thematic analysis obtained the following categories: the impact of COVID-19 on nursing home residents' lives and their families, procedures and frameworks of nursing homes during and after lockdown, and solutions and resources implemented by health care professionals to improve the connection between older people and their families.

CONCLUSIONS

Visitor restrictions have a high impact on the health and well-being of older adults' and their families. The main strategies and solutions employed to reduce social isolation and facilitate the communication between older adults' and their families were the use of information and communication technologies, family support groups, and the assignment of reference staff to each family.

CLINICAL IMPLICATIONS

The strategies and solutions mentioned should be internationally considered by health care providers in nursing homes to improve connections between family and older adults.

Investigation of a COVID-19 Outbreak and Its Successful Containment in a Long Term Care Facility in Qatar

Introduction: The objective of this study is to investigate the COVID-19 outbreak and its successful containment in a long-term care facility, Qatar.

Materials and Methods: It was a retrospective case series of 24 COVID-19 positive patients inclusive of elderly, patient attenders, and front-liners from 06th to 18th June 2020. Laboratory, radiological, and treatment findings were assessed from electronic records.

Results: The outbreak management team concluded that despite all the pre-existing preventive measures implemented at the start of the pandemic, there was still evidence of lapses in infection control practices such as breach of infection control protocols like improper use of personal protective equipment. The infection prevention and control team promptly reassessed and implemented more stringent infection control methods and practices that successfully contained the outbreak on July 1, 2020. Among the seven elderly patients, the average age was 76.28 years ± SD25.5 and all were females. 57% of the patients were symptomatic. The most common comorbidities were Dementia (57%), Diabetes mellitus (43%), Coronary Artery Disease (43%), and Seizures (43%). Ground glass appearances in the lungs were found in 29% of the patients. Among the three deceased patients, Dementia and Coronary Artery Disease were the common comorbidities. Persistent elevation in blood glucose levels was observed among all patients during this period of infection.

Conclusion: Elderlies in long-term care facilities are with certain pre-existing comorbidities which makes them more prone to develop COVID-19 complications. Thus, intensive infection control measures like ongoing education and awareness, staff compliance monitoring, quick contact tracing, visitor policy revision, ongoing patient and caregivers monitoring are inevitable recommendations for effective outbreak prevention and management.

Clinical features and risk factors for mortality among long-term care facility residents hospitalized due to COVID-19 in Spain

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.

Virtual Support in Dementia: A Possible Viable Strategy for Caregivers

Background: In the last 10 months, due to the Covid-19 pandemic, several studies have shown that health education and virtual support strategies for caregivers of patients with dementia, in the management of home care, can be viable. Low and middle income countries, in particular, have sought to use these means to reduce the daily burden of caregivers, through virtual meetings of education and support.

Objectives: To present the feasibility of a pilot study on the use of a support action contemplated by the Caad Project–indirect costs of dementia–from HC-FMUSP.

Methods: Observational study in which 93 caregivers were invited to participate in virtual meetings on a frequency of three times/week, lasting 1 h each.

Results: Of the 93 invited family members, and after 3 months, 42 answered eight questions about the effectiveness of the action. High percentages of positive responses regarding program satisfaction ranged from 86 to 100%.

Conclusion: This study showed results of a very simple intervention that suggests that it is possible to offer caregivers of patients with dementia a program that can be used in primary care, in order to understand the difficulty of caregivers in their daily care of patients with dementia, with daily management guidelines on a case-by-case basis, in addition to promoting the implementation of an education strategy about the importance of knowing, and recognizing anatomophysiological changes in the aging process and its implications for the rupture of the imaginary line that involves senescence and senility. This allows the caregiver to feel able to protect his patient and himself by preventing the emergence of common diseases in this age group. Further studies are needed to explore this type of non-pharmacological support.

SARS-CoV-2 Epidemics in Retirement and Nursing Homes in Italy: A New Preparedness Assessment Model after the First Epidemic Wave

The aim of the study is to evaluate the preparedness of retirement and nursing homes in the city of Sassari at the end of the first wave of the severe acute respiratory syndrome coronavirus 2 epidemic, first by investigating the risk perception of epidemic outbreaks by the facility managers and subsequently by carrying out a field assessment of these facilities. To perform the field assessment, a checklist developed by the CDC (Infection Prevention and Control Assessment Tool for Nursing Homes Preparing for COVID-19) and adapted to the Italian context was used. Fourteen facilities took part in the survey (87.5%). The application of good practices for each survey area was expressed as a percentage with the following median values: restriction policies (87.5%), staff training (53.8%), resident training (67.6%), availability of personal protective equipment (41.7%), infection control practices (73.5%) and communication (80%). Among the facilities, considerable variability was observed in these evaluation fields: only the restriction policies and communication activities were applied uniformly. A discrepancy was found between perceived risk and real danger in the facilities, requiring targeted communication actions. At present, it is necessary to promote a new approach based on the prediction of critical events, thereby providing the means to effectively address them.

The nutritional status of the elderly patient infected with COVID-19: the forgotten risk factor?

BACKGROUND

Since the first cases of COVID-19 were reported in Wuhan, the nutritional status of individuals infected with the virus has not been included in the risk profiles prepared. However, nutritional status, along with other factors, is decisive in the evolution of patients with other infectious diseases. The nutritional status of individuals is considered an indicator of health status. Furthermore, optimal nutritional status transcends the individual, and poor diet in a population can be considered a group risk factor. Evidence exists on the influence that diet has on the immune system and susceptibility to disease.

OBJECTIVE

To evaluate the nutritional status of patients older than 65 years who were admitted due to COVID-19 and how this has influenced the evolution of patients.

DESIGN

This prospective and observational study was performed in patients with COVID-19 infection confirmed by real-time polymerase chain reaction. Data were collected from the first 24 h of admission. All patients admitted during one month to the wards assigned to COVID-19 infection were included.

RESULTS

A total of 83 patients were studied. The statistical study of mortality showed associations with age (p = .005), living in a nursing home (p = .022), a high Charlson Comorbidity Index (p = .039), hypertension (p = .032), comorbidities of dementia (p = .019) and cerebral vascular disease (p = .041), and Barthel Index (p = .010). The analysis of the influence of the nutritional state on mortality revealed a statistical association between malnutrition and mortality in the pooled data analysis (p = .005) and analysis by degrees of malnutrition (p = .27).

CONCLUSIONS

Malnutrition was a risk factor as powerful as others such as hypertension, age, and different comorbidities. We must evaluate and treat the nutritional status of elderly patients with COVID-19 infection since it directly affects their evolution.

Influence of the physical activity in the elderly people diagnosed with knee osteoarthritis during the pandemic period caused by COVID-19

Introduction. Knee osteoarthritis is considered to be a chronic disease that affects the joints by causing pain, joint stiffness and decreased functional capacity. Regular physical activity can keep and increase functional capacity, it can reduce pain by improving movement behavior. The disruption of the sedentary behavior of the elderly patients with knee osteoarthritis can lead to improved physical function and general health. The purpose of this paper is to point out the role of physical activity in the elderly people diagnosed with knee osteoarthritis during the COVID-19 pandemic. Material and method. A total of 155 patients diagnosed (clinical and imaging) with knee ostoarthritis, who were treated on an outpatient basis, from May to September 2020, were studied. The parameters assessed in the study were pain, joint stiffness, the ability to carry out daily activities, anxiety and quality of life. Results and discussion.The studied group of patients was homogeneous in terms of the weight by age group and gender. Higher values were recorded in the study group in the evaluation of patients based on scales, the results being statistically significant, with value for p<0.05, which means that the hypothesis was validated. Conclusions. Patients of the study group recorded improvementin of functional capacity, joint stability and static and dynamic balance, which allowed a faster reintegration into the family and society. Keywords: physical activity, pain, elderly people, knee osteoarthritis,

Predictors of Hospitalization Among Older Adults with COVID-19 in Saudi Arabia: A Cross-Sectional Study of a Nationally Representative Sample

Background

The aim of this study was to identify the predictors of hospitalization in older (≥60 years) patients with coronavirus disease-19 (COVID-19) in Saudi Arabia.

Methods

Patients were randomly selected from a COVID-19 database maintained by the Ministry of Health, Saudi Arabia. All patients were aged ≥60 years, had reverse transcriptase-polymerase chain reaction (RT-PCR)-confirmed COVID-19, and were registered in the database during March 2020 to July 2020. Medical and sociodemographic characteristics were retrieved from the database. Additional data were collected by telephone interviews conducted by trained health professionals. Descriptive statistics and multiple logistic regression analyses were used to analyze the relationship between patient characteristics and the risk of hospitalization.

Results

Of the 613 included patients (51.1% females), more than half (57.3%) were between 60 to 69 years of age, and 53% (324/613) had been hospitalized. The independent predictors of hospitalization included age ≥65 years (OR = 2.35, 95% CI: 1.66–3.33, P < 0.001), having more than one comorbidity (OR = 1.55, 95% CI: 1.09–2.20, P = 0.01), diabetes mellitus (OR = 1.52, 95% CI: 1.09–2.11, P = 0.01), hypertension (OR = 1.40, 95% CI: 1.007–1.97, P = 0.04), chronic kidney disease (OR = 3.87, 95% CI: 1.41–10.58, P = 0.008), and history of hospital admission within the preceding year (OR = 1.69, 95% CI: 1.11–2.55, P = 0.013). Risk of hospitalization was lower in males (OR = 0.65, 95% CI: 0.43–0.90, P = 0.01) and in patients co-living with health care workers (OR = 0.64, 95% CI: 0.43–0.96, P = 0.03).

Conclusion

Factors associated with higher risk of COVID-19-associated hospitalization should be used in prioritizing older adults’ admission. Future studies with more robust designs should be conducted to examine the risk of COVID-19-associated illness severity and mortality.

Challenges in communication, prognostication and dialysis decision-making in the COVID-19 pandemic: implications for interdisciplinary care during crisis settings

PURPOSE OF REVIEW

Using case vignettes, we highlight challenges in communication, prognostication, and medical decision-making that have been exacerbated by the coronavirus disease-19 (COVID-19) pandemic for patients with kidney disease. We include best practice recommendations to mitigate these issues and conclude with implications for interdisciplinary models of care in crisis settings.

RECENT FINDINGS

Certain biomarkers, demographics, and medical comorbidities predict an increased risk for mortality among patients with COVID-19 and kidney disease, but concerns related to physical exposure and conservation of personal protective equipment have exacerbated existing barriers to empathic communication and value clarification for these patients. Variability in patient characteristics and outcomes has made prognostication nuanced and challenging. The pandemic has also highlighted the complexities of dialysis decision-making for older adults at risk for poor outcomes related to COVID-19.

SUMMARY

The COVID-19 pandemic underscores the need for nephrologists to be competent in serious illness communication skills that include virtual and remote modalities, to be aware of prognostic tools, and to be willing to engage with interdisciplinary teams of palliative care subspecialists, intensivists, and ethicists to facilitate goal-concordant care during crisis settings.

Age-Friendly Health Care: A Systematic Review

Background: Health care provided to older adults must take into account the characteristics of chronic diseases and the comorbidities resulting from ageing. However, health services are still too oriented towards acute situations. To overcome this problem, the World Health Organization (WHO) proposed a set of Age-Friendly Principles that seek to optimize the provision of health care for this population. This article aims to understand how such Principles are considered in the implementation of age-friendly health care worldwide. Methods: A systematic review was conducted to synthesize the literature on age-friendly health care in accordance with the PRISMA recommendations in the PubMed, Web of Science, and Scopus databases. Results: The research identified 34 articles, with only seven recognizing the WHO Principles and only four using the implementation toolkit. In addition, in the context of primary care, three studies recognize the WHO Principles, but only two use the toolkit. Conclusions: The WHO Principles are being implemented in health care, but in a smaller scale than desired, which reveals possible flaws in their dissemination and standardization. Thus, a greater scientific investment in age-friendly health care should be considered, which represents a greater operationalization of the Principles and an evaluation of their effectiveness and impacts.

Delirium: Clinical Presentation and Outcomes in Older COVID-19 Patients

The aim of the study is to describe the clinical characteristics and outcomes of a series of older patients consecutively admitted into a non-ICU ward due to SARS-CoV-2 infection (14, males 11), developing delirium. Hypokinetic delirium with lethargy and confusion was observed in 43% of cases (6/14 patients). A total of eight patients exhibited hyperkinetic delirium and 50% of these patients (4/8) died. The overall mortality rate was 71% (10/14 patients). Among the four survivors we observed two different clinical patterns: two patients exhibited dementia and no ARDS (acute respiratory distress syndrome), while the remaining two patients exhibited ARDS and no dementia. The observed different clinical patterns of delirium (hypokinetic delirium; hyperkinetic delirium with or without dementia; hyperkinetic delirium with or without ARDS) identified patients with different prognosis: we believe these observations may have an impact on the management of older subjects with delirium due to COVID-19.

Older People Living in Long-Term Care Facilities and Mortality Rates During the COVID-19 Pandemic in Italy: Preliminary Epidemiological Data and Lessons to Learn

Background: Long-Term Care Facilities (LTCF) in Italy have been particularly affected by the COVID-19 pandemic, especially in terms of mortality rates of older residents. However, it is still unclear the actual extent of this situation. The aim of this manuscript is to assess the extent of mortality rates of older adults in LTCF during the pandemic across different regions of Italy, compared to the previous years and to older general population not resident in LTCF. Methods: We extracted and analyzed data collected by three Italian institutions (i.e., Italian Statistician Institute ISTAT, Italian N.I.H, Milan Health Unit) about the number of deaths among older people living in the community and among LTCF residents during the pandemic and the previous years. We also compared the observed mortality rate among LTCF residents in each Italian Region with the corresponding expected number of deaths of the general older adult population to obtain an observed/expected ratio (O/E ratio). Results: During the pandemic, about 8.5% (N = 6,797) of Italian older adults residents in LTCF died. Findings resulting from the O/E ratio suggest that LTCF residents (in particular in the Lombardy Region) show higher mortality rates when compared to expected values of mortality rates among the older general population living in the community. Furthermore, we found that the risk of death among LTCF residents increased about 4 times during the pandemic when compared to the previous years. Conclusions: Mortality rates in LTCF were high during the pandemic, especially in Lombardy. Possible causes of higher mortality rates in LTCF and suggestions for specific targeted interventions are discussed.