Geriatrics, Volume 6, Issue 4 (December 2021) – 23 articles

The Montreal Cognitive Assessment (MoCA) is the commonly used cognitive test for detecting mild cognitive impairment (MCI) in Thailand. Nevertheless, cultural biases and educational levels influence its performance. The Rowland Universal Dementia Assessment Scale (RUDAS) seems to lower the limitation of the MoCA. This study aimed to compare the performance of the RUDAS and the MoCA for the diagnosis of MCI and demonstrate the correlation between them. A cross-sectional study of 150 older participants from the outpatient setting of the Internal Medicine Department, Srinagarind Hospital, Thailand was recruited during January 2020 and March 2021. The diagnostic properties in detecting MCI of the RUDAS and the MoCA were compared. MCI was diagnosed in 42 cases (28%). The AUC for both RUDAS (0.82, 95% CI 0.75–0.89) and MoCA (0.80, 95% CI 0.72–0.88) were similar. A score of 25/30 provided the best cut-off point for the RUDAS (sensitivity 76.2%, specificity 75%) and a score of 19/30 for the MoCA had sensitivity and specificity of 76.2% and 71.3%. The Spearman’s correlation coefficient between both tests was 0.6. In conclusion, the RUDAS-Thai could be an option for MCI screening. It was correlated moderately to the MoCA. Full article

The proportion of geriatric depression recorded in Vietnam was 66.9%. Depression in older people is a risk factor for problems related to dementia, poor quality of life, and suicide. To have a good Vietnamese questionnaire for assessing geriatric depression, we conducted the study to translate and cross-culturally adapt the Geriatric Depression Scale—long-form with 30 items (GDS-30). The study has two steps. Step 1 is a translation of the GDS-30 scale. We followed the guideline by Beaton et al., (2000 & 2007). Firstly, two translators (informed and uninformed) translated the questionnaires. Secondly, the translations were synthesized. Thirdly, back translation was performed by two translators fluent in both Vietnamese and English but completely unknown of the original version of the scale and did not have medical expertise. Finally, seven experts reached a consensus on the pre-final Vietnamese version (GDS-30). Step 2 is a field test of the questionnaires on people 60 years or older. Then, we determined the internal consistency and test-retest reliability of the questionnaire in 55 Vietnamese inpatients in a geriatric department. Construct validity was determined by examining the relationship between depressive scores and patient characteristics. The Vietnamese version of GDS-30 was built with the agreement of all experts on the semantic, idiomatic, experiential, and conceptual equivalences between the original and pre-final Vietnamese versions of the GDS-30. The Cronbach’s alpha coefficient value was 0.928, indicating the items’ adequate internal consistency. Spearman’s correlation coefficient value of total scores between the first and second interviews showed medium correlation (0.479, p < 0.001), and the stability is acceptable. The GDS-30 scale reached the construct validity because the proportion of geriatric depression according to GDS-30 was significantly different between characteristics groups, such as gender, employment, level of education, economic status, and sleep disturbance. The Vietnamese version of the GDS-30 scale had high consistency, satisfactory reliability, and understanding and can be used as a screening tool for depression in elderly patients in primary healthcare centers. This is the first depression rating scale for the elderly in Vietnam to be translated and validated. Non-psychiatric health professionals or patients can quickly self-assess and screen for the illness. Full article

Background: This study aims to investigate whether certain demographic factors of patients receiving home healthcare (HHC) interventions have any positive impact on mortality. Methods: the study included all patients who were enrolled in the HHC program in a referred medical complex, Jeddah, Saudi Arabia between the years 2017 and 2020 (593 patients). Results: A total of 6548 HHC visits were received during the study period. From the total number of visits, 3592 (54.9%) HHC visits were scheduled in the year 2020 compared to 157 (2.4%) scheduled HHC visits in 2017 (p < 0.001). The most successful HHC visits were provided in 2020 compared with the year 2017 (2193 vs. 132; p < 0.001). The cancelled HHC visits were observed to be the lowest (194) in 2019. Three explanatory variables of mortality [age, having a major diagnosis (diabetes mellitus, cerebrovascular diseases, and bedridden), and having more cancelled visits] made a statistically significant contribution to the logistic regression model after controlling for other variables. Suffering from cerebrovascular diseases and/or bedridden were the strongest predictor of death in patients receiving HHC. Conclusions: During the 2020 pandemic, there was a sharp increase in HHC compared to previous years. Three significant explanatory variables of mortality [age, having a major diagnosis (diabetes mellitus, cerebrovascular diseases, and bedridden), and having more cancelled visits] were reported. Full article

Our aim was to clarify the effect of aging on the coherence of electromyograms of plantar flexor pairs during bipedal stance and to clarify the relationship between coherence and center-of-mass acceleration (COMacc). The subjects were 16 adults and 18 older adults. Intra- and intermuscular coherence and phase analyses were used to analyze the muscle pairs of bilateral and unilateral plantar flexor muscle groups. The relationship between coherence value and anterior–posterior COMacc of the plantar flexor muscle pairs was also examined to determine whether the connectivity of the lower limb muscle pairs is functionally important. The older adults showed higher coherence in the frequency range of 0–4 Hz for muscle pairs than the younger adults. In phase analysis, the older adults showed a phase difference between bilateral heteronymous muscle pairs in the frequency range of 0–6 Hz, which was one of the characteristics not seen in the younger adults. Correlation analysis showed that all the muscle pairs were moderately correlated with COMacc in the older adults. Not only does aging affects the organization of the bilateral and unilateral postural muscle activity of the plantar flexors during bipedal stance, but such organization may also be related to the increased COMacc characteristics of older adults. Full article

We aimed to clarify the physical factors associated with the incidence of aspiration pneumonia in a community-based integrated care unit. This retrospective cohort study included 412 patients aged 65 years or older admitted to a community-based integrated care unit. A new diagnosis of aspiration pneumonia made by the attending physician based on physical examination, imaging findings, and blood test data after 48 h of admission was considered as an incidence of aspiration pneumonia. Basic patient information, activities of daily living, swallowing function, nutritional status, cognitive function, oral health-related factors, and energy intake were retrospectively investigated. We classified the patients into a pneumonia group and a non-pneumonia group, and examined the factors associated with the development of aspiration pneumonia. The mean age was 86.9 ± 8.1 years, and the pneumonia group comprised 49 participants. Comparison between the groups showed significant differences in oral environment, denture use, cognitive functional independence measure, and discharge to home. In multivariate logistic regression analysis, oral environment (odds ratio (OR) = 0.229, 95% confidence interval (CI): 0.070–0.753, p = 0.015) and use of dentures (OR = 0.360, 95% CI: 0.172–0.754, p = 0.007) were independently associated with aspiration pneumonia. Oral care and the use of dentures may be effective in preventing aspiration pneumonia. Full article

Background: Pneumonia has an impact on long-term mortality in elderly patients. The risk factors associated with poor long-term outcomes are understated. We aimed to assess the ability of scores that evaluate patients’ comorbidities (cumulative illness rating scale—geriatric, CIRS-G), malnutrition (mini nutritional assessment, MNA) and functionality (functional independence measure, FIM) to predict 1-year mortality in a cohort of older patients having a suspicion of pneumonia. Methods: Our prospective study included consecutive patients over 65 years old and hospitalized with a suspicion of pneumonia enrolled in a monocentric cohort from May 2015 to April 2016. Each score was analysed in univariate and multivariate models and logistic regressions were used to identify contributors to 1-year mortality. Results: 200 patients were included (51% male, mean age 83.8 ± 7.7). Their 1-year mortality rate was 30%. FIM (p < 0.01), CIRS-G (p < 0.001) and MNA (p < 0.001) were strongly associated with poorer long-term outcomes in univariate analysis. CIRS-G (p < 0.05) and MNA (p < 0.05) were significant predictors of 1-year mortality in multivariate analysis. Conclusion: Long-term prognosis of patients hospitalized for pneumonia was poor and we identified that scores assessing comorbidities and malnutrition seem to be important predictors of 1-year mortality. This should be taken into account for evaluating elderly patients’ prognosis, levels and goals of care. Full article

Patients following cardiac surgery commonly experience post-operative delirium (POD) during their postoperative hospital stay. A multifaceted, specialty wide, quality improvement (QI) project was undertaken for patients experiencing POD. The goal was to develop a reduction in POD care bundle (rPOD-a structured patient care program) that encompasses efficient preoperative risk factor identification and a postoperative patient-care process to ensure early POD identification and treatment. The following steps were taken to implement the rPOD care bundle including: (a) Developing a quality driven, evidence-based guideline for the perioperative cardiac surgery health care team, (b) identifying and addressing local barriers to implementation, (c) selecting performance measures to assess intervention adherence and patient outcomes, and (d) ensuring that all patients receive the interventions through staff engagement and education, and regular project evaluation. Trends of process measures and quality improvement measures were examined. An increasing trend in the rate of postoperative delirium screening during implementation of rPOD intervention was demonstrated. This quality improvement study provides a bases for future postoperative delirium reduction interventions. Full article

Significant progress has been made in our understanding of the neurobiology of Parkinson’s disease (PD). Post-mortem studies are an important step and could help to comprehend not only the progression of motor symptoms, but also the involvement of other clinical domains, including cognition, behavior and impulse control disorders (ICDs). The correlation of neuropathological extension of the disease with the clinical stages remains challenging. Molecular imaging, including positron emission tomography (PET) and single photon computed tomography (SPECT), could allow for bridging the gap by providing in vivo evidence of disease extension. In the last decade, we have observed a plethora of reports describing improvements in the sensitivity of neuroimaging techniques. These data contribute to increasing the accuracy of PD diagnosis, differentiating PD from other causes of parkinsonism and also obtaining a surrogate marker of disease progression. FDG-PET has been used to measure cerebral metabolic rates of glucose, a proxy for neuronal activity, in PD. Many studies have shown that this technique could be used in early PD, where reduced metabolic activity correlates with disease progression and could predict histopathological diagnosis. The aim of this work is to report two particular cases of PD in which the assessment of brain metabolic activity (from FDG-PET) has been combined with clinical aspects of non-motor symptoms. Integration of information on neuropsychological and metabolic imaging allows us to improve the treatment of PD patients irrespective of age. Full article

Hospitalization is common among older adults. Prolonged time in bed during hospitalization can lead to deconditioning and functional impairments. Our team is currently working with Department of Veterans Affairs (VA) medical centers across the United States to implement STRIDE (assiSTed eaRly mobIlity for hospitalizeD older vEterans), a hospital-based walking program designed to mitigate the risks of immobility during hospitalization. However, the COVID-19 pandemic made in-person, or face-to-face, walking challenging due to social distancing recommendations and infection control concerns. In response, our team applied principles of implementation science, including stakeholder engagement, prototype development and refinement, and rapid dissemination and feedback, to create STRIDE in Your Room (SiYR). Consisting of self-guided exercises, light exercise equipment (e.g., TheraBands, stress ball, foam blocks, pedometer), the SiYR program provided safe alternative activities when face-to-face walking was not available during the pandemic. We describe the methods used in developing the SiYR program; present feedback from participating sites; and share initial implementation experiences, lessons learned, and future directions. Full article

Purees are often recommended for older adults in residential aged care facilities (RACFs) to target swallowing difficulties and nutrition. However, they lack appeal and may have negative impacts on nutritional intake. This study investigated the subjective experiences and objective swallowing function and safety of older adults in response to a modified puree. Twenty-eight residents from three RACFs whose regular diets consisted of purees were recruited. Purees were modified to improve visual appeal by adding a commercial enzyme gellant. Each participant was observed during three puree and three modified puree meals, and completed a brief questionnaire after each meal. A videofluoroscopic swallowing study (VFSS) was performed with 16 of the participants. Compared to purees, modified purees were observed to be easier for oral processing and intake amount was higher, but participants required assistance more often and mealtimes were longer. Participants did not show preference for either type of puree. VFSS showed similar swallowing responses between the two puree types; however, a distinction was observed for modified pureed meat compared to other ingredients. Modifying puree meals in RACFs is a feasible approach to improve nutritional intake while maintaining swallowing safety, but their appeal to consumers is not definitive. Full article

Respiration rate (RR) dynamics entrains brain neural networks. RR differences between mild cognitive impairment (MCI) and Alzheimer’s disease (AD) in response to oral appliance therapy (OAT) are unknown. This pilot study investigated if RR during stable sleep shows a relationship to pathological severity in subjects with MCI and AD who snore and if RR is influenced following stabilization of the upper airway using OAT. The study cohort was as follows: cognitively normal (CN; n = 14), MCI (n = 14) and AD (n = 9); and a sub-population receiving intervention, CN (n = 5), MCI (n = 7), AD (n = 6) subjects. The intervention used was an oral appliance plus a mouth shield (Tx). RR maximum (max) rate (breaths/minute) and RR fluctuation during 2116 stable sleep periods were measured. The Montreal cognitive assessment (MoCA) was administered before and after 4 weeks with Tx. Baseline data showed significantly higher RR fluctuation in CN vs. AD (p < 0.001) but not between CN vs. MCI (p = 0.668). Linear mixed model analysis indicated Tx effect (p = 0.008) for RR max. Tx after 4 weeks lowered the RR-max in MCI (p = 0.022) and AD (p < 0.001). Compared with AD RR max, CN (p < 0.001) and MCI (p < 0.001) were higher with Tx after 4 weeks. Some MCI and AD subjects improved executive and memory function after 4 weeks of Tx. Full article

The Short Physical Performance Battery (SPPB) is a physical fall-risk screening tool and predictor of adverse health effects for the older. Its limited use in Japan is due to the relative ease for high-functioning older adults to achieve perfect scores. Japanese researchers thus created a community-based SPPB (SPPB-com). This study investigated whether the SPPB-com score can distinguish between older patients classified as “fallers” and “non-fallers.” Participants comprised 185 older outpatients aged 65 and above who self-reported their history of accidental falls and relevant physical activity. Fall risk was assessed using SPPB and SPPB-com. Handgrip strength, maximum isometric knee extensor strength, and maximum walking speed were measured as physical functions. Multivariate logistic regression and receiver-operating characteristic analyses determined criteria indicating faller status. Fallers were older and had lower physical function, physical activity, SPPB, and SPPB-com scores than non-fallers. Multivariate logistic regression analysis showed SPPB (OR 0.76, 95% CI 0.59–0.99, p = 0.045) and SPPB-com (OR 0.63, 95% CI 0.45–0.87, p = 0.005) scores were both independently associated with prior falls. The SPPB-com score may function as a fall-risk assessment tool for older outpatients, and its combined use with SPPB can increase the accuracy and precision of distinction between fallers and non-fallers. Full article

Introduction: Parkinson’s disease is most prevalent among elderly people, 65 years and over, and leads to an alteration in motor control associated with postural instability. Current evidence shows that postural control decreases with the aging process. In addition, postural control is more altered in healthy aged men than in women. Until today, few studies have evaluated the combined impact of Parkinson’s disease and sex on postural control. This review has allowed to evaluate the impact of Parkinson’s disease and sex on postural control measurements in elderly people. Methodology: Studies have been selected from two main databases: PubMed and EBSCO using the keywords “Parkinson”, “postural control OR balance” and “sex”. Articles related to the evaluation of postural control, including men and women with Parkinson’s aged over 65 years old, regardless of stage, were included (n = 179). Articles were excluded if not written in French or English or not presenting original content. Results: Ten (10) studies out of 179 that fulfilled inclusion and exclusion criteria were reported in the final analysis, which cumulates a total of 944 individuals with Parkinson’s (410 women). In general, results show greater postural instability among people with Parkinson’s compared to healthy subjects, and this according to different objective measurements using stabilographic parameters from force platforms. Only two studies out of ten evaluated postural control while briefly considering distinctions between sex, but without showing a significant difference between men and women with Parkinson’s. Parkinson’s severity, length of time of Parkinson’s disease and cognitive state of the person are the three variables with a negative impact on postural control. Conclusion: Older people with Parkinson’s disease have greater postural instability. Sex does not seem to influence the postural control of elderly people with Parkinson’s, although more studies are necessary. Full article

In Asia, including Japan, dementia incidence peaks in older adults over ≥75 years; it is therefore important to detect mild cognitive impairment (MCI), and prevent its onset in this age group. Our study hypothesized that physical and psychological status would be associated with MCI incidence among community-dwelling people aged 75 years and older. The study population comprised 291 such individuals. Participants with a Mini-Mental State Examination score of 28 or more were considered non-MCI, and those with a score of less than 28 and greater than 24 were considered to have MCI. Several other measures were also evaluated, including information about their current medical visits due to diseases, depressive symptom severity, various physical functions (trunk function, 30 s chair-stand test, one-legged stance test, timed up and go test time, 5 m walking time, grip strength, knee-extension strength, and toe-grip strength), and body composition (body fat and skeletal muscle mass). Participants suspected of having MCI had significantly shorter educational histories, higher rates of medical visits due to hypertension, and poorer balance abilities. The results suggest that these indices can be considered screening indicators for detecting MCI in people aged 75 years and older, which may be useful for planning intervention programs for this population. Full article

There is an integral research gap regarding whether there is a relationship between pain levels and low physical activity among older women. This is a secondary analysis of a longitudinal cohort study, the Women’s Health and Aging Study (WHAS) II. Our analyses included 436 community-dwelling women between the ages of 70 and 79, who were followed for 10.5 years. We employed marginal structural modeling, which controls for time-dependent confounding, with the aim of assessing the potential direct association between pain levels and low physical activity and assess a graded relationship. Compared to women with no pain, those with widespread pain were nearly half as likely to be moderately active versus low active (aOR: 0.46, 95% confidence interval (CI): 0.22, 0.96). A graded association was observed across the four pain levels (no pain or mild pain, other pain, moderate or severe lower extremity pain, and widespread pain) on low physical activity. Our findings indicate that reducing chronic widespread pain in older women may increase moderate physical activity, and therefore reduce the downstream health risks of low physical activity, including morbidity and mortality risk. Full article

The increased percentage of older people retaining their natural dentition was associated with a burden of poor oral health and increased service demands. This study analyses the dental service utilisation of the ageing population in Australia and develops a modelled cost design that estimates the dental expenditure required to cover dental services for the aged population. Using the Australian Census of Population and Housing, ageing population and socioeconomic data were mapped to geographic boundaries and integrated with dental service provision data to estimate a model for the utilisation of dental services. The estimated financial cost of dental services was calculated based on the mean fees as per the Australian Dental Association’s Dental Fees Survey. The utilisation of the services varied considerably across the states and also by type of service, with limited numbers using periodontic services. However, there was an increase in cost for replacement and restorative services (5020 million AUD), most evident in the socioeconomic deprivation areas. In addition, the average dental services utilisation cost increased noticeably in the lower socioeconomic deciles of all regions outside major cities. The geographic maldistribution of older people significantly affects the utilisation of dental services, especially among disadvantaged communities. A predicted cost model of 6385 million AUD would cover the oral health needs of older Australians. Full article

Pain is prevalent in older people, especially in those with advanced dementia who have communication impairments. Although pain is recognised to be present in this population, it is often under-assessed and ineffectively managed. The assessment of pain in advanced dementia is extremely challenging and complex, particularly in institutional settings such as care homes. This study systematically reviews the literature to examine and characterise the evidence for the use of pain assessment tools in care homes with individuals living with advanced dementia. Relevant publications were sourced from electronic bibliometric medical databases including AMED, CINAHL Plus, Medline, PsycINFO, EMBASE, TRIP Pro, Google Scholar, and HINARI. The database search was supplemented by screening citations and reference lists, in addition to a grey literature searches. The search identified 2221 studies, among which 26 were included in the review. The majority of the studies were observational, which created a rich source of data to create four major themes. The findings were informed and shaped by working with key stakeholders to develop a conceptual model that can contribute to developing evidence-based practice. This highlights the importance of a comprehensive, multi-disciplinary approach to pain assessment in this population, which is beyond the use of tools. Full article

This study retrospectively compared the perioperative bleeding, hemodynamics, and clinical outcomes of total knee arthroplasty (TKA) performed with and without a tourniquet between two age groups. We grouped 103 patients with knee osteoarthritis who underwent primary TKA based on age at surgery: <76 years and ≥76 years. Tourniquet was used for TKA until March 2010 and stopped thereafter; hence, the patients were further classified according to TKA performed with or without a tourniquet. The differences in the operation time; perioperative bleeding; estimated bleeding; and hemoglobin (Hb) and hematocrit (Ht) levels immediately, 1 day, and 7 days postoperatively were evaluated. The clinical outcomes for range of motion, and Knee Society Knee Scores preoperatively and at 4 weeks postoperatively were assessed. Operation time was longer in the ≥76-year-old non-tourniquet group. No difference was observed in estimated bleeding among the groups. Changes in the Hb and Ht levels at postoperative days 1 and 7 were negatively correlated with age but were not different for TKA performed with or without a tourniquet in the ≥76-year-old-patient group. There were no differences in clinical outcomes among the groups. TKA can be performed with or without a tourniquet in patients aged ≥ 76 years with careful assessment of postoperative anemia. Full article

This study aimed to compare the effects of reflexology and aromatherapy massage on the severity of restless legs syndrome (RLS) in 105 female patients undergoing hemodialysis. A randomized placebo-controlled clinical trial was conducted in a hemodialysis center with 48 beds in a high turnover hospital in an urban area of Iran. Intervention groups received reflexology (n = 35) and aromatherapy massage using lavender essential oil (n = 35) for 24 sessions, and the placebo group (n = 35) received simple foot massage. The restless legs syndrome rating scale was used to assess RLS severity in the groups before the intervention and after 4 and 8 weeks of the interventions. Results obtained by the mixed model analysis 3 * 3 (3 groups * 3 times) revealed the significant effect of time, group, and the time–group interrelationship (p = 0.001). Aromatherapy massage reduced the RLS severity, but reflexology did not appear to cause any significant reduction in it. Therefore, we suggest that aromatherapy massage be incorporated into routine care for relieving the ailment and suffering of patients undergoing hemodialysis. Full article

The aim of this study was to assess the relationship between social support, positive identity, and resilience and the successful aging of older sexual minority men. The study involved having 210 self-identified gay and bisexual men aged between 50 and 80 years complete a cross-sectional online survey comprised of sociodemographic information; the Portuguese version of the Multidimensional Scale of Perceived Social Support; the Lesbian, Gay, and multifactor Bisexual Positive Identity Measure; the Connor–Davidson Resilience Scale 10; and the Successful Aging Perceptions Scale. The results showed that self-identified gay participants showed higher levels of positive identity, while bisexual participants scored higher for resilience, mental health, and successful aging. Higher levels of social support, resilience, and positive identity were significant predictors of mental health (28%), physical health (18%), and successful aging (10%) in our sample. These results offer similarities with the growing body of literature on the positive factors of successful aging in the gay and bisexual men communities, which is an important step in the development of aging and health preventive initiatives among this population. Full article

The older adult population is increasing both in number and in proportion worldwide. In Hong Kong, the number of people aged 65 or above is expected to reach 2.5 million in 2039, thus becoming one-third of the population. With this growing population, the need for dental care among older adults is expected to surge. Oral health care is one of the government’s core policy agendas and the Department of Health has emphasised its importance. It has implemented a number of policies, such as increasing the number of dental training places, setting up an expert group for oral health care policy planning, and conducting regular oral health surveys of the population. It is subsidizing several programmes, including the Elderly Health Care Voucher Scheme, Community Care Fund Elderly Dental Assistance Programme, Outreach Dental Care Programme, and Comprehensive Social Security Assistance Programme, in order to promote oral health care in older adults. These programmes have received support and positive feedback from both the public and dental service providers. The purpose of this review is to provide an overview of the oral health care of older adults in Hong Kong and recommendations to enhance their effectiveness. Full article

Delirium leading to agitation is a common issue in elderly people and patients with underlying neurocognitive impairment. Despite use of medications to treat agitation, polypharmacy is a major concern and might lead to multiple side effects in this patient population. Therefore, it is imperative to investigate non-pharmacological methods that can provide solutions to the problem. The objective of this review was to evaluate the impact of pet-assisted therapy on elderly patients, with a major focus on agitation and delirium. For the purposes of this study, a scoping review was performed using PubMed, Google Scholar, and ClinicalTrials. We reviewed literature from 1980 to 2021. Out of the 31 studies reviewed, 14 commented on agitation with respect to pet-assisted interventions. Of these, eight studies (57%) reported a statistically significant reduction in agitation and/or delirium in patients who were exposed to pet therapy. Pet-assisted therapy can improve the standardized care in hospital-based settings for patients with neurocognitive impairment because of better companionship, reduced agitation and mood disorders, and better stability of hemodynamic status. These interventions can pave the way for better patient and hospital satisfaction. Full article

Data about outbreaks of nosocomial COVID-19 disease within geriatric rehabilitation facilities are scarce. In this retrospective case series analysis, we describe such an outbreak, determine the proportion of a-/presymptomatic patients, the median time before symptom onset among presymptomatic patients and investigate whether the viral load differs between patients with and without symptoms. Typical and atypical symptoms were retrieved from the electronic medical records of patients who tested positive for COVID-19 disease during their stay at a 95-bed geriatric rehabilitation facility. The viral load at the time of diagnosis was estimated on cycle threshold values of the rRT-PCR test. Overall, 34 patients (median age, 87 years; range, 66–98; 67% female) tested positive for SARS-CoV-2. During the same period, 19 health care workers were also diagnosed with COVID-19. Among the 27 patients who provided consent, 20 (74%) were symptomatic at the time of testing. Among the remaining seven patients, six developed symptoms after a median of 2 days. A viral load > 10⁶ copies/mL was observed in 20 out of the 27 patients, including five out of the seven initially asymptomatic patients. The rapid transmission of SARS-CoV-2 and the prevalence of initially asymptomatic patients with high viral loads support an extended screening strategy at such facilities. Full article