scholarly journals Geriatrics-focused indicators predict mortality more than age in older adults hospitalized with COVID-19

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Liron Sinvani ◽  
Allison Marziliano ◽  
Alex Makhnevich ◽  
Sergey Tarima ◽  
Yan Liu ◽  
...  
Keyword(s):  
Older Adults ◽  
New York ◽  
Multivariable Analysis ◽  
Information Criterion ◽  
Treatment Preferences ◽  
Severe Illness ◽  
Stepwise Logistic Regression ◽  
Normal Body Mass Index ◽  
Do Not Resuscitate ◽  
Hospitalized Older Adults

Abstract Background Age has been implicated as the main risk factor for COVID-19-related mortality. Our objective was to utilize administrative data to build an explanatory model accounting for geriatrics-focused indicators to predict mortality in hospitalized older adults with COVID-19. Methods Retrospective cohort study of adults age 65 and older (N = 4783) hospitalized with COVID-19 in the greater New York metropolitan area between 3/1/20-4/20/20. Data included patient demographics and clinical presentation. Stepwise logistic regression with Akaike Information Criterion minimization was used. Results The average age was 77.4 (SD = 8.4), 55.9% were male, 20.3% were African American, and 15.0% were Hispanic. In multivariable analysis, male sex (adjusted odds ration (adjOR) = 1.06, 95% CI:1.03-1.09); Asian race (adjOR = 1.08, CI:1.03-1.13); history of chronic kidney disease (adjOR = 1.05, CI:1.01-1.09) and interstitial lung disease (adjOR = 1.35, CI:1.28-1.42); low or normal body mass index (adjOR:1.03, CI:1.00-1.07); higher comorbidity index (adjOR = 1.01, CI:1.01-1.02); admission from a facility (adjOR = 1.14, CI:1.09-1.20); and mechanical ventilation (adjOR = 1.52, CI:1.43-1.62) were associated with mortality. While age was not an independent predictor of mortality, increasing age (centered at 65) interacted with hypertension (adjOR = 1.02, CI:0.98-1.07, reducing by a factor of 0.96 every 10 years); early Do-Not-Resuscitate (DNR, life-sustaining treatment preferences) (adjOR = 1.38, CI:1.22-1.57, reducing by a factor of 0.92 every 10 years); and severe illness on admission (at 65, adjOR = 1.47, CI:1.40-1.54, reducing by a factor of 0.96 every 10 years). Conclusion Our findings highlight that residence prior to admission, early DNR, and acute illness severity are important predictors of mortality in hospitalized older adults with COVID-19. Readily available administrative geriatrics-focused indicators that go beyond age can be utilized when considering prognosis.

scholarly journals Variables Impacting Nursing Home Goals of Care Discussions and Order Implementation During COVID-19

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 734-734
Author(s):  
Orah Burack ◽  
Joann Reinhardt ◽  
Wingyun Mak ◽  
Himali Weerahandi ◽  
Benjamin Canter ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nurse Practitioners ◽  
Older Age ◽  
Treatment Preferences ◽  
Severe Illness ◽  
Cognitively Impaired ◽  
Short Stay ◽  
Do Not Resuscitate ◽  
Goals Of Care ◽  
Specialized Care

Abstract Nursing home (NH) residents are especially vulnerable to COVID-19, disproportionately suffering from severe illness and death. As such, resident Goals of Care (GOC) often had to be quickly established to ensure treatment preferences were known and respected. This study examined variables related to the occurrence of GOC discussions and added orders (Do Not Resuscitate, Do Not Intubate, and Do Not Hospitalize), including demographic, physical functioning, cognitive impairment, depression, number of diagnoses, and Optum participation (Optum provided added specialized care by nurse practitioners who routinely address GOC preferences). Subjects were 286 COVID positive residents from a large NYC NH. All data were obtained from the NH’s electronic medical records. Patient median age was 81 n (interquartile range 71-88), 59% were female, 61% were long stay (stay >100 days) and 39% were short stay. Using bivariate correlations we found that older short stay residents were more likely to have GOC conversations. Additionally, older, cognitively impaired, Optum participants were more likely to have orders added. When all independent variables were entered into binary logistic regressions, only older age and being a primary English speaker were significantly related to the occurrence of GOC conversations (□2= 21.76**; N=278; Nagelkerke R2 = .10), while older age and being an Optum participant were related to added orders (□2=32.18**; N=164; Nagelkerke R2 = .24). Results have implications for (1) ensuring the GOC wishes of diverse populations are known and abided by and (2) improving the quality of clinician – resident GOC discussions.

scholarly journals Factors Associated with Mortality in Hospitalized Older Adults with COVID-19: A Large Retrospective Cohort Study

2021 ◽  
Author(s):  
Liron Sinvani ◽  
Allison Marziliano ◽  
Alex Makhnevich ◽  
Yan Liu ◽  
Michael Qiu ◽  
...  
Keyword(s):  
Older Adults ◽  
New York ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Factors Associated ◽  
York Metropolitan Area ◽  
Included Patient ◽  
Hospitalized Older Adults ◽  
Oxygen Requirements

Abstract Background: Age has been implicated as the main risk factor for COVID-19-related mortality. Our objective was to determine patient factors associated with mortality in hospitalized older adults with COVID-19. Methods: Retrospective cohort study of adults age 65+ (N=4,949) hospitalized with COVID-19 in the greater New York metropolitan area between 3/1/20-4/20/20. Data included patient demographics and clinical presentation. Multivariate logistic regression was used to evaluate associations. Results: Average age 77.3 (SD=8.4), 56.0% male, 20.8% African American, 15.1% Hispanic. In a multivariate analysis, male gender (OR=1.47), higher comorbidity index (OR=1.10), admission from a facility (lower baseline function; OR=1.71), early DNR (declining life-sustaining treatments, OR=2.45), and higher illness severity (higher MEWS, OR=6.26, and higher oxygen requirements, OR=15.00) were associated with mortality, while age was not (p = 0.22). Conclusion: Our findings highlight the need to look beyond age in hospitalized older adults with COVID-19 when considering prognosis and treatment decisions.

scholarly journals Timing of Do-Not-Resuscitate Orders for Hospitalized Older Adults Who Require a Surrogate Decision-Maker

2011 ◽  
Vol 59 (7) ◽  
pp. 1326-1331 ◽  
Author(s):  
Alexia M. Torke ◽  
Greg A. Sachs ◽  
Paul R. Helft ◽  
Sandra Petronio ◽  
Christianna Purnell ◽  
...  
Keyword(s):  
Older Adults ◽  
Decision Maker ◽  
Surrogate Decision Maker ◽  
Do Not Resuscitate ◽  
Do Not Resuscitate Orders ◽  
Hospitalized Older Adults ◽  
Surrogate Decision

scholarly journals Age Does Not Predict Mortality in Hospitalized COVID-19+ Older Adults: Rethinking Resource Allocation Based on Age

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 933-933
Author(s):  
Liron Sinvani ◽  
Allison Marziliano ◽  
Alex Makhnevich ◽  
Meng Zhang ◽  
Maria Carney ◽  
...  
Keyword(s):  
Older Adults ◽  
Resource Allocation ◽  
Hospital Mortality ◽  
Warning System ◽  
Cognitive Status ◽  
Treatment Preferences ◽  
Do Not Resuscitate ◽  
Main Indicator ◽  
Life Sustaining Treatment ◽  
Related Mortality

Abstract Older adults are disproportionately affected by the coronavirus (COVID-19) pandemic. While age has been used to guide resource allocation based on studies implicating age as the main risk factor for COVID-19-related mortality, most did not account for critical factors such as baseline functional and cognitive status, or life-sustaining treatment preferences. The objective of this study was to determine whether age is independently associated with mortality in older adults hospitalized with COVID-19. We conducted a retrospective cohort study of adults age 65+ with confirmed COVID-19 hospitalized in the greater NY metropolitan area between 3/1/20-4/20/20. Primary outcome was in-hospital mortality, with age as the primary predictor. Multivariate logistic regression was used to evaluate association between age and in-hospital mortality after controlling for demographics, severity of acute illness, comorbidities, and baseline function, cognition, and life-sustaining treatment preferences. 4,969 patients were included, average age 77.3, 56.0% male, 46.8% White, 20.8% African American, 15.1% Hispanic. Common comorbidities included hypertension (61.1%), and diabetes (36.8%); average number of comorbidities was 3.4 (SD 2.8) and 13.0% had dementia. 20.8% arrived from a facility and 5.7% had early do-not-resuscitate orders. On arrival, the Modified Early Warning System score was 4.2 (SD 1.7) and 79.6% required oxygen therapy. 35.3% of patients expired. In multivariate analysis, age was not independently associated with mortality (p = .173). Functional status, multi-morbidity, life-sustaining treatment preferences, and illness severity, not age, were associated with mortality among older adults hospitalized with COVID-19, suggesting age should not be used as the main indicator to guide resource allocation.

scholarly journals Religion and Spirituality in Surrogate Decision Making for Hospitalized Older Adults

2015 ◽  
Vol 55 (3) ◽  
pp. 765-777 ◽  
Author(s):  
Kristin N. Geros-Willfond ◽  
Steven S. Ivy ◽  
Kianna Montz ◽  
Sara E. Bohan ◽  
Alexia M. Torke
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Surrogate Decision Making ◽  
Religion And Spirituality ◽  
Hospitalized Older Adults ◽  
Surrogate Decision

The 32-Item Multilingual Naming Test: Cultural and Linguistic Biases in Monolingual Chinese-Speaking Older Adults

2021 ◽  
pp. 1-9
Author(s):  
Clara Li ◽  
Xiaoyi Zeng ◽  
Judith Neugroschl ◽  
Amy Aloysi ◽  
Carolyn W. Zhu ◽  
...  
Keyword(s):  
Older Adults ◽  
New York ◽  
Test Performance ◽  
Item Difficulty ◽  
Chinese Older Adults ◽  
Chinese Speakers ◽  
School Of Medicine ◽  
Consensus Conferences ◽  
Linguistic Groups ◽  
Naming Test

ABSTRACT Objectives: This study describes the performance of the Multilingual Naming Test (MINT) by Chinese American older adults who are monolingual Chinese speakers. An attempt was also made to identify items that could introduce bias and warrant attention in future investigation. Methods: The MINT was administered to 67 monolingual Chinese older adults as part of the standard dementia evaluation at the Alzheimer’s Disease Research Center (ADRC) at the Icahn School of Medicine at Mount Sinai (ISMMS), New York, USA. A diagnosis of normal cognition (n = 38), mild cognitive impairment (n = 12), and dementia (n = 17) was assigned to all participants at clinical consensus conferences using criterion sheets developed at the ADRC at ISMMS. Results: MINT scores were negatively correlated with age and positively correlated with education, showing sensitivity to demographic factors. One item, butterfly, showed no variations in responses across diagnostic groups. Inclusion of responses from different regions of China changed the answers from “incorrect” to “correct” on 20 items. The last five items, porthole, anvil, mortar, pestle, and axle, yielded a high nonresponse rate, with more than 70% of participants responding with “I don’t know.” Four items, funnel, witch, seesaw, and wig, were not ordered with respect to item difficulty in the Chinese language. Two items, gauge and witch, were identified as culturally biased for the monolingual group. Conclusions: Our study highlights the cultural and linguistic differences that might influence the test performance. Future studies are needed to revise the MINT using more universally recognized items of similar word frequency across different cultural and linguistic groups.

scholarly journals Influenza Vaccine Effectiveness and Waning Effect in Hospitalized Older Adults. Valencia Region, Spain, 2018/2019 Season

2021 ◽  
Vol 18 (3) ◽  
pp. 1129
Author(s):  
Ainara Mira-Iglesias ◽  
F. Xavier López-Labrador ◽  
Javier García-Rubio ◽  
Beatriz Mengual-Chuliá ◽  
Miguel Tortajada-Girbés ◽  
...  
Keyword(s):  
Older Adults ◽  
Influenza Vaccine ◽  
Influenza A ◽  
Vaccine Effectiveness ◽  
Surveillance Network ◽  
Adjuvanted Vaccine ◽  
Clinical Registries ◽  
Populations At Risk ◽  
Influenza A H1n1 ◽  
Hospitalized Older Adults

Influenza vaccination is annually recommended for specific populations at risk, such as older adults. We estimated the 2018/2019 influenza vaccine effectiveness (IVE) overall, by influenza subtype, type of vaccine, and by time elapsed since vaccination among subjects 65 years old or over in a multicenter prospective study in the Valencia Hospital Surveillance Network for the Study of Influenza and other Respiratory Viruses (VAHNSI, Spain). Information about potential confounders was obtained from clinical registries and/or by interviewing patients and vaccination details were only ascertained by registries. A test-negative design was performed in order to estimate IVE. As a result, IVE was estimated at 46% (95% confidence interval (CI): (16%, 66%)), 41% (95% CI: (−34%, 74%)), and 45% (95% CI: (7%, 67%)) against overall influenza, A(H1N1)pdm09 and A(H3N2), respectively. An intra-seasonal not relevant waning effect was detected. The IVE for the adjuvanted vaccine in ≥75 years old was 45% (2%, 69%) and for the non-adjuvanted vaccine in 65–74 years old was 59% (−16%, 86%). Thus, our data revealed moderate vaccine effectiveness against influenza A(H3N2) and not significant against A(H1N1)pdm09. Significant protection was conferred by the adjuvanted vaccine to patients ≥75 years old. Moreover, an intra-seasonal not relevant waning effect was detected, and a not significant IVE decreasing trend was observed over time.

Relationship of hospital volume on outcomes in patients with acute pulmonary embolism: Analysis of a 70,000 patient database

2020 ◽  
pp. 1358863X2097026
Author(s):  
Mark Finkelstein ◽  
Mario A Cedillo ◽  
David C Kestenbaum ◽  
Obaib S Shoaib ◽  
Aaron M Fischman ◽  
...  
Keyword(s):  
New York ◽  
Pulmonary Embolism ◽  
Length Of Stay ◽  
New York State ◽  
Multivariable Analysis ◽  
High Volume ◽  
Categorical Variables ◽  
Patient Database ◽  
Very High ◽  
Total Charges

Positive relationships between volume and outcome have been seen in several surgical and medical conditions, resulting in more centralized and specialized care structures. Currently, there is a scarcity of literature involving the volume–outcome relationship in pulmonary embolism (PE). Using a state-wide dataset that encapsulates all non-federal admissions in New York State, we performed a retrospective cohort study on admitted patients with a diagnosis of PE. A total of 70,443 cases were separated into volume groups stratified by hospital quartile. Continuous and categorical variables were compared between cohorts. Multivariable regression analysis was conducted to assess predictors of 1-year mortality, 30-day all-cause readmission, 30-day PE-related readmission, length of stay, and total charges. Of the 205 facilities that were included, 128 (62%) were labeled low volume, 39 (19%) medium volume, 23 (11%) high volume, and 15 (7%) very high volume. Multivariable analysis showed that very high volume was associated with decreased 30-day PE-related readmission (OR 0.64; 95% CI, 0.55 to 0.73), decreased 30-day all-cause readmission (OR 0.84; 95% CI, 0.79 to 0.89), decreased 1-year mortality (OR 0.85; 95% CI, 0.80 to 0.91), decreased total charges (OR 0.96; 95% CI, 0.94 to 0.98), and decreased length of stay (OR 0.94; 95% CI, 0.92 to 0.96). In summary, facilities with higher volumes of acute PE were found to have less 30-day PE-related readmissions, less all-cause readmissions, shorter length of stay, decreased 1-year mortality, and decreased total charges.

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