Presenting symptoms of COVID ‐19 and clinical outcomes in hospitalised older adults

Osteopenia/osteoporosis and sarcopenia are common geriatric diseases among older adults and harm activities of daily living (ADL) and quality of life (QOL). Osteosarcopenia is a unique syndrome that is a concomitant of both osteopenia/osteoporosis and sarcopenia. This review aimed to summarize the related factors and clinical outcomes of osteosarcopenia to facilitate understanding, evaluation, prevention, treatment, and further research on osteosarcopenia. We searched the literature to include meta-analyses, reviews, and clinical trials. The prevalence of osteosarcopenia among community-dwelling older adults is significantly higher in female (up to 64.3%) compared to male (8–11%). Osteosarcopenia is a risk factor for death, fractures, and falls based on longitudinal studies. However, the associations between osteosarcopenia and many other factors have been derived based on cross-sectional studies, so the causal relationship is not clear. Few studies of osteosarcopenia in hospitals have been conducted. Osteosarcopenia is a new concept and has not yet been fully researched its relationship to clinical outcomes. Longitudinal studies and high-quality interventional studies are warranted in the future.

Download Full-text

Medication Adherence: Expanding the Conceptual Framework

American Journal of Hypertension ◽

10.1093/ajh/hpab046 ◽

2021 ◽

Author(s):

Marie Krousel-Wood ◽

Leslie S Craig ◽

Erin Peacock ◽

Emily Zlotnick ◽

Samantha O’Connell ◽

...

Keyword(s):

Older Adults ◽

Medication Adherence ◽

Conceptual Framework ◽

Clinical Outcomes ◽

Implicit Attitudes ◽

Explanatory Power ◽

Population Level ◽

Time Preferences ◽

Adherence Behavior ◽

Individual Level

Abstract Interventions targeting traditional barriers to antihypertensive medication adherence (AHMA) have been developed and evaluated, with evidence of modest improvements in adherence. Translation of these interventions into population-level improvements in adherence and clinical outcomes among older adults remains suboptimal. From the Cohort Study of Medication Adherence among Older adults (CoSMO), we evaluated traditional barriers to AHMA among older adults with established hypertension (N=1544; mean age=76.2 years, 59.5% women, 27.9% Black, 24.1% and 38.9% low adherence by proportion of days covered (i.e., PDC<0.80) and the 4-item Krousel-Wood Medication Adherence Scale (i.e., K-Wood-MAS-4≥1), respectively), finding that they explained 6.4% and 14.8% of variance in pharmacy refill and self-reported adherence, respectively. Persistent low adherence rates, coupled with low explanatory power of traditional barriers, suggest that other factors warrant attention. Prior research has investigated explicit attitudes toward medications as a driver of adherence; the roles of implicit attitudes and time preferences (e.g., immediate versus delayed gratification) as mechanisms underlying adherence behavior are emerging. Similarly, while associations of individual-level social determinants of health (SDOH) and medication adherence are well-reported, there is growing evidence about structural SDOH and specific pathways of effect. Building on published conceptual models and recent evidence, we propose an expanded conceptual framework that incorporates implicit attitudes, time preferences and structural SDOH, as emerging determinants that may explain additional variation in objectively and subjectively measured adherence. This model provides guidance for design, implementation and assessment of interventions targeting sustained improvement in implementation medication adherence and clinical outcomes among older women and men with hypertension.

Download Full-text

USE OF GRADED EVIDENCE AND CLINICAL OUTCOMES TO MAKE AN INFORMED RECOMMENDATION REGARDING USE OF MONCHROMATIC NEAR-INFRARED PHOTOTHERAPY TO IMPROVE IMPAIRMENTS IN OLDER ADULTS WITH DIABETIC PERIPHERAL NEUROPATHY.

Journal of Geriatric Physical Therapy ◽

10.1519/00139143-200612000-00036 ◽

2006 ◽

Vol 29 (3) ◽

pp. 129-130

Author(s):

G. L. Pariser ◽

S. Keeling ◽

S. Sullivan ◽

D. Boyce ◽

T. Brosky ◽

...

Keyword(s):

Older Adults ◽

Peripheral Neuropathy ◽

Clinical Outcomes ◽

Diabetic Peripheral Neuropathy ◽

Near Infrared

Download Full-text

Faculty Opinions recommendation of Frailty and clinical outcomes of direct oral anticoagulants versus warfarin in older adults with atrial fibrillation : A cohort study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.740496627.793587241 ◽

2021 ◽

Author(s):

Adam Skolnick

Keyword(s):

Atrial Fibrillation ◽

Older Adults ◽

Cohort Study ◽

Clinical Outcomes ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants

Download Full-text

Every step counts: synthesising reviews associating objectively measured physical activity and sedentary behaviour with clinical outcomes in community-dwelling older adults

The Lancet Healthy Longevity ◽

10.1016/s2666-7568(21)00203-8 ◽

2021 ◽

Vol 2 (11) ◽

pp. e764-e772

Author(s):

Keenan A Ramsey ◽

Carel G M Meskers ◽

Andrea B Maier

Keyword(s):

Physical Activity ◽

Older Adults ◽

Sedentary Behaviour ◽

Clinical Outcomes ◽

Community Dwelling ◽

Step Counts ◽

Objectively Measured ◽

Community Dwelling Older Adults ◽

Objectively Measured Physical Activity

Download Full-text

Cardiac and other Presentation and Clinical Outcomes of COVID-19 Pandemic among different ethnic and religious populations in the city of Jerusalem

10.22541/au.162506999.99797857/v1 ◽

2021 ◽

Author(s):

Elad Asher ◽

Tal Y Samuel ◽

Oren Yagel ◽

Arik Wolak ◽

Rivka Farkash ◽

...

Keyword(s):

Clinical Outcomes ◽

Health Planning ◽

Orthodox Jews ◽

Major Adverse Cardiovascular Events ◽

Cerebrovascular Event ◽

Cultural Groups ◽

Admission Rates ◽

Presenting Symptoms ◽

Coronary Syndrome ◽

Religion And Ethnicity

Background: The COVID‑19 pandemic is an ongoing global pandemic. Jerusalem with its 919,400 inhabitants has a wide variety of populations, of which 62% are Jews (36% ultra-orthodox; 64% non-ultraorthodox) and 38% Arabs which were largely affected by the pandemic. The aim of our study was to understand the different presentations, course and clinical outcomes in these different ethnical and cultural groups in Jerusalem in the COVID-19 pandemic. Methods: We performed a cohort study of all COVID-19 patients admitted between March 9 - July 16, 2020 to the two university medical centers in Jerusalem. Patients were divided according to their religion and ethnicity into 3 main groups: 1) Ultra-Orthodox Jews; 2) other (non-Ultra-Orthodox) Jews and 3) Arabs. Results: Six hundred and two patients comprised the study population. Of them the 361 (60%) were Ultra-Orthodox Jews; 166 (27.5%) non-Ultra-Orthodox Jews and 75 (12.5%) Arabs. The Arab patients were younger than the Ultra-Orthodox Jews and the non-Ultra-Orthodox Jews (51±18 year-old vs. 57±21 and 59±19, respectively, p<0.01), but suffered from significantly more co-morbidities. Moreover, hemodynamic shock, ischemic ECG changes and pathological chest x-ray were all more frequent in the Ultra-Orthodox patients as compared the other groups of patients. Being an Ultra-Orthodox was independently associated with significantly higher rate of Major Adverse Cardiovascular Events (MACE) [OR=1.96; 95% CI (1.03-3.71), p<0.05]. Age was the only independent risk factor associated with increased mortality rate [OR=1.10; 95% CI (1.07 - 1.13), p<0.001]. Conclusions: The COVID-19 first phase in Jerusalem, affected different ethnical and cultural groups differently, with the Ultra-Orthodox Jews mostly affected by admission rates, presenting symptoms clinical course and MACE (Acute coronary syndrome, shock, cerebrovascular event or venous thromboembolism). It is conceivable that vulnerable populations need special attention and health planning in time of pandemic, to prevent rapid distribution and severe morbidity.

Download Full-text

The Association Between Body Mass Index, Frailty and Long-term Clinical Outcomes in Hospitalized Older Adults

The American Journal of the Medical Sciences ◽

10.1016/j.amjms.2021.04.004 ◽

2021 ◽

Author(s):

Prarthna V. Bhardwaj ◽

Vida Rastegar ◽

Rohini Meka ◽

Khalid Sawalha ◽

Maura Brennan ◽

...

Keyword(s):

Older Adults ◽

Body Mass Index ◽

Clinical Outcomes ◽

Body Mass ◽

Hospitalized Older Adults

Download Full-text

Treatment practices, response to therapy and adverse events in ANCA-associated vasculitis patients in Europe: top-line findings from a retrospective observational study

10.21203/rs.2.16847/v1 ◽

2019 ◽

Author(s):

Peter Rutherford ◽

Dieter Goette

Keyword(s):

Adverse Events ◽

Clinical Outcomes ◽

Real World ◽

Response To Therapy ◽

Remission Induction ◽

Induction Treatment ◽

Symptom Duration ◽

Similar Distribution ◽

Presenting Symptoms ◽

Anca Associated Vasculitis

Abstract Background ANCA-associated vasculitis patient outcome data in the real world setting is scarce. This study measures key clinical outcomes and adverse effects over the first 12 months of remission induction therapy.Methods This was a retrospective study of 929 newly diagnosed [ND] and 268 relapsing patients [RP] conducted online by 399 clinicians. Each clinician completed a survey for 3 patients meeting the following criteria: initiated remission induction treatment for new or relapsing disease between Nov 2014 and Feb 2017, ≥ 6 months of therapy including ≥ 1 course of induction therapy, under continuous care for ≥12 months. Data were collected relating to baseline presentation and at 1, 3, 6, and 12 months.Results 58% were >55 years old with more granulomatosis with polyangiitis (GPA, 54%) versus microscopic polyangiitis (MPA, 46%), and <20% of patients had Birmingham Vasculitis Activity Scoring (BVAS) performed. Median symptom duration prior to diagnosis was 6 to 7 weeks. Presenting symptoms were similar between ND and RP, noted differences (≥ 5%) were more fever, rash, and neuropathy, and less renal disease in RP. The majority (68% ND and 84% RP) had at least one comorbidity at diagnosis, with a similar distribution. Glucocorticoids (GC) were used by 83% ND and 76% RP; >50% were still receiving GC at 12 months. Most common treatments were cyclophosphamide+GC for ND (59%) and rituximab+GC for RP (44%). Many patients had slow and/or partial response to therapy, by 12 months >60% had a full response. 81% of patients with response by month 1 maintained full response through month 12. Adverse events and infections were common, especially during the first 3 months when GC use is highest.Conclusions Real world data show that both ND and RP ANCA-associated vasculitis patients respond variably to induction remission treatment and many experience adverse events and infections over the first 12 months of treatment. The presence of comorbidities at treatment initiation in most patients compounded the adverse impacts of disease and treatment. This study improves our understanding of the reality of clinical outcomes in ANCA-associated vasculitis and the need for targeted therapeutic approaches.

Download Full-text

Relationship between markers of malnutrition and clinical outcomes in older adults with cancer: systematic review, narrative synthesis and meta-analysis

European Journal of Clinical Nutrition ◽

10.1038/s41430-020-0629-0 ◽

2020 ◽

Vol 74 (11) ◽

pp. 1519-1535 ◽

Cited By ~ 2

Author(s):

Alex F. Bullock ◽

Sarah L. Greenley ◽

Gordon A. G. McKenzie ◽

Lewis W. Paton ◽

Miriam J. Johnson

Keyword(s):

Older Adults ◽

Food Intake ◽

Nutritional Status ◽

Clinical Outcomes ◽

Screening Tool ◽

Meta Analysis ◽

Screening Tools ◽

Narrative Synthesis ◽

Markers Of Inflammation ◽

Risk Of Cancer

Abstract Malnutrition predicts poorer clinical outcomes for people with cancer. Older adults with cancer are a complex, growing population at high risk of weight-losing conditions. A number of malnutrition screening tools exist, however the best screening tool for this group is unknown. The aim was to systematically review the published evidence regarding markers and measures of nutritional status in older adults with cancer (age ≥ 70). A systematic search was performed in Ovid Medline, EMBASE, Web of Science, CINAHL, British Nursing Database and Cochrane CENTRAL; search terms related to malnutrition, cancer, older adults. Titles, abstracts and papers were screened and quality-appraised. Data evaluating ability of markers of nutritional status to predict patient outcomes were subjected to meta-analysis or narrative synthesis. Forty-two studies, describing 15 markers were included. Meta-analysis found decreased food intake was associated with mortality (OR 2.15 [2.03–4.20] p = < 0.00001) in univariate analysis. Prognostic Nutritional Index (PNI) was associated with overall survival (HR 1.89 [1.03–3.48] p = 0.04). PNI markers (albumin, total lymphocyte count) could be seen as markers of inflammation rather than nutrition. There a suggested relationship between very low body mass index (BMI) (<18 kg/m2) and clinical outcomes. No tool was identified as appropriate to screen for malnutrition, as distinct from inflammatory causes of weight-loss. Risk of cancer-cachexia and sarcopenia in older adults with cancer limits the tools analysed. Measures of food intake predicted mortality and should be included in clinical enquiry. A screening tool that distinguishes between malnutrition, cachexia and sarcopenia in older adults with cancer is needed.

Download Full-text