Covid-19 Infection in Older Adults: A Geriatrician's Perspective

Neuroleptic Malignant Syndrome in Patients With Dementia: Experiences of A Single Memory Clinic

OBJECTIVES

Neuroleptic malignant syndrome (NMS) is a life-threatening condition that occurs as an adverse reaction to antipsychotic and antiemetic agents or sudden withdrawal of dopaminergic medications. Given the metabolic and functional reserves and the comorbidities in older adults, NMS may show an atypical course.

METHODS

The medical records of patients with neurodegenerative diseases leading to dementia between 2013 and 2020 were reviewed for the diagnosis of NMS. Demographic and clinical characteristics of the patients were obtained from the records of laboratory parameters, management, and length of stay.

RESULTS

Fifteen older adults (19 episodes) diagnosed with NMS were included. The median age was 76 years, and 5 were female. Ten of 15 NMS patients were atypical. Most of them had an infection accompanying NMS. Neuroleptic malignant syndrome was caused by antidopaminergic agents (5 antipsychotics, 1 metoclopramide) in 6 episodes and discontinuation of a dopaminergic agent, l -DOPA, in 12 episodes. In 1 patient, it was associated with simultaneous use of domperidone and amantadine withdrawal. Rigidity in NMS due to l -DOPA discontinuation was higher than in those due to antipsychotic use ( P = 0.027). Two of our patients needed intensive care, and 1 died.

CONCLUSIONS

This study highlights the high frequency of atypical NMS and the importance of early recognition of this potentially fatal syndrome, which can accompany neurodegenerative diseases and infections in older adults.

An atypical presentation of COVID-19: Hidden risk for seniors to misdiagnose

The outbreak of coronavirus disease (COVID-19) was announced as a pandemic by the World Health Organization in March 2020. Clinical manifestations include cough, fever, dyspnea, myalgia, and loss of sense of smell and taste. Less common extrapulmonary signs and symptoms such as cutaneous manifestations, diarrhea, confusion, functional decline have been reported in the literature. Older patients with multiple comorbidities are at a greater risk for severe disease and death and are vulnerable to atypical presentations due to changes in organ systems, multimorbidity, cognitive impairment, and sensory disturbances. In this case, a 77-year-old patient diagnosed with COVID-19 pneumonia presented with atypically acute urticaria with angioedema was reported. Although there were no typical signs of the disease, such as cough or shortness of breath, the patient's laboratory values, and chest imaging were compatible with COVID-19. Therefore, the diagnosis of COVID-19 should be considered in older patients presenting with subtle signs or cutaneous manifestations.

E-mail-based health care in patients with dementia during the pandemic

INTRODUCTION/AIM

Frail and cognitively impaired older patients are particularly vulnerable groups during the pandemic. Lockdowns, social isolation, and physical inactivity considerably affect physical and mental wellbeing. During the pandemic process, routine medical checks and acute medical care services may be disrupted. The study aimed to demonstrate the feasibility and effectiveness of telemedicine in the delivery of healthcare services to elderly patients during the pandemic.

MATERIALS AND METHODS

E-mails sent to the e-mail address of the department of geriatrics, which has been actively used for 4 years, between April 2020 and June 2021, were retrospectively evaluated. The time and reason for each application, referral to the patients, demographic data of the patients, and chronic diseases were recorded. E-mail frequencies were considered monthly time series, and time series charts for e-mail frequencies from patients were produced.

RESULTS

A total of 374 e-mails that 213 patients sent were assessed. A vast majority, 97.6% of the e-mails, were sent by proxies. The mean age of patients was 78.7 ± 8.1 years, and 59.2% were women. Hypertension and dementia were the most common comorbidities. The applications mostly occurred in April-May and October-November 2020. The most common complaint in dementia was behavioral disturbances (13.6%). Geriatric outpatient appointments were arranged for 29.9% of the applicants, 14.2% were referred to the emergency department, and 23.0% were offered medical treatment. Outpatient examination and treatment were completed in 15% of the patients and 10.4% of them were hospitalized. The time series charts showed that e-mails were sent more frequently by patients with dementia than the others (p = 0.03).

CONCLUSIONS

Telemedicine, which enables many problems of patients to be solved in geriatric practice without face-to-face appointments, can also prevent infections and unnecessary hospitalizations, especially during these unusual pandemic days.

Dementia and Mental Health During the COVID-19 Pandemic: A Systematic Review

OBJECTIVES

The COVID-19 pandemic raised significant concerns related to the management of care for people with dementia, but few studies have examined the mental health of older adults with dementia and their caregivers during the pandemic, when compared to other populations. This systematic review thus aims to compare and discuss the impact of the COVID-19 pandemic on people with dementia and on their caregivers' mental health.

METHODS

A search was performed in the PubMed/Medline and ISI databases according to the PRISMA methodology. We included studies published in 2020 and 2021 with the following combinations of keywords: "COVID-19 and mental health and elderly," "COVID-19 and mental health and dementia;" "COVID-19 and dementia and caregivers," "pandemic and mental health and elderly," and "pandemic and anxiety."

RESULTS

Twenty-two studies were included. Technology has proven to be an essential ally during the pandemic, since all 22 studies performed remote data collection. Nearly all the studies emphasized that social isolation and withdrawal can lead to the emergence or increase of neuropsychiatric symptoms and motor difficulties. However, the findings were mixed concerning the pandemic's impact on the cognition of people with dementia. Caregivers also suffered from the pandemic's impact, experiencing an increase in the burden of care and symptoms of stress, depression, and anxiety. Few studies suggested measures to alleviate the difficulties of people with dementia and their caregivers. There are reports of the benefits of technology in communication and treatment through teleconsultations, however, not everyone has access to such technology, making it difficult to disseminate this tool to the target population.

CONCLUSIONS

The studies generally showed that social isolation can increase motor deficits and neuropsychiatric symptoms and caregivers' burden and anxiety. New avenues for care and intervention are thus needed for older adults with cognitive deficits and their caregivers to avoid the intensification of physical and psychological suffering. Technological initiatives and support should consider people with cognitive impairment and different levels of technology literacy.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/.

Moving Through COVID-19: Perspectives of Older Adults in the Getting Older Adults Outdoors Study

Safety guidelines resulting from the coronavirus disease 2019 pandemic may reduce physical activity participation of older adults, particularly prefrail and frail individuals. The objective was to explore older adults' experiences with physical activity during the coronavirus disease 2019 pandemic. Using a qualitative descriptive approach, interviews were conducted with 16 older adults. Data were analyzed thematically. Two themes emerged: (a) coming to a standstill and (b) small steps. Participants described that imposed provincial and federal recommendations caused them to reduce their physical activity with negative consequences. As time progressed, participants used emerging public health knowledge about coronavirus disease 2019 to safely increase physical activity. Many participants developed strategies to remain active during the pandemic (e.g., wearing a pedometer, walking outdoors at particular times of day). Findings from this study can better inform the development of programs, clinical practice, and policy for physical activity promotion in older adults during periods of physical distancing and isolation.

Effective online COVID-19 messages? A thematic analysis of major senior living community websites in the United States

Due to seniors being at high risk of severe COVID-19, senior living communities became most impacted settings from COVID-19. This study investigated how senior living communities managed COVID-19 by looking at situational factors in their responses to COVID-19 on their websites. The study found that COVID-19 information had the least presence on the websites. However, most communities still exhibited their efforts to practice COVID-19 preventions. Many websites provided detailed vaccination information to encourage people to be vaccinated for new normal, while others illustrated the impact of social isolation on mental and physical health of their residents with health recommendations.