Changes in respiratory function and physical performance in middle-aged and old inpatients recovering from COVID-19 after a rehabilitation program

Степень изменений дыхательной функции и физической подготовленности у пациентов, выздоравливающих после COVID-19, представляет интерес для реабилитационных мер. 56 пациентов (67 % - женщины), средний возраст - 64±11 лет, перенесшие COVID-19, прошли курс комплексной реабилитации (16,9±3,8 дня). После курса реабилитации пациенты показали улучшение дыхательной функции: проба Штанге - на 19 % (p=0,006), проба Генчи - на 25 % (p=0,026), улучшение самочувствия по результатам КТ легких (p<0,001); повышение физической подготовленности: скорость привычной ходьбы - на 80 % (р=0,025); толерантности к физической нагрузке: пройденное расстояние до первых признаков утомления - на 227 % (р<0,001), ЧСС в покое - на 1 % (р=0,011). Темпы изменений дыхательной функции и физической подготовленности были значительными и превышали подобные изменения, приводимые в литературе для относительно здоровых пожилых людей, которые приступают к физическим занятиям. Однако абсолютные показатели функции дыхания и физической подготовленности после реабилитационной программы были ниже нормированных значений для данного возраста. Данные результаты могут быть полезны для клиницистов при составлении программы реабилитации пациентов, перенёсших COVID-19. Changes in respiratory and physical performance in geriatric inpatients recovering from COVID-19 are of interest for rehabilitation interventions. 56 inpatients (67 % women), average age 64±11 years recovering from COVID-19 underwent a comprehensive rehabilitation program (16,9±3,8 days). After the rehabilitation program, the patients showed an improvement in respiratory function: voluntary breath-holding after inhalation - by 19 % (p=0,006), breath-holding after exhalation - by 25 % (p=0,026), lungs computed tomography (p<0,001); physical performance: handgrip strength - by 14 % (p=0,083), preferred walking speed - by 80 % (p=0,025); exercise tolerance: distance walked until the first signs of fatigue - by 227 % (p<0,001), resting heart rate - by 1 % (p=0,011). The interaction of rehabilitation time and patient sex was statically nonsignificant across all variables of interest. The rates of changes in respiratory function and physical performance were significant and exceeded similar changes recorded in healthy old people who begin an exercise program. However, in absolute values, respiratory function and physical performance values after the rehabilitation were lower than reference values for this age group. These results can be valuable for clinicians when designing a rehabilitation program for geriatric patients recovering from COVID-19.

Restoration of dysnatremia and acute kidney injury benefits outcomes of acute geriatric inpatients

Dysnatremia and dyskalemia are common problems in acutely hospitalized elderly patients. These disorders are associated with an increased risk of mortality and functional complications that often occur concomitantly with acute kidney injury in addition to multiple comorbidities. In a single-center prospective observational study, we recruited 401 acute geriatric inpatients. In-hospital outcomes included all-cause mortality, length of stay, and changes in functional status as determined by the Activities of Daily Living (ADL) scale, Eastern Cooperative Oncology Group (ECOG) performance, and Clinical Frailty Scale (CFS). The prevalence of dysnatremia alone, dyskalemia alone, and dysnatremia plus dyskalemia during initial hospitalization were 28.4%, 14.7% and 32.4%, respectively. Patients with electrolyte imbalance exhibited higher mortality rates and longer hospital stays than those without electrolyte imbalance. Those with initial dysnatremia, or dysnatremia plus dyskalemia were associated with worse ADL scores, ECOG performance and CFS scores at discharge. Subgroup analyses showed that resolution of dysnatremia was related to reduced mortality risk and improved CFS score, whereas recovery of renal function was associated with decreased mortality and better ECOG and CFS ratings. Our data suggest that restoration of initial dysnatremia and acute kidney injury during acute geriatric care may benefit in-hospital survival and functional status at discharge.

Elevated C-reactive protein in early COVID-19 predicts worse survival among hospitalized geriatric patients

Background The objective of this cohort study was to determine whether elevated CRP in early COVID-19 was associated with 14-day mortality in geriatric patients. Methods Plasma CRP levels at hospital admission and 14-day all-cause mortality were assessed in geriatric inpatients hospitalized for COVID-19. Potential confounders were age, sex, functional abilities, history of malignancies, hypertension, cardiomyopathy, albuminemia, number of acute health issues, use of antibiotics and respiratory treatments. Results Ninety-five participants (mean±SD 88.0±5.5years; 49.5%women; mean CRP, 76.7±77.5mg/L; mean albuminemia, 32.9±6.0g/L) were included. Sixteen participants who did not survive at day 14 exhibited higher CRP level at baseline than the others (120.3±71.2 versus 67.9±76.1 mg/L, P = 0.002). There was no difference in albuminemia (P = 0.329). Plasma CRP level was directly associated with 14-day mortality (fully adjusted HR = 1.11, P = 0.025). The cut-off for CRP associated with 14-day mortality was set at 35mg/L (sensitivity = 0.88; specificity = 0.56). Those with CRP<35mg/L had longer survival time than the others (log-rank P<0.001). Conclusions Elevated CRP levels were associated with poorer 14-day survival in hospitalized geriatric COVID-19 patients.

Functional Status among Polymedicated Geriatric Inpatients at Discharge: A Population-Based Hospital Register Analysis

This study explored and compared the functional status of polymedicated and non-polymedicated geriatric inpatients at hospital discharge. We used a cross-sectional registry of geriatric patients’ hospital records from a multi-site public hospital center in Switzerland. The analysis included all inpatients aged 65 years old or more admitted between 1 January 2015 and 31 December 2017 (n = 53,690), of whom 67.5% were polymedicated at hospital discharge, 52.1% were women (n = 18,909), and 42.7% were 75–84 years old (n = 15,485). On average, the polymedicated patients’ hospital lengths of stay were six days longer, they presented with more than three comorbidities, and they were prescribed more than nine medications at hospital discharge (p < 0.001). They showed more frequent general mobility decline (43.2% vs. 41.9%), gait disorders (46.2% vs. 43%), fatigue (48.6% vs. 43.4%) and dependence on lower-body care (49.7% vs. 47.6%), and presented a higher malnutrition risk (OR = 1.411; 95%CI 1.263–1.577; p < 0.001). However, the non-polymedicated inpatients had proportionally more physical and cognitive impairments. The comparison of the functional status of polymedicated and non-polymedicated geriatric inpatients at hospital discharge is important for clinicians trying to identify and monitor those who are most vulnerable to functional decline, and to design targeted strategies for the prevention of functional impairment and related adverse health outcomes.

Dignity and Predictors of Its Change Among Inpatients in Long-Term Care

The purpose of this study was to identify any differences in the dignity evaluation of geriatric inpatients after 1 month of hospitalization in a long-term care wards (LTC) and predictors of this change. This follow-up study included 125 geriatric inpatients who filled the Patient Dignity Inventory (PDI-CZ), Geriatric Depression Scale, Barthel Index, and Mini-Mental State Examination. In the initial measurement, the patients rated of PDI-CZ item “Not able to perform tasks of daily living” the worst. One month after, the items “Not able to perform tasks of daily living,” “Not able to attend to bodily functions,” and “Not feeling worthwhile or valued” were improved. Patients with higher education, for whom self-sufficiency improved and depression decreased, rated their dignity more positively 1 month after the hospitalization in LTC. Our findings suggest that these factors are important for the maintenance of the dignity of older adults hospitalized in LTC.

The Impact of COVID-19 and Quarantine on Suicidality in Geriatric Inpatients—A Case Report

The mental health burden of COVID-19 and associated quarantine can be enormous for the elderly. Being at higher risk for serious illnesses results in them being further isolated at a time of prolonged social distancing. In the following suicide-attempt cases, we examine the effects of quarantine and a global pandemic that expose the elderly to increased risk for negative mental health outcomes. Examining defense mechanisms and the effects of quarantine may help healthcare professionals better identify individuals at higher risk during times of crises that warrant isolation and quarantine, and provide appropriate interventions.

Energy and protein intake in medical and geriatric inpatients with MEDPass versus conventional administration of oral nutritional supplements: study protocol for the randomized controlled MEDPass Trial

Background Disease-related malnutrition is highly prevalent in hospitalized medical and geriatric inpatients. It is associated with negative outcomes such as muscle wasting, decline of functional status, and increased morbidity and mortality. Oral nutritional supplements (ONS) are frequently used in nutritional therapy to increase intake. However, compliance to ONS is often limited and maybe improved by prescribing ONS in small portions timed with the medication (MEDPass). However, it is unknown whether the MEDPass administration enhances patients’ total energy and protein intake. Methods The MEDPass Trial is a randomized, controlled, open-label superiority trial. Patients in the MEDPass group receive 50 ml of ONS four times per day, distributed with the medication rounds. Patients in the control group receive ONS between meals. The primary outcome is average daily energy intake (% of calculated daily requirement). For our power analysis, we assumed that administration of ONS in the MEDPass administration mode increases energy intake by at least 10% (i.e., by 200 kcal for an average energy requirement of 2200 kcal/day). Thus, with the inclusion of 200 patients, this trial has 80% power to demonstrate that intervention group patients have an average intake of 2200 kcal/day (SD 500 kcal) versus 2000 kcal/day (SD 500 kcal) in control group patients. Energy and protein intakes from ONS and all food consumed are monitored continuously throughout the hospital stay and are statistically compared to the patient’s requirements. Secondary outcomes include average daily protein intake (% of calculated daily requirement), average intake of ONS/day, the course of body weight, handgrip strength, appetite, and nausea. Furthermore, hospital length of stay and 30-day mortality are assessed. The primary statistical analysis will be performed as an intention-to-treat analysis adjusted for the stratification factors used in randomization. Discussion To our knowledge, this is the first randomized controlled trial assessing total energy and protein intake for the entire hospitalization period in patients receiving MEDPass versus conventional ONS administration. Thus, the MEDPass Trial will fill a gap and answer this relevant clinical question. Trial registration ClinicalTrials.gov NCT03761680. Registered on 3 December 2018. Kofam.ch SNCTP000003191. Registered on 15 October 2018