Temporal trends in hospitalizations and 30-day mortality in older patients during the COVID pandemic from March 2020 to July 2021

Importance: Previous reports have suggested reductions in mortality risk from COVID-19 throughout the first wave of the COVID-19 pandemic. Mortality changes later in the pandemic and pandemic effects on other types of geriatric hospitalizations are less studied. Objectives: To describe the changes in hospitalizations and 30-day mortality in Stockholm for patients 70+ receiving inpatient geriatric care for COVID-19 and other causes. Design: Observational study. For patients 70 or older, we present the incidence of 30-day mortality from COVID-19 in the Stockholm region, in relationship to geriatric hospitalizations and 30-day mortality after admission for COVID-19 and other causes. Setting: Hospitalizations for patients 70+ from geriatric clinics in Stockholm, Sweden hospitalized for COVID-19 or other causes between March 2020 and July 31, 2021, were included. Participants: The total number of geriatric hospitalizations for patients 70+ was 5,320 for COVID-19 and 32,243 for non-COVID-19 causes, corresponding to 4,565 individual COVID-19 patients and 19,308 non-COVID-19 patients. Exposure(s): The date of hospital admission to a geriatric clinic. Main Outcome(s) and Measure(s): 30-day mortality after admission. Results: In patients with COVID-19, the 30-day mortality rate was highest at the beginning of the first wave (29% in March-April 2020), decreased as the first wave subsided (7% July-August), increased again in the second wave (17% November-December), but failed to increase as much in the third wave (11-13% March-July 2021). In non-COVID-19 geriatric patients during the same period, the 30-day mortality presented a similar trend, but with a smaller magnitude of variation (5 to 10%). The number of persons 70 or older testing positive for COVID-19 in Stockholm reached two peaks in 2020 (April and December), fell in January 2021 and then increased again in March-April 2021. Conclusions and Relevance: During the first and second waves, hospital admissions and 30-day mortality after geriatric hospitalization for COVID-19 increased in periods of high community transmission, although the mortality peak was lower in wave 2 than in wave 1. The mortality for non-COVID geriatric cases was lower and more stable but also showed an increase with the pandemic peaks.

Psychiatric and Physical Comorbidity in Elderly Attending the Geriatric Clinic of a Psychiatric Hospital

Background: Physical comorbidity is quite common in older adults. When psychiatric and medical conditions co-occur, the combination is associated with elevated symptom burden, functional impairment, decreased length and quality of life, and increased costs of treatment. To estimate the proportion and patterns of physical comorbidity in elderly psychiatric patients. Methods: A retrospective observational study was carried out in the Geriatric Clinic of National Institute of Mental Health and Hospital (NIMHH). Patient registry of the clinic was used to collect required information and 113 consecutive older adults with psychiatric disorders who attended the clinic in a three-month period, were enrolled for the study. Psychiatric diagnoses were made by psychiatrists, according to DSM-5 criteria. Medical diagnoses were made by specialist physicians by reviewing physicians’ prescriptions. Data analysis was done by using SPSS 23.0. Results: Most of the patients (58.4%) belonged to the 7th decade. Among 113 patients 90 (79.7%) had only psychiatric illness & 23 had (20.4%) comorbid physical disorders. Depressive disorders (30%) and dementia (22.1%) were the most common psychiatric reasons for consultation. Among the associated physical comorbidities hypertension (43.5%) and diabetes (34.8%) were the most commons. Conclusion: Co-occurrence of psychiatric and physical disorder conditions is very common in a clinical setting. Physical comorbidity may influence follow up consultation pattern. Bangladesh J Medicine July 2022; 33(1) : 40-43

A comparison of anticholinergic burden in older patients with and without cancer

Aim: To compare anticholinergic burden (ACB) in older patients with and without cancer and evaluate the effects of ACB on geriatric syndromes. Methods: A total of 291 patients from the geriatric clinic and 301 patients from the oncology clinic were evaluated. ACB <2 was categorized as low ACB and ACB ≥2 was categorized as high ACB. A comprehensive geriatric assessment was performed on patients from the geriatric clinic. Results: ACB scores were significantly higher in patients without cancer compared with those with cancer (p < 0.005). Number of falls and Geriatric Depression Scale 15 scores were higher and Mini-Nutritional Assessment and Barthel/Lawton activities of daily living scores were lower in geriatric patients with high ACB scores compared with those with low ACB scores (p < 0.005). Conclusion: It is crucial to understand the potential effects of ACB for rational drug use and optimum cancer management in older patients with cancer.

Validity of the Clinical Frailty Scale in Korean older patients at a geriatric clinic

Background/Aims: We aimed to assess the validity of the Korean translated version of the Clinical Frailty Scale (CFS) in determining the frailty status in geriatric outpatients.Methods: The records of 123 ambulatory outpatients who had undergone CFS and comprehensive geriatric assessments (CGAs) including measurements for the Cardiovascular Health Study (CHS) frailty scale and the frailty index (CGA-FI) were analyzed. Correlations between CFS, CHS frailty scale, and CGA-FI were assessed. The ability of CFS to classify frailty status was calculated using the CHS frailty scale and CGA-FI as references.Results: The mean CFS score was 3.2 in the study population, with a mean age of 77.49 years (45.5% men). Individuals with higher CFS scores were older, had a greater burden of chronic diseases, and worse daily functions and cognitive performance. CFS scores positively correlated with CGA-FI (B = 0.78, p < 0.001) and CHS frailty scale (B = 0.67, p < 0.001) scores. For CFS, C-statistics to classify frailty by CGA-FI and CHS scale were 0.905 and 0.826, respectively. The cut-off value of CFS ≥ 4 maximized Youden’s J to classify frailty by both the CHS scale and CGAFI.Conclusions: The CFS is a valid screening tool to assess the frailty status in outpatients of a geriatric clinic in Korea. As a simple and quick measure, the CFS may facilitate frailty assessments in real-world clinical practice.

Sociodemographic and Health-Related Factors Associated with Severity of Cognitive Impairment in Elderly Patients Hospital-ized in a Geriatric Clinic

Identification of risk factors for cognitive impairment is crucial for providing proper care and treatment. The aim of the study was to investigate the relationship between sociodemographic and health-related factors and the severity of cognitive impairment in elderly patients. In this retrospective study, we assessed the medical documentation of 323 patients aged 60+ years hospitalized in a geriatric clinic of university hospital. The patients were classified into five groups of cognitive impairment severity based on the Mini Mental State Examination and Clock Drawing Test. Kruskal-Wallis and Chi square tests and multivariate ordinal logistic regression were used to assess relationships involved. Cognitive impairment was identified in 84.2% of subjects. The following factors were indicative for higher level of cognitive disorders: primary and vocational education, older age, presence of vascular brain injury, and inability of walking independently. On the other hand, the factors associated with lower severity of cognitive impairment were co-morbid anxiety disorders, ischemic heart disease, and a higher BMI index. Dementia is one of the leading causes of disability and mortality in the elderly. Enhancing knowledge about the risk factors that worsen cognition is particularly relevant for accelerating the diagnosis of dementia and improving patient care.

The Role of Serum Omega 3 Levels on Muscle Mass, Muscle Strength, and Physical Performance in the Elderly Community

A B S T R A C TIntroduction. Old age is related to geriatric syndrome where there are several healthproblems that often occur related to a decrease in body function and an increase inthe inflammatory process. Decrease in muscle mass, muscle strength and physicalperformance will lead to a condition of sarcopenia and frailty syndrome in the elderly.The importance of prevention so that sarcopenia does not occur in the elderly byevaluating the factors that can cause it, one of which is controlling nutritional factors(macro and micro nutrients), such as in research, namely omega-3 macronutrients.The purpose of this study was to determine the correlation between serum omega-3levels with muscle mass, muscle strength, and physical performance in the elderlycommunity at Moehammad Hoesin Hospital Palembang. Methods. This research isan observational analytic study with a cross-sectional approach which wasconducted at the Integrated Geriatric Clinic Internal Medicine RSMH Palembangfrom November 2019 to November 2020. A sample of 21 people aged> 60 years wasexamined for muscle mass, muscle strength, physical performance and omega-levels. 3 serums. All data processing and analysis in this study used SPSS version25 for Windows. Results. Of the 21 subjects, it was found that women were 19people (90.5%) and 2 men (9.5%). The mean value of muscle mass was 37.65 ± 5.7,hand grip strength was 24.04 ± 5 kg, and walking speed was 6.72 ± 1.8 seconds per6 meters. There were 11 subjects with low serum omega-3 levels of 485.25 ± 110.19mg. There was a significant relationship between serum omega-3 levels and musclemass (p = 0.041) with moderate correlation strength (r = 0.448). Conclusion: Musclemass has a significant relationship with serum omega-3 levels in the elderly withmoderate strength. Meanwhile, muscle strength and physical performance did nothave a significant relationship.

The Role of Serum Omega 3 Levels on Muscle Mass, Muscle Strength, and Physical Performance in the Elderly Community

A B S T R A C TIntroduction. Old age is related to geriatric syndrome where there are several healthproblems that often occur related to a decrease in body function and an increase inthe inflammatory process. Decrease in muscle mass, muscle strength and physicalperformance will lead to a condition of sarcopenia and frailty syndrome in the elderly.The importance of prevention so that sarcopenia does not occur in the elderly byevaluating the factors that can cause it, one of which is controlling nutritional factors(macro and micro nutrients), such as in research, namely omega-3 macronutrients.The purpose of this study was to determine the correlation between serum omega-3levels with muscle mass, muscle strength, and physical performance in the elderlycommunity at Moehammad Hoesin Hospital Palembang. Methods. This research isan observational analytic study with a cross-sectional approach which wasconducted at the Integrated Geriatric Clinic Internal Medicine RSMH Palembangfrom November 2019 to November 2020. A sample of 21 people aged> 60 years wasexamined for muscle mass, muscle strength, physical performance and omega-levels. 3 serums. All data processing and analysis in this study used SPSS version25 for Windows. Results. Of the 21 subjects, it was found that women were 19people (90.5%) and 2 men (9.5%). The mean value of muscle mass was 37.65 ± 5.7,hand grip strength was 24.04 ± 5 kg, and walking speed was 6.72 ± 1.8 seconds per6 meters. There were 11 subjects with low serum omega-3 levels of 485.25 ± 110.19mg. There was a significant relationship between serum omega-3 levels and musclemass (p = 0.041) with moderate correlation strength (r = 0.448). Conclusion: Musclemass has a significant relationship with serum omega-3 levels in the elderly withmoderate strength. Meanwhile, muscle strength and physical performance did nothave a significant relationship.

The Efficacy and Safety of Plant Oil Mixtures in the Treatment of Xerosis with Pruritus in Elderly People: Randomized double blind Controlled Trial

A B S T R A C TBackground: Xerosis skin and pruritus is the most commonly found in elderly withsymptoms mild to severe recurrent pruritus, the skin looks rough, scaly, fissured orcracked caused defects in the epidermal barrier function, increase co-morbidity aschronic infections and ulcers that are difficult to heal can decrease the quality of life.Virgin Coconut Oil (VCO) has been traditionally used for people in tropical regionas a moisturizer and anti-bacterial effect. In recent study that essential plant oilmixture have effect synergistically as anti inflammatory, anti pruritus, promotingwound healing may act promoting barrier skin and therapeutic. Objective: Efficacyand safety of plant oil mixtures as therapeutic and maintenance moisturizer.forXerosis and pruritus in elderly Method:A randomized controlled trial was involved61 elderly from nursing home and geriatric clinic in Moh. Hoesin General Hospital.They were randomized into 2 groups: plant oil mixtures (n=30) and Virgin Coconutoil (VCO) (n=31), applied on the volar legs twice a day for 4 weeks.Outcomes weremeasured at baseline and weekly, week 2 and 4.To measure of clinical dry scoreused ODSS; pruritus severity and side effect used VAS; for skin hydration usedcorneometer CM825and for sebum level used sebumeter SM 810. Results:Clinicaldry score, pruritus severity of plants oil mixtures group were significantly decreasedthan VCO at week 2 and 4 (p 0.000). Skin hydration and sebum level of plants oilmixture group were significantly increased than VCO at week 2 and 4 (p0.000).Clinical dry score, pruritus severity, skin hydration, andskin sebum levels ofplant oil mixtures were significantly better than VCO at week 4 (p 0.000). There isno side effects on both of plant oil mixtures and VCO groups Conclusion: Plant oilmixtures add pureCelin oil showed better efficacy as a therapeutin and maintanancemoisturizer for xerosis and pruritus in elderly. Both of plant oil mixtures and VCOcan be tolerated and safe to use.