scholarly journals Confusion and a cough: an experience of COVID-19 in dementia patients

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S25-S25
Author(s):  
Emily Giles
Keyword(s):  
Older Adults ◽  
Patient Group ◽  
Mortality Rates ◽  
University Hospital ◽  
Patient Demographic ◽  
Atypical Symptoms ◽  
Dementia Patients ◽  
Risk Stratification Tool ◽  
Specific Symptoms ◽  
The Impact

AimsTo assess the clinical presentation and outcomes of COVID-19 positive patients with dementia and to evaluate the suitability of the “4C mortality score.” Older adults with dementia are a vulnerable patient group therefore it was predicted that this patient demographic would have poorer outcomes and high mortality rates. Ward 24 is an organic old age psychiatry ward in University Hospital Monklands, Lanarkshire for patients with advanced dementia. Older adults have been found to have atypical presentations and non-specific symptoms in COVID-19, however given COVID is still a new and evolving disease, little is known about the impact on dementia patients. The 4C mortality score was designed to predict in-hospital mortality for hospitalised COVID-19 patients using a number of clinical parameters.MethodData were collected retrospectively from all inpatients on ward 24 testing positive for COVID-19 between October and December 2020. Data were collected using online MIDIS entries, paper notes, NEWS charts and Clinical Portal. A 4C mortality score was calculated for each patient using an online calculator based on the data collected.Result15 patients tested positive for COVID-19; 47% male and 53% female, age range between 64 and 92 years old. 67% of patients had 3 or more comorbidities and 89% had either a high or very high 4C mortality score. Mortality from COVID-19 was 13% and 20% of patients required oxygen. 27% of patients were asymptomatic, these patients also had the lower risk mortality scores. 67% presented with pyrexia, 33% had a cough and 13% had breathlessness. Non-specific symptoms were also seen; 53% had fatigue, 20% had diarrhoea and 20% had unresponsive episodes. Post COVID delirium was seen in 20% of patients.ConclusionMortality rates were lower than expected, indicating that the 4C mortality score might not be appropriate to use in this patient demographic due to confounding factors. Atypical symptoms were common in patients, with a variability of clinical presentations within the patient demographic. These findings suggest the importance of having a low threshold for COVID-19 infection even in the absence of typical symptoms. Development of an alternative risk stratification tool would be beneficial for this patient group, with further studies needed on a larger scale to facilitate this.

scholarly journals Older people’s beliefs on prevention and etiology of cancer in Poland. Implications for health promotion

2015 ◽  
Vol 78 (3) ◽  
pp. 289-296
Author(s):  
Małgorzata Synowiec-Piłat
Keyword(s):  
Older Adults ◽  
Health Promotion ◽  
Cancer Incidence ◽  
Mortality Rates ◽  
Control Beliefs ◽  
External Locus ◽  
Raising Awareness ◽  
Oncology Care ◽  
The Impact ◽  
Interview Questionnaire

AbstractIntroduction: Poland is among the countries with the highest mortality rates from cancer, and 75% of deaths from cancer occur after the age of 60. In the case of cancer, particular attention should be paid to beliefs people have in society.Aim of research: To learn about older people’s beliefs about the importance of preventive oncology care, individual’s responsibility for getting cancer, and the etiology of cancer. We analyzed the association between beliefs about cancer and the age of the respondents.Materials and Methods: The study was carried out in 2012 with a sample of 910 adult residents of Wrocław. An interview questionnaire was used. The article presents data on older adults (aged older than 56 years) (N = 188).Results: The vast majority of respondents recognize the need to engage in preventive oncology care. Only 5% of respondents hold fatalistic beliefs, 50% of older adults believe that “if someone is sick with cancer, it does not depend on them”. An association was confirmed that the oldest adults (65 years and older) are more likely to agree with the above statement, 34% disagree with the belief that “if someone is sick with cancer it depends largely on the lifestyle and the environment”.Discussion: In developing strategies for cancer prevention aimed at older adults, special attention should be paid to raising awareness about the impact of lifestyle on cancer incidence, increasing the sense of responsibility for their health, and reducing older adult’s “external locus of control” beliefs.

scholarly journals Clinical features and inpatient trajectories of older inpatients with COVID-19: a retrospective observational study.

2020 ◽  
Author(s):  
Christopher N Osuafor ◽  
Catriona Davidson ◽  
Alistair J Mackett ◽  
Marie Goujon ◽  
Lelane Van Der Poel ◽  
...  
Keyword(s):  
Older Adults ◽  
Observational Study ◽  
Clinical Features ◽  
University Hospital ◽  
Retrospective Observational Study ◽  
Clinical Frailty Scale ◽  
Atypical Symptoms ◽  
Risk Of Death ◽  
Frail Patients ◽  
Older Inpatients

Abstract Background: A comprehensive description of the clinical characteristics, inpatient trajectory and relationship with frailty of older inpatients admitted with COVID-19 is essential in the management of older adults during the COVID-19 pandemic. The aim of this study was to describe the clinical features and inpatient trajectory of older inpatients with confirmed COVID -19.Methods: This was a retrospective observational study of hospitalised older adults. Subjects include unscheduled medical admissions of older inpatients to a University Hospital with laboratory and clinically confirmed COVID-19. The primary outcome was death during the inpatient stay or within 14 days of discharge after a maximum follow up time of 45 days. The characteristics of the cohort were described in detail as a whole and by frailty status.Results: 214 patients were included in this study with a mean length of stay of 11 days (Range 6 to 18 days), of whom 140 (65.4%) patients were discharged and 74 (34.6%) patients died in hospital. 142 (66.4%) patients were frail with median Clinical Frailty Scale (CFS) score of 6. Frail patients were more likely to present with atypical symptoms including new or worsening confusion compared to non-frail patients (20.8% vs 45.1%, p<0.001) and were more likely to die in hospital or within 14 days of discharge (66% vs 16%, p=0.001). Older age, being male, presenting with high illness acuity and high frailty were all independently associated with higher risk of death and a dose response association between higher frailty and higher mortality was observed.Conclusions: Older adult inpatients with COVID-19 infection are likely to present with atypical symptoms, experience delirium and have a high mortality, especially if they are also living with frailty. Clinicians should have a low threshold for testing for COVID-19 in older and frail patients presenting to hospital as an emergency during periods when there is community transmission of COVID-19 and, when diagnosed, this should prompt early advanced care planning with the patient and family.

scholarly journals Severe Hypoalbuminemia at Admission Is Strongly Associated with Worse Prognosis in Older Adults with SARS-CoV-2 Infection

2021 ◽  
Vol 10 (21) ◽  
pp. 5134
Author(s):  
Isabel Arnau-Barrés ◽  
Ana Pascual-Dapena ◽  
Inmaculada López-Montesinos ◽  
Silvia Gómez-Zorrilla ◽  
Luisa Sorlí ◽  
...  
Keyword(s):  
Older Adults ◽  
Logistic Regression ◽  
Hospital Mortality ◽  
Serum Albumin ◽  
Regression Model ◽  
Logistic Regression Model ◽  
University Hospital ◽  
Multivariate Logistic Regression Model ◽  
Increased Risk ◽  
The Impact

Serum albumin levels have been associated with prognosis in several conditions among older adults. The aim of this study is to assess the prognostic value in mortality of serum albumin in older adults with SARS-CoV-2 infection. Methods. Cohort observational study with consecutive older-adults (≥65 years old), with confirmed SARS-CoV-2 infection admitted to a university hospital between March–May 2020. A logistic regression model was fitted to assess the impact of albumin levels on in-hospital mortality adjusted by potential confounders. Results. Among a total of 840 patients admitted to the hospital, 405 (48%) were older adults with a total of 92 deaths (23%) among them. Those who died were older, had more comorbidities, higher inflammation status and lower levels of serum albumin at admission [3.10 g/dL (0.51) vs. 3.45 g/dL (0.45); p < 0.01. Serum albumin levels at admission were negatively correlated with inflammatory markers such as C-Reactive protein (Pearson Coeff −0.4634; p < 0.001) or IL-6 (Pearson’s Coeff −0.244; p = 0.006) at admission but also to other clinical outcomes such time to clinical stability (Pearson’s Coeff −0.259; p < 0.001). Severe hypoalbuminemia associated with increased risk of mortality was defined as ≤3 g/dL at admission according to the AUC/ROC analysis (0.72 95% CI 0.63–0.81) In a multivariate logistic regression model adjusting by age, inflammation, comorbidities and severity at admission severe hypoalbuminemia was a strong predictor of in-hospital mortality (OR 2.18 95% CI 1.03–4.62; p = 0.039). Conclusion. Severe hypoalbuminemia with ≤3 g/dL is an independent risk factor for mortality among older adults with SARS-CoV-2 infection. There is a consistent correlation between albumin levels and inflammatory biomarkers. Further studies are needed to determine whether the supplementation of albumin as coadjuvant treatment will have a positive impact on the prognosis of this infection.

Donor Single Nucleotide Polymorphism in the CCR9 Gene Affects the Incidence of Acute Skin Graft-Versus-Host Disease

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 1253-1253
Author(s):  
Yoshihiro Inamoto ◽  
Makoto Murata ◽  
Yachiyo Kuwatsuka ◽  
Akane Tsujimura ◽  
Kyoko Sugimoto ◽  
...  
Keyword(s):  
Acute Gvhd ◽  
Survival Rates ◽  
Mortality Rates ◽  
University Hospital ◽  
Red Cross ◽  
Single Nucleotide ◽  
Intestinal Gvhd ◽  
Grade Ii ◽  
The Impact ◽  
Relapse Rates

Abstract Chemokines are a group of small molecules that regulate trafficking of leukocytes through interactions with a subset of seven-transmembrane, G protein-coupled chemokine receptors. Their interactions may play an important role in initiating acute graft-versushost disease (GVHD) after allogeneic hematopoietic stem cell transplanation. CCR9 is a very unique receptor because, outside of the thymus, it is almost exclusively expressed by epithelial cells and Pyer’s patches in the small intestine. We focused on rs12721497 (G926A), one of the single nucleotide polymorphisms (SNPs) in the CCR9 gene, and analyzed the impact of its genotype on the onset of organ-specific acute GVHD and transplant outcome. Included in the study were consecutive patients who had received allogeneic bone marrow or peripheral blood stem cell transplantation from an HLA-identical sibling donor at the Nagoya University Hospital and the Japanese Red Cross Nagoya First Hospital between 1987 and 2006. Of these, a total of 167 patients who received T cell replete transplantation with short-term methotrexate and cyclosporine as a GVHD prophylaxis were analyzed. Informed consent was obtained from all patients and donors, and the study was approved by the ethics committees at Nagoya University Hospital and Japanese Red Cross Nagoya First Hospital. The CCR9 G926A genotype was determined by the polymerase chain reaction-restriction fragment length polymorphism method using genomic DNA obtained from donor cells. The impact of CCR9 genotype on the incidence of acute GVHD in each organ, overall survival rates, relapse rates and nonrelapse mortality rates were analyzed using the Cox proportional hazard regression model. Age, intensity of conditioning, total body irradiation, disease risk, remission state and graft source were used as covariates for adjustment. Median age was 38 years old (range 15–62). Diseases were malignancies (n=148) and non-malignancies (n=19). The incidences of acute GVHD were 22% (grade I), 12% (grade II) and 6.6% (grade III-IV). The frequencies of the AA, AG and GG genotype were 94%, 6% and 0%, respectively. CCR9 926AG genotype was significantly associated with the incidence of stage³2 skin GVHD (hazard ratio 3.2; 95% CI, 1.1–9.1), but not associated with the incidence of liver GVHD, intestinal GVHD, grade II-IV GVHD, overall survival rates, relapse rates and nonrelapse mortality rates. In conclusion, the frequencies of each genotype were compatible with the reports in HapMap database. It was notable that donor CCR9 SNPs affected the incidence of skin GVHD, but did not affect that of intestinal GVHD. Beilhack et al. (Blood. 2008;111:2919–2928) recently reported redundancy of secondary lymphoid organs at different anatomical sites in GVHD initiation. They suggested that primed T cells could initiate GVHD at different sites from their original priming sites. Since Pyer’s patches are important as sites of antigen presenting, T cell homing to Pyer’s patches may be different between each CCR9 926AG genotype, resulting in different incidences of skin GVHD. We are now investigating the functional differences between each genotype.

The Impact of Subjective and Objective Hearing Loss on Cognition and Memory in Older Adults

2015 ◽  
Vol 20 (2) ◽  
pp. 49-57 ◽  
Author(s):  
Yvonne Rogalski ◽  
Amy Rominger
Keyword(s):  
Older Adults ◽  
Hearing Loss ◽  
Reading Aloud ◽  
Cognitive Testing ◽  
Professional Collaboration ◽  
Cognitive Screening ◽  
Speech Language Pathologist ◽  
Text Passage ◽  
The Impact ◽  
Audiologic Evaluation

For this exploratory cross-disciplinary study, a speech-language pathologist and an audiologist collaborated to investigate the effects of objective and subjective hearing loss on cognition and memory in 11 older adults without hearing loss (OAs), 6 older adults with unaided hearing loss (HLOAs), and 16 young adults (YAs). All participants received cognitive testing and a complete audiologic evaluation including a subjective questionnaire about perceived hearing difficulty. Memory testing involved listening to or reading aloud a text passage then verbally recalling the information. Key findings revealed that objective hearing loss and subjective hearing loss were correlated and both were associated with a cognitive screening test. Potential clinical implications are discussed and include a need for more cross-professional collaboration in assessing older adults with hearing loss.

The Impact of TimeSlips on Undergraduate Students in Service Learning With Older Adults

2020 ◽  
pp. 1-8
Author(s):  
Sabine Heuer
Keyword(s):  
Older Adults ◽  
Service Learning ◽  
Undergraduate Students ◽  
Attitude Scale ◽  
Evidence Based ◽  
Attitudes Toward Older Adults ◽  
Students Attitudes ◽  
Attitude Shift ◽  
The Impact ◽  
Journal Entries

Purpose Future speech-language pathologists are often unprepared in their academic training to serve the communicative and cognitive needs of older adults with dementia. While negative attitudes toward older adults are prevalent among undergraduate students, service learning has been shown to positively affect students' attitudes toward older adults. TimeSlips is an evidence-based approach that has been shown to improve health care students' attitudes toward older adults. The purpose of this study is to explore the change in attitudes in speech-language pathology students toward older adults using TimeSlips in service learning. Method Fifty-one students participated in TimeSlips service learning with older adults and completed the Dementia Attitude Scale (DAS) before and after service learning. In addition, students completed a reflection journal. The DAS data were analyzed using nonparametric statistics, and journal entries were analyzed using a qualitative analysis approach. Results The service learners exhibited a significant increase in positive attitude as indexed on the DAS. The reflective journal entries supported the positive change in attitudes. Conclusions A noticeable attitude shift was indexed in reflective journals and on the DAS. TimeSlips is an evidence-based, patient-centered approach well suited to address challenges in the preparation of Communication Sciences and Disorders students to work with the growing population of older adults.

The impact of caffeine on older adults' name learning

2011 ◽  
Author(s):  
Elizabeth A. Crandall ◽  
Lori E. James
Keyword(s):  
Older Adults ◽  
The Impact

Fear of memory decline predicts lower quality of life and increased memory failures in older adults: Preliminary findings from a novel fear-avoidance of memory decline scale.

2020 ◽  
Author(s):  
Francesca Farina ◽  
Marc Patrick Bennett ◽  
James William Griffith ◽  
Bert Lenaert
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Memory Performance ◽  
Fear Avoidance ◽  
Subjective Memory ◽  
Memory Decline ◽  
General Anxiety ◽  
Quality Of Life Scale ◽  
The Impact

Evidence concerning the impact of fear of memory decline on health-related outcomes is limited. To determine the relationship between fear-avoidance of memory decline, quality of life and subjective memory in older adults using a novel scale to measure fear of memory decline. Sixty-seven older adults (59-81 years) completed a 23-item self-report questionnaire designed to capture experiential, cognitive and behavioral components of fear of memory decline, known as the fear and avoidance of memory decline (FAM) scale. Memory performance was assessed using the Wechsler Memory Scale (WMS-IV) and the Memory Failures Scale (MFS). General anxiety was assessed using the Depression, Anxiety and Stress Scales (DASS) and the Geriatric Anxiety Inventory (GAI). Quality of life was assessed using the Older Person’s Quality of Life scale (OPQOL-35). The FAM scale demonstrated good reliability and validity. Three latent factors were observed including: (1) fear-avoidance, (2) problematic beliefs and (3) resilience. After adjusting for age, education, memory performance and general anxiety, higher fear-avoidance predicted lower quality of life (p=.021) and increased memory failures (p=.022). Increased fear of memory decline predicts lower quality of life and subjective memory failures in healthy older adults. Based on these findings, we propose a preliminary fear-avoidance model that explains the development and maintenance of dementia-related functional disability in terms of psychological processes.

scholarly journals Outcomes of COVID-19 Hospitalized Patients Previously Treated with Renin-Angiotensin System Inhibitors

2020 ◽  
Vol 9 (11) ◽  
pp. 3472 ◽  
Author(s):  
Elena-Mihaela Cordeanu ◽  
Lucas Jambert ◽  
Francois Severac ◽  
Hélène Lambach ◽  
Jonathan Tousch ◽  
...  
Keyword(s):  
Renin Angiotensin System ◽  
Severe Pneumonia ◽  
University Hospital ◽  
Angiotensin System ◽  
Angiotensin Converting Enzyme 2 ◽  
Renin Angiotensin ◽  
Previously Treated ◽  
The Impact ◽  
Harmful Effects ◽  
Observation Period

(1) Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) penetrates respiratory epithelium through angiotensin-converting enzyme-2 binding, raising concerns about the potentially harmful effects of renin–angiotensin system inhibitors (RASi) on Human Coronavirus Disease 2019 (COVID-19) evolution. This study aimed to provide insight into the impact of RASi on SARS-CoV-2 outcomes in patients hospitalized for COVID-19. (2) Methods: This was a retrospective analysis of hospitalized adult patients with SARS-CoV-2 infection admitted to a university hospital in France. The observation period ended at hospital discharge. (3) Results: During the study period, 943 COVID-19 patients were admitted to our institution, of whom 772 were included in this analysis. Among them, 431 (55.8%) had previously known hypertension. The median age was 68 (56–79) years. Overall, 220 (28.5%) patients were placed under mechanical ventilation and 173 (22.4%) died. According to previous exposure to RASi, we defined two groups, namely, “RASi” (n = 282) and “RASi-free” (n = 490). Severe pneumonia (defined as leading to death and/or requiring intubation, high-flow nasal oxygen, noninvasive ventilation, and/or oxygen flow at a rate of ≥5 L/min) and death occurred more frequently in RASi-treated patients (64% versus 53% and 29% versus 19%, respectively). However, in a propensity score-matched cohort derived from the overall population, neither death (hazard ratio (HR) 0.93 (95% confidence interval (CI) 0.57–1.50), p = 0.76) nor severe pneumonia (HR 1.03 (95%CI 0.73–1.44), p = 0.85) were associated with RASi therapy. (4) Conclusion: Our study showed no correlation between previous RASi treatment and death or severe COVID-19 pneumonia after adjustment for confounders.

The Impact of Stressful Life Events and Social Support on Drinking among Older Adults: A General Population Survey

1992 ◽  
Vol 35 (2) ◽  
pp. 99-123 ◽  
Author(s):  
Karen M. Jennison
Keyword(s):  
Social Support ◽  
Older Adults ◽  
Life Events ◽  
Stressful Life Events ◽  
Prolonged Exposure ◽  
Drinking Behavior ◽  
National Sample ◽  
Stressful Life ◽  
Stress Buffering ◽  
The Impact

This article is an analysis of stressful life events, the buffering hypothesis, and alcohol use in a national sample of 1,418 respondents 60 years of age and over. The results indicate that older adults who experience stressful losses are significantly more likely to drink excessively than those who have not experienced such losses or who have experienced them to a lesser extent. Increased drinking among older adults may therefore be a reaction to life circumstances in which alcohol represents an attempt to cope with traumatic loss, personal as well as within the kinship network. Supportive resources of spouse, family, friends, and church appear to have a stress-buffering effects that reduces the excessive-drinking response to life crisis. Data suggest, however, that older persons are vulnerable to the magnitude of losses experienced as they grow older and lose more of their family, friends, and peers. These stressors appear to seriously impact their drinking behavior and are not effectively buffered. Respondents report that drinking may increase during periods of prolonged exposure to emotionally depleting life change and loss, when supportive needs may exceed the capacities of personal and social support resources.

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