scholarly journals Different aspects of frailty and COVID-19: points to consider in the current pandemic and future ones

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hani Hussien ◽  
Andra Nastasa ◽  
Mugurel Apetrii ◽  
Ionut Nistor ◽  
Mirko Petrovic ◽  
...  
Keyword(s):  
Older Adults ◽  
Poor Response ◽  
Adverse Outcomes ◽  
Exclusion Criterion ◽  
Clinical Frailty Scale ◽  
Time Saving ◽  
Acute Setting ◽  
Icu Admission ◽  
The Impact ◽  
Microbiota Diversity

Abstract Background Older adults at a higher risk of adverse outcomes and mortality if they get infected with Severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2). These undesired outcomes are because ageing is associated with other conditions like multimorbidity, frailty and disability. This paper describes the impact of frailty on coronavirus disease 2019 (COVID-19) management and outcomes. We also try to point out the role of inflamm-ageing, immunosenescence and reduced microbiota diversity in developing a severe form of COVID-19 and a different response to COVID-19 vaccination among older frail adults. Additionally, we attempt to highlight the impact of frailty on intensive care unit (ICU) outcomes, and hence, the rationale behind using frailty as an exclusion criterion for critical care admission. Similarly, the importance of using a time-saving, validated, sensitive, and user-friendly tool for frailty screening in an acute setting as COVID-19 triage. We performed a narrative review. Publications from 1990 to March 2021 were identified by searching the electronic databases MEDLINE, CINAHL and SCOPUS. Based on this search, we have found that in older frail adults, many mechanisms contribute to the severity of COVID-19, particularly cytokine storm; those mechanisms include lower immunological capacity and status of ongoing chronic inflammation and reduced gut microbiota diversity. Higher degrees of frailty were associated with poor outcomes and higher mortality rates during and after ICU admission. Also, the response to COVID-19 vaccination among frail older adults might differ from the general population regarding effectiveness and side effects. Researches also had shown that there are many tools for identifying frailty in an acute setting that could be used in COVID-19 triage, and before ICU admission, the clinical frailty scale (CFS) was the most recommended tool. Conclusion Older frail adults have a pre-existing immunopathological base that puts them at a higher risk of undesired outcomes and mortality due to COVID-19 and poor response to COVID-19 vaccination. Also, their admission in ICU should depend on their degree of frailty rather than their chronological age, which is better to be screened using the CFS.

scholarly journals Family Caregiving for Older Adults

2020 ◽  
Vol 71 (1) ◽  
pp. 635-659 ◽  
Author(s):  
Richard Schulz ◽  
Scott R. Beach ◽  
Sara J. Czaja ◽  
Lynn M. Martire ◽  
Joan K. Monin
Keyword(s):  
Older Adults ◽  
Family Caregiving ◽  
Empirical Studies ◽  
Primary Source ◽  
Intervention Strategies ◽  
Adverse Outcomes ◽  
Care Recipient ◽  
Wide Range ◽  
Intensity Of Care ◽  
The Impact

Family members are the primary source of support for older adults with chronic illness and disability. Thousands of published empirical studies and dozens of reviews have documented the psychological and physical health effects of caregiving, identified caregivers at risk for adverse outcomes, and evaluated a wide range of intervention strategies to support caregivers. Caregiving as chronic stress exposure is the conceptual driver for much of this research. We review and synthesize the literature on the impact of caregiving and intervention strategies for supporting caregivers. The impact of caregiving is highly variable, driven largely by the intensity of care provided and the suffering of the care recipient. The intervention literature is littered with many failures and some successes. Successful interventions address both the pragmatics of care and the emotional toll of caregiving. We conclude with both research and policy recommendations that address a national agenda for caregiving.

scholarly journals SARS-CoV-2 infection and adverse outcomes in users of ACE inhibitors and angiotensin-receptor blockers: a nationwide case-control and cohort analysis

Thorax ◽  
2020 ◽  
pp. thoraxjnl-2020-215768 ◽  
Author(s):  
Christian Fynbo Christiansen ◽  
Anton Pottegård ◽  
Uffe Heide-Jørgensen ◽  
Jacob Bodilsen ◽  
Ole Schmeltz Søgaard ◽  
...  
Keyword(s):  
Angiotensin Receptor Blockers ◽  
Cohort Analysis ◽  
Case Control ◽  
Adverse Outcomes ◽  
Angiotensin Receptor ◽  
Current Recommendation ◽  
Icu Admission ◽  
Registration Number ◽  
Receptor Blockers ◽  
The Impact

ObjectiveTo examine the impact of ACE inhibitor (ACE-I)/angiotensin receptor blocker (ARB) use on rate of SARS-CoV-2 infection and adverse outcomes.MethodsThis nationwide case-control and cohort study included all individuals in Denmark tested for SARS-CoV-2 RNA with PCR from 27 February 2020 to 26 July 2020. We estimated confounder-adjusted ORs for a positive test among all SARS-CoV-2 tested, and inverse probability of treatment weighted 30-day risk and risk ratios (RRs) of hospitalisation, intensive care unit (ICU) admission and mortality comparing current ACE-I/ARB use with calcium channel blocker (CCB) use and with non-use.ResultsThe study included 13 501 SARS-CoV-2 PCR-positive and 1 088 695 PCR-negative individuals. Users of ACE-I/ARB had a marginally increased rate of a positive PCR when compared with CCB users (aOR 1.17, 95% CI 1.00 to 1.37), but not when compared with non-users (aOR 1.00 95% CI 0.92 to 1.09).Among PCR-positive individuals, 1466 (11%) were ACE-I/ARB users. The weighted risk of hospitalisation was 36.5% in ACE-I/ARB users and 43.3% in CCB users (RR 0.84, 95% CI 0.70 to 1.02). The risk of ICU admission was 6.3% in ACE-I/ARB users and 5.4% in CCB users (RR 1.17, 95% CI 0.64 to 2.16), while the 30-day mortality was 12.3% in ACE-I/ARB users and 13.9% in CCB users (RR 0.89, 95% CI 0.61 to 1.30). The associations were similar when ACE-I/ARB users were compared with non-users.ConclusionsACE-I/ARB use was associated neither with a consistently increased rate nor with adverse outcomes of SARS-CoV-2 infection. Our findings support the current recommendation of continuing use of ACE-Is/ARBs during the SARS-CoV-2 pandemic.Trial registration numberEUPAS34887

scholarly journals LETTER TO THE EDITOR: COVID-19 AND THE CHALLENGES OF FRAILTY SCREENING IN OLDER ADULTS

2020 ◽  
pp. 1-2 ◽  
Author(s):  
R. O’Caoimh ◽  
S. Kennelly ◽  
E. Ahern ◽  
S. O’Keeffe ◽  
R.R. Ortuño
Keyword(s):  
Older Adults ◽  
Severe Acute Respiratory Syndrome ◽  
Healthcare Professionals ◽  
Management Strategies ◽  
Careful Examination ◽  
Geriatric Syndromes ◽  
Clinical Frailty Scale ◽  
The Impact ◽  
Recent Editorial ◽  
The Relationship

We read with interest the recent editorial examining the relationship between geriatric syndromes and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of Covid-19 (1), particularly the authors recognition of the need to identify frailty among older adults presenting with suspected symptoms and the importance of mobilising a range of healthcare professionals to tackle this disease (1). However, the identification of frailty and the utilisation of screening instruments by those without geriatric training and especially in acute care is challenging. Frailty is a complex condition. While age-associated, it is multi-dimensional and remains difficult to define (2). Although the Covid-19 pandemic has disproportionately affected older adults (1), data are lacking and pathophysiological mechanisms and the impact of differential management strategies on the course of the disease among older adults is uncertain (1). Further, the prevalence of frailty among those diagnosed, admitted or dying is not clearly reported at present. Nevertheless, the rationale for using frailty to identify those at risk and to allocate care has been correctly highlighted (1). We suggest however, that the use of instruments such as the Clinical Frailty Scale (CFS) (3) and particularly by non-specialised staff in this setting warrants more careful examination.

scholarly journals 1415. Use of Adjunctive Steroids in Adults with Encephalitis

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S515-S515
Author(s):  
Ambreen Allana ◽  
Mohammed Samannodi ◽  
Michael Hansen ◽  
Rodrigo Hasbun
Keyword(s):  
Clinical Outcomes ◽  
Brain Mri ◽  
Tertiary Care ◽  
Brain Magnetic Resonance Imaging ◽  
Adverse Outcomes ◽  
Neurological Deficits ◽  
Icu Admission ◽  
Magnetic Resonance Imaging Mri ◽  
Tertiary Care Hospitals ◽  
The Impact

Abstract Background To describe the use and the impact on clinical outcomes of adjunctive steroids in adults with encephalitis. Methods We conducted a retrospective observational study of 230 adults (age >17 years) who met the international consortium definition for encephalitis. An adverse clinical outcome was defined as a Glasgow outcome score of 1–4. The study took place at three tertiary care hospitals in Houston TX, between August 2008 and September 2017. Results A total of 230 adults with encephalitis were enrolled, out of which 121 (52.6%) received steroids. Adjunctive steroids were given more frequently to those with focal neurological deficits (P = 0.013), had a positive cerebrospinal fluid (CSF) HSV PCR (P = 0.013), required mechanical ventilation (MV) (P = 0.011), required intensive care unit (ICU) admission (P < 0.001), had white matter abnormalities (P = 0.014) or had cerebral edema on the brain magnetic resonance imaging (MRI) (P = 0.003). An adverse outcome was seen in 139 (60.7%) of patients. Predictors for adverse outcomes included a Glasgow coma score (GCS) < 8, fever, seizures, ICU admission, and presence of edema on brain MRI. The use of adjunctive steroids did not impact clinical outcomes (P = 0.521). Independent prognostic factors on logistic regression analysis were edema on brain MRI (7.780 [1.717–35.263] P = 0.008), GCS < 8 (6.339 [1.992–20.168] P = 0.002), and fever (2.601 [1.342–5.038] P = 0.005). Conclusion Adults with encephalitis continues to be associated with significant adverse clinical outcomes in the majority of patients. Adjunctive steroids are used in the sicker patients and it is not associated with improved clinical outcomes. Disclosures All authors: No reported disclosures.

scholarly journals MP32: Mid-morning huddle: a coordinated team approach to facilitating disposition of older adults

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S54
Author(s):  
N. Kelly ◽  
S. Campbell
Keyword(s):  
Older Adults ◽  
Length Of Stay ◽  
Average Length ◽  
Adverse Outcomes ◽  
Team Approach ◽  
Discharge Disposition ◽  
Consulting Services ◽  
Discharge Rates ◽  
The Impact ◽  
Bounce Back

Background: Older adults in the emergency department (ED) take an increasingly larger portion of resources, have increased length of stay and a higher likelihood of adverse outcomes. In many cases bad planning, multiple vague handovers, and lack of coordinated care exacerbate this problem. With the impending onset of our aging population this is a situation that can be expected to compound in complexity in the years to come. Aim Statement: We describe daily interdisciplinary review of ED patients over the age of 75 years (or otherwise identified as a challenging discharge) to discuss barriers and facilitators to discharge/disposition. We will use data to identify the impact of this particular population to ED flow. Measures &amp; Design: This initiative developed from our participation in the Acute Care of the Elderly (ACE) Collaborative and applies Plan/Do/Study/Act (PDSA) cycles and run reports to compare: length of stay; Identification of Seniors at Risk (ISAR) screening tool; ED census, admission/discharge rates, bounce back rates, consulting services, and interdisciplinary participation. Evaluation/Results: The average daily census of our ED between the months of July-October of 2018 was over 211 patients/day, of which over 12% were patients 75 years and older. We conducted over 70 huddles, reviewing an average of 11 patients per day. The average length of stay for patients at the time of the huddle was 19 hours, significantly higher than the general emergency population. Next day admission and discharge rates were comparable, 44.8% and 43.1% respectively with the additional patients remaining in the ED with no disposition. Internal medicine was consulted on 30% of all huddle patients and 38.4% subsequently admitted. Thirty day bounce back rates for huddle patients discharged home was 29.3%. Around 60% of patients 75 and older were screened with the ISAR and 55.7% of these were positive (2 or more questions). Discussion/Impact: Older patients consume a disproportionate amount of ED resources. Daily interdisciplinary ‘geriatric huddles’ improved communication between members of the ED team and with consulting services. The huddles enhanced awareness of the unique demands that older adults place on the flow of the ED, and identified opportunities to enhance patient flow.

scholarly journals Risk of clinical severity by age and race/ethnicity among adults hospitalized for COVID-19 — United States, March–September 2020

2020 ◽  
Author(s):  
Audrey F Pennington ◽  
Lyudmyla Kompaniyets ◽  
April D Summers ◽  
Melissa L Danielson ◽  
Alyson B Goodman ◽  
...  
Keyword(s):  
Older Adults ◽  
Ethnic Groups ◽  
Invasive Mechanical Ventilation ◽  
Clinical Severity ◽  
Adjusted Risk ◽  
Icu Admission ◽  
Risk Of Death ◽  
Race Ethnicity ◽  
Poor Outcomes ◽  
The Impact

Abstract Background Older adults and people from certain racial and ethnic groups are disproportionately represented in COVID-19 hospitalizations and deaths. Methods Using data from the Premier Healthcare Database on 181,813 hospitalized adults diagnosed with COVID-19 during March–September 2020 we applied multivariable log-binomial regression to assess the associations between age and race/ethnicity and COVID-19 clinical severity (intensive care unit [ICU] admission, invasive mechanical ventilation [IMV], and death); and determine whether the impact of age on clinical severity differs by race/ethnicity. Results Overall, 84,497 (47%) patients were admitted to the ICU, 29,078 (16%) received IMV, and 27,864 (15%) died in the hospital. Increased age was strongly associated with clinical severity when controlling for underlying medical conditions and other covariates; the strength of this association differed by race/ethnicity. Compared with non-Hispanic White patients, risk of death was lower among non-Hispanic Black patients (adjusted risk ratio [95% CI]: 0.96 [0.92, 0.99]), and higher among Hispanic/Latino patients (RR [95% CI]: 1.15 [1.09, 1.20]), non-Hispanic Asian patients (RR [95% CI]: 1.16 [1.09, 1.23]), and patients of other racial and ethnic groups (RR [95% CI]: 1.13 [1.06, 1.21]). Risk of ICU admission and IMV was elevated among some racial and ethnic groups. Conclusions These results indicate that age is a driver of poor outcomes among hospitalized persons with COVID-19. Additionally, clinical severity may be elevated among patients of some racial and ethnic minority groups. Public health strategies to reduce SARS-CoV-2 infection rates among older adults and racial and ethnic minorities are essential to reduce poor outcomes.

scholarly journals Artificial intelligence prediction of adverse outcomes in emergency department patients with hyperglycemic crises in real-time

2020 ◽  
Author(s):  
Chin-Chuan Hsu ◽  
Yuan Kao ◽  
Chien-Chin Hsu ◽  
Chia-Jung Chen ◽  
Shu-Lien Hsu ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Septic Shock ◽  
Logistic Regression ◽  
Prediction Model ◽  
Real Time ◽  
Adverse Outcomes ◽  
Support Vector ◽  
Icu Admission ◽  
All Cause Mortality ◽  
The Impact

Abstract Background Hyperglycemic crises are associated with high morbidity and mortality. Previous studies proposed methods for predicting adverse outcome in hyperglycemic crises, artificial intelligence (AI) has however never been tried. We implemented an AI prediction model integrated with hospital information system (HIS) to clarify this issue. Methods We included 3,715 patients with hyperglycemic crises from emergency departments (ED) between 2009 and 2018. Patients were randomized into a 70%/30% split for AI model training and testing. Twenty-two feature variables from their electronic medical records were collected, and multilayer perceptron (MLP) was used to construct an AI prediction model to predict sepsis or septic shock, intensive care unit (ICU) admission, and all-cause mortality within 1 month. Comparisons of the performance among random forest, logistic regression, support vector machine (SVM), K-nearest neighbor (KNN), Light Gradient Boosting Machine (LightGBM), and MLP algorithms were also done. Results Using the MLP model, the areas under the curves (AUCs) were 0.808 for sepsis or septic shock, 0.688 for ICU admission, and 0.770 for all-cause mortality. MLP had the best performance in predicting sepsis or septic shock and all-cause mortality, compared with logistic regression, SVM, KNN, and LightGBM. Furthermore, we integrated the AI prediction model with the HIS to assist physicians for decision making in real-time. Conclusions A real-time AI prediction model is a promising method to assist physicians in predicting adverse outcomes in ED patients with hyperglycemic crises. Further studies on the impact on clinical practice and patient outcome are warranted.

scholarly journals Outcomes of Older Adults With Sepsis at Admission to an Intensive Care Unit

2016 ◽  
Vol 3 (1) ◽  
Author(s):  
Theresa Rowe ◽  
Katy L. B. Araujo ◽  
Peter H. Van Ness ◽  
Margaret A. Pisani ◽  
Manisha Juthani-Mehta
Keyword(s):  
Older Adults ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Icu Admission ◽  
Baseline Characteristics ◽  
The Impact

Abstract Background.  Sepsis is a major cause of morbidity and mortality among older adults. The main goals of this study were to assess the association of sepsis at intensive care unit (ICU) admission with mortality and to identify predictors associated with increased mortality in older adults. Methods.  We conducted a prospective cohort study of 309 participants ≥60 years admitted to an ICU. Sepsis was defined as 2 of 4 systemic inflammatory response syndrome criteria plus a documented infection within 2 calendar days before or after admission. The main outcome measure was time to death within 1 year of ICU admission. Sepsis was evaluated as a predictor for mortality in a Cox proportional hazards model. Results.  Of 309 participants, 196 (63%) met the definition of sepsis. Among those admitted with and without sepsis, 75 (38%) vs 20 (18%) died within 1 month of ICU admission (P &lt; .001) and 117 (60%) vs 48 (42%) died within 1 year (P &lt; .001). When adjusting for baseline characteristics, sepsis had a significant impact on mortality (hazard ratio [HR] = 1.80; 95% confidence interval [CI], 1.28–2.52; P &lt; .001); however, after adjusting for baseline characteristics and process covariates (antimicrobials and vasopressor use within 48 hours of admission), the impact of sepsis on mortality became nonsignificant (HR = 1.26; 95% CI, .87–1.84; P = .22). Conclusions.  The diagnosis of sepsis in older adults upon ICU admission was associated with an increase in mortality compared with those admitted without sepsis. After controlling for early use of antimicrobials and vasopressors for treatment, the association of sepsis with mortality was reduced.

scholarly journals The FRAIL-FIT 30 Study – Factors influencing 30-day mortality in frail patients admitted to ICU: A retrospective observational cohort study

2021 ◽  
pp. 175114372098516
Author(s):  
David Hewitt ◽  
Michael Ratcliffe ◽  
Malcolm G Booth
Keyword(s):  
Cohort Study ◽  
Single Point ◽  
Observational Cohort Study ◽  
Adverse Outcomes ◽  
Royal Infirmary ◽  
Clinical Frailty Scale ◽  
Icu Admission ◽  
Frail Patients ◽  
Observational Cohort ◽  
Retrospective Observational Cohort Study

Background Frailty is a multi-dimensional syndrome of reduced reserve, resulting from overlapping physiological decrements across multiple systems. The contributing factors, temporality and magnitude of frailty’s effect on mortality after ICU admission are unclear. This study assessed frailty’s impact on mortality and life sustaining therapy (LST) use, following ICU admission. Methods This single-centre retrospective observational cohort study analysed data collected prospectively in Glasgow Royal Infirmary ICU. Of 684 eligible patients, 171 were frail and 513 were non-frail. Frailty was quantified using the Rockwood Clinical Frailty Scale (CFS). All patients were followed up 1-year after ICU admission. The primary outcome was all-cause mortality at 30-days post-ICU admission. Key secondary outcomes included mortality at 1-year and LST use. Results Frail patients were significantly less likely to survive 30-days post-ICU admission (61.4% vs 81.1%, p < 0.001). This continued to 1-year (48.5% vs 68.2%, p < 0.001). Frailty significantly increased mortality hazards in covariate-adjusted analyses at 30-days (HR 1.56; 95%CI 1.14–2.15; p = 0.006), and 1-year (HR 1.35; 95%CI 1.03–1.76; p = 0.028). Single-point CFS increases were associated with a 30-day mortality hazard of 1.23 (95%CI 1.13–1.34; p < 0.001) in unadjusted analyses, and 1.11 (95%CI 1.01–1.22; p = 0.026) after covariate adjustment. Frail patients received significantly more days of LST (median[IQR]: 5[3,11] vs 4[2,9], p = 0.008). Conclusion Frailty was significantly associated with greater mortality at all time points studied, but most notably in the first 30-days post-ICU admission. This was despite greater LST use. The accrual effect of frailty increased adverse outcomes. Point-by-point use of frailty scoring could allow for more informed decision making in ICU.

scholarly journals Frailty as a Moderator of the Relationship Between Social Isolation and Health Outcomes

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 269-270
Author(s):  
Fereshteh Mehrabi ◽  
François Béland
Keyword(s):  
Older Adults ◽  
Cognitive Decline ◽  
Social Isolation ◽  
Social Participation ◽  
Social Ties ◽  
Extended Family ◽  
Adverse Outcomes ◽  
Community Dwelling ◽  
Cross Sectional ◽  
The Impact

Abstract Previous studies have reported that social isolation is a predictor of adverse outcomes, which is also closely associated with frailty. Very little is known about the moderating role of frailty on the impact of social isolation on health. We performed a cross-sectional analysis of the first wave of the FRéLE longitudinal study, consisting of 1643 Canadian community-dwelling older adults aged 65 years and over. Multivariate regression analysis was performed to examine the interaction between social isolation and frailty on health, controlling for socioeconomic characteristics and life habits. Social isolation was measured through social participation, social networks and support for different social ties namely, friends, children, extended family, and partner. In contrast to Berkman’s theory on the impact of social isolation on health, we found that frailty had no modifying role on the effects of social isolation on health. Frailty was significantly associated with all adverse outcomes. Less social participation was associated with ADLs, IADLs, depression and cognitive decline. The absence of friends was associated with depression and cognitive decline. Less support from children and having no children were associated with ADLs, comorbidity and depression. Fewer contact with extended family and having no family members were notably associated with ADLs and IADLs. Those who received less support from a partner or had no partner were more depressed and had more difficulties in performing IADLs. This study suggests that older adults who participate in social activities and have social ties, feel better with respect to physical health than those who feel isolated.

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