Characteristics, hospital referrals and 60-day mortality of older patients living in nursing homes with COVID-19 assessed by a liaison geriatric team during the first wave: a research article

Background The infection by SARS-CoV-2 (COVID-19) has been especially serious in older patients. The aim of this study is to describe baseline and clinical characteristics, hospital referrals, 60-day mortality, factors associated with hospital referrals and mortality in older patients living in nursing homes (NH) with suspected COVID-19. Methods A retrospective observational study was performed during March and April 2020 of institutionalized patients assessed by a liaison geriatric hospital-based team. Were collected all older patients living in 31 nursing homes of a public hospital catchment area assessed by a liaison geriatric team due to the suspicion of COVID-19 during the first wave, when the hospital system was collapsed. Sociodemographic variables, comprehensive geriatric assessment, clinical characteristics, treatment received including care setting, and 60-days mortality were recorded from electronic medical records. A logistic regression analysis was performed to analyze the factors associated with mortality. Results 419 patients were included in the study (median age 89 years old, 71.6 % women, 63.7 % with moderate-severe dependence, and 43.8 % with advanced dementia). 31.1 % were referred to the emergency department in the first assessment, with a higher rate of hospital referral in those with better functional and mental status. COVID-19 atypical symptoms like functional decline, delirium, or eating disorders were frequent. 36.9% had died in the 60 days following the first call. According to multivariate logistic regression age (p 0.010), Barthel index <60 (p 0.002), presence of tachypnea (p 0.021), fever (p 0.006) and the use of ceftriaxone (p 0.004) were associated with mortality. No mortality differences were found between those referred to the hospital or cared at the nursing home. Conclusions and implications 31% of the nursing home patients assessed by a liaison geriatric hospital-based team for COVID-19 were referred to the hospital, being more frequently referred those with a better functional and cognitive situation. The 60-days mortality rate due to COVID-19 was 36.8% and was associated with older age, functional dependence, the presence of tachypnea and fever, and the use of ceftriaxone. Geriatric comprehensive assessment and coordination between NH and the hospital geriatric department teams were crucial.

Identification of Mortality Predictors among Elderly Patients Admitted to Geriatrics and Gerontology Department, Ain Shams University Hospitals

Background Elderly persons are prone to frequent hospitalization for a longer period of time. It has been reported that approximately 5% of elderly die during hospital stay, whereas 20%– 30% die within one year following hospital discharge. Many factors including aging-associated diseases, chronic diseases, drug abuse, poly pharmacy, functional disability, feeding problems, prolonged length of hospital stay are associated with increasing mortality risk. In addition, symptoms and signs are significantly variable in the elderly and usually atypically represented. Objective To identify predictive factors associated with in-hospital mortality in elderly patients admitted to Ain Shams University Geriatric hospital wards and intermediate care unit. Methods A prospective cohort study of all Egyptian elderly patients (aged 60 years old or above) admitted at Geriatric Hospital (general ward and intermediate care unit), Ain Shams University Hospitals (Cairo, Egypt), over a period of 6 months (from April 2019 to September 2019). Patients were subjected to structured interview questionnaire including data pertaining socio-demographic data, past medical history, relevant physical examination, Short-form of Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) and SOFA score. Association between different risk factors and mortality rate was done to identify the most significant predictive factors leading to mortality in elderly in order to implement specific geriatric interventions in the future to prevent such fatal consequences. Results The present study included 140 patients, of whom 73 (52.1%) were females and 67 (47.8%) were males. Nearly, 80% of the studied sample were discharged, while 20% died during hospitalization. The most common pre-morbid conditions were hypertension (58.6%), diabetes mellitus (40%), gastrointestinal tract diseases (40.7%), cerebrovascular strokes (37.8%) and ischemic heart disease (35.7%). On admission, the mean SOFA score of the discharged group was (6±2.8) while the mean score of the deceased group was (8.9± 3.6). Evaluation of the general characteristics of the discharged and deceased groups revealed that the mortality rate is significantly associated with male gender (p = 0.018), depressive disorders (p &lt; 0.001), hepatic diseases (p = 0.008), gastrointestinal tract diseases (p = 0.048), length of hospital stay (p = 0.001) and initial SOFA score on admission to acute care setting (p &lt; 0.001). Conclusion Predictors of mortality during hospitalization of elderly patients include; male gender, depression, hepatic diseases, GIT diseases, length of hospital stay and initial SOFA score on admission. These factors must be evaluated to identify the potential candidates for specific geriatric interventions and specific plan of care.

550 - Caregiver Burden and Geriatric Patients Undergoing Electroconvulsive Therapy in the COVID-19 Era

IntroductionCaregivers are essential in providing valuable patient information to medical providers. With limited available research investigating caregiver burden among those caring for patients receiving ECT and the new life challenges presented by the COVID-19 pandemic, it is more important now than ever to take a closer look at the caregivers’ experiences.MethodsEmory’s Wesley Woods Geriatric Hospital is one of the busiest ECT services in the country with around 2000 treatments completed every year. In this chart review, researchers are looking at caregivers’ responses to the Zarit Caregiver Burden Interview. This assessment includes 22 questions assessing the caregivers’ current emotional state in order to examine the impact of the patient’s condition oncaregiver wellbeing. The score ranges from 0 (no burden) to 88 (severe burden). Other objective assessments completed with ECT patients are BDI (Beck Depression Inventory), BDI Suicide, Sheehan Disability Scale, ECCA (Electrocompulsive Cognitive Assessment), GAD-7 (Generalized Anxiety Disorder Scale), and CGI (Clinical Global Impression). The purpose of this chart review is to investigate whether the higher severity of depression in patients correlates with higher levels of caregiver burden and whether the pandemic contributed to caregiver burden.ResultsThe Zarit Caregiver Burden Interview has been administered on twelve caregivers (n=12; 6 male and 6 female), all providing care for patients currently undergoing ECT for depressive symptoms. Out of the twelve caregivers, 66.6% reported little caregiver burden, 16.6% reported mild to moderate burden, and 16.6% reported moderate to severe burden. Additional patients are being interviewed in the ECT suite and further data collected will be presented at the 2021 IPA Virtual International Congress.ConclusionAs the world adjusts to life in the COVID-19 era, caregivers face new challenges in providing care for vulnerable, at-risk populations. Caregivers of patients receiving ECT facilitate frequent COVID testing and limited visitation policies while continuing to provide care and emotional support to patients with advanced age and a mental illness. Administrating the Zarit Caregiver Burden Interview can help providers look at the degree of burden in caregivers of patients receiving ECT for depressive symptoms and provide better caregiving strategies during and post pandemic.

Characteristics, Hospital Referrals and 60-Day Mortality of Older Patients Living In Nursing Homes With Covid-19 Assessed by a Liaison Geriatric Team During The First Wave: A Research Article.

Background: The infection by SARS-CoV-2 (COVID-19) has been especially serious in older patients. The aim of this study is to describe baseline and clinical characteristics, hospital referrals, 60-day mortality, factors associated with hospital referrals and mortality in older patients living in nursing homes (NH) with suspected COVID-19.Methods: A retrospective observational study was performed during March and April 2020 of institutionalized patients assessed by a liaison geriatric hospital-based team. Were collected all older patients living in 31 nursing homes of a public hospital catchment area assessed by a liaison geriatric team due to the suspicion of COVID-19 during the first wave, when the hospital system was collapsed. Sociodemographic variables, comprehensive geriatric assessment, clinical characteristics, treatment received including care setting, and 60-days mortality were recorded from electronic medical records. A logistic regression analysis was performed to analyze the factors associated with mortality. Results: 419 patients were included in the study (median age 89 years old, 71.6% women, 63.7% with moderate-severe dependence, and 43.8% with advanced dementia). 31.1% were referred to the emergency department in the first assessment, with a higher rate of hospital referral in those with better functional and mental status. COVID-19 atypical symptoms like functional decline, delirium, or eating disorders were frequent. 36.9% had died in the 60 days following the first call. According to multivariate logistic regression age (p 0.010), Barthel index <60 (p 0.002), presence of tachypnea (p 0.021), fever (p 0.006) and the use of ceftriaxone (p 0.004) were associated with mortality. No mortality differences were found between those referred to the hospital or cared at the nursing home.Conclusions and implications: 31% of the nursing home patients assessed by a liaison geriatric hospital-based team for COVID-19 were referred to the hospital, being more frequently referred those with a better functional and cognitive situation. The 60-days mortality rate due to COVID-19 was 36.8% and was associated with older age, functional dependence, the presence of tachypnea and fever, and the use of ceftriaxone. Geriatric comprehensive assessment and coordination between NH and the hospital geriatric department teams were crucial.

Detection of a COVID-19 cluster by universal SARS-CoV-2 testing in a geriatric hospital and implications for infection control management

Hospital-level COVID-19 testing strategies may require rapid changes depending on the dynamics of local epidemiology. A COVID-19 outbreak in a hospital near the authors’ institution, a Geriatric Medicine centre in Berlin, Germany, prompted the implementation of comprehensive SARS-CoV-2 testing. Serial nasopharyngeal swabs were collected from all patients and staff and analysed for SARS-CoV-2 virus RNA using quantitative real-time PCR. In total, 11 of 84 patients (13.1%) and 1 of 147 employees (0.68%) tested positive. Of the 11 positive patients, 9 (81.8%) were asymptomatic at the time of testing. The data were used as the basis for adjusting local COVID-19 containment measures. Only one staff-to-staff transmission was observed, and there was no patient-to-patient, patient-to-staff or staff-to-patient transmission. Three patients infected with SARS-CoV2 died, two deaths being attributable to advanced malignant disease and one to COVID-19–associated myocarditis. In conclusion, universal SARS-CoV-2 testing revealed a cluster of predominantly asymptomatic infections, enabled appropriate local COVID-19 containment decisions and presumably contributed to the prevention of in-hospital SARS-CoV-2 transmission.