Geriatrics, Volume 7, Issue 1 (February 2022) – 22 articles

The new coronavirus disease 2019 (COVID-19) could be associated with elevated inflammatory cytokine levels, suggesting the involvement of cytokine release syndrome. This syndrome is characterized by release of interleukin 6 correlated with COVID-19 severity and mortality. Targeting IL-6 with Tocilizumab treatment could be a potential therapeutic option for old patients. We report the case of an 88-year-old man with COVID-19 disease who presented at the admission with anemia, fever, oxygen desaturation (92%), and inflammatory syndrome (C-reactive protein (CRP) at 182.5 mg/L; reference range <5.0 mg/L). After remaining CRP level increase (206.6 mg/L), Tocilizumab administration led to rapid clinical outcome and resolution of his inflammatory syndrome. This case report represents a supplementary data confirming the efficacy and safety of Tocilizumab for COVID-19 in elderly patients. Full article

Corticosteroids have been widely used for acute respiratory distress syndrome (ARDS), but their role in the early phase of SARS-CoV-2 infection is controversial. Our study aimed to determine the effectiveness of early corticosteroid therapy (ECT) in preventing the progression of disease, reducing the escalation of care and improving clinical outcome in older patients hospitalized for COVID-19 pneumonia. A total of 90 subjects (47.7% women; mean age = 82.3 ± 6.7 years) were enrolled. ECT was administered to 33 out of 90 patients before the hospitalization. At admission, no difference was detected in median SOFA score (2, IQR:2 vs. 2, IQR: 2). We found a significant difference in mean PaO₂/FiO₂ ratio during the first week of hospitalization between ECT patients and controls (F = 5.49, p = 0.002) and in mean PaO₂/FiO₂ ratio over time (F = 6.94, p < 0.0001). We detected no-significant differences in terms of in-hospital mortality and transfer to ICU between ECT patients and controls (27.1% vs. 22.8%, respectively, p = 0.63). ECT was associated with worse clinical outcomes, showing no benefit in attenuating the progression of the disease or reducing the escalation of care. These findings are crucial given the current pandemic, and further studies are needed to provide additional data on the optimal timing of initiating corticosteroid treatment. Full article

Atrial fibrillation (AF) is commonly associated with advanced age and the presence of multiple, concomitant acute and chronic health conditions, placing this population at high risk for serious therapeutic side effects. Nonvitamin K antagonist oral anticoagulants (NOACs) are increasingly used for stroke prevention in patients with atrial fibrillation. The purpose of this study was to investigate the effectiveness and safety of NOAC in a group at high risk of bleeding complications, in a real-world setting. We conducted a retrospective analysis of a high-risk cohort of 418 patients (pts) followed-up in our anticoagulation unit; data on patient characteristics, anticoagulation treatment, and bleeding and thrombotic complications were evaluated. The population had a median age of 77.8 ± 10.3 years and the mean CHA₂DS₂-VASc score was 3.85 (SD ± 1.4). Overall, 289 (69.1%) were ≥75 years old. During a mean follow-up time of 51.2 ± 35.7 months, we observed a rate of any bleeding of 7, a clinically relevant non-major bleeding rate of 4.8, a major bleeding rate of 2.2, a stroke rate of 1.6, and a rate of thrombotic events of 0.28 per 100 patient-years. There were 59 hospitalizations due to any cause (14.1%) and 36 (8.6%) deaths (one due to ischemic stroke). A structured follow-up, with judicious prescribing and drug compliance, may contribute to preventing potential complications. Full article

Background: Due to the increasing care needs of older adults, family caregivers are more and more solicited. This can have a negative impact on their quality of life related to a lack of preparedness for caregiving and feelings of burden. Objectives: To measure perceptions of burden and preparedness for caregiving among the family caregivers of hospitalised older adults, and to explore their possible associations. Methods: A cross-sectional study conducted in two university hospital geriatrics wards in Switzerland. Principal family caregivers of hospitalised older adults were invited to complete sociodemographic, the Zarit Burden Interview, and the Preparedness for Caregiving Scale questionnaires. Descriptive and correlational data analyses were performed. Results: Of the 38 responding caregivers, 80% provided informal care to their spouse or parent; 45% reported a lack of preparedness to provide care and 61% reported substantial levels of burden. There was no statistically significant correlation between preparedness and burden (ρ ≤ −0.30, p = 0.07). Conclusions: A significant proportion of caregivers reported burden and a lack of preparedness. Healthcare professionals should provide adequate support to help informal caregivers to fulfil their roles. Full article

This study aimed to examine the primary arthroplasty attitudes of Turkish orthopedics and traumatology specialists and residents to patients with intertrochanteric fractures, of various ages, comorbidity situations and fracture types, using an internet-based questionnaire. Between March and April 2021, a cross-sectional survey was conducted with a total of 159 orthopedics and traumatology specialists and residents in Turkey, using an online questionnaire that consisted of 16 different patient scenarios of varying intertrochanteric fracture types, ages, and comorbidity conditions. Respondents’ preference ratio for primary arthroplasty was 24.1% in the scenarios with patients over the age of 71, while it was 8.4% in the scenarios with patients aged between 50 and 70. The ratios of primary arthroplasty preference were 12.4%, 21% and 27.3% in 2-part, 3-part and 4-part fracture scenarios, respectively. The primary arthroplasty preferences of respondents with 10 years or more of professional experience were observed to be statistically significantly different to those of the respondents with 1 to 10 years of experience in the 4-part fracture scenario where the patient was aged 71 years and above with an ASA (American Society of Anesthesiologists) score of 3–4 (p < 0.05). Despite varying opinions in the literature in recent years, primary arthroplasty can be considered a valuable alternative approach for Turkish surgeons, and in older adult patients with unstable intertrochanteric fractures, particularly those who need early mobilization and have high ASA scores. Full article

Ageism seeps deep into our society, whether in law, policies, or healthcare practices it segregates individuals based on their age. The aim of this work was to evaluate the impact of an educational strategy in ageist attitudes against older adults in healthcare undergraduate students. A five-week intervention: Healthy environments and self-care for the older adults was implemented. To assess the impact of this strategy in ageist attitudes in participants, a simulated consultation with an older adult was conducted. Participants’ perspectives on the experience were collected using an online survey. One hundred and thirty-eight undergraduate students from health programs were included. They highlighted growth in the understanding of the normal aging process and the prejudices that surround aging. During the role-play activity, participants identified communication, empathy, and professionalism as the abilities developed with this strategy and the need to show empathy and avoid prejudice against older adults in their clinical interactions. Educational interventions are a great tool to promote cultural changes, diminish prejudices and misconceptions of ageism in future healthcare professionals. Full article

Proposed strategies for preventing protein deficiencies in older patients include increasing protein intake at breakfast. However, protein is highly satiating and the effects of very high protein intakes at breakfast on subsequent appetite and free-living energy intake (EI) in older adults are unclear. This study compared the acute effects of two breakfast drinks varying in protein and energy contents on appetite and free-living EI in healthy older adults using a randomized 2 × 2 crossover design. Participants (n = 48 (20 men, 28 women); mean ± SD age: 69 ± 3 years; BMI: 22.2 ± 2.0 kg·m⁻²; fat-free mass: 45.5 ± 8.0 kg) consumed two drinks for breakfast (high-protein (30.4 ± 5.3 g), low-energy (211.2 ± 37.1 kcal) content (HPLE) and very high-protein (61.8 ± 9.9 g), fed to energy requirements (428.0 ± 68.9 kcal) (VHPER)) one week apart. Appetite perceptions were assessed for 3 h post-drink and free-living EI was measured for the remainder of the day. Appetite was lower in VHPER than HPLE from 30 min onwards (p < 0.01). Free-living energy and protein intake did not differ between conditions (p = 0.814). However, 24 h EI (breakfast drink intake + free-living intake) was greater in VHPER than HPLE (1937 ± 568 kcal vs. 1705 ± 490 kcal; p = 0.001), as was 24 h protein intake (123.0 ± 26.0 g vs. 88.6 ± 20.9 g; p < 0.001). Consuming a very high-protein breakfast drink acutely suppressed appetite more than a low-energy, high-protein drink in older adults, though free-living EI was unaffected. The long-term effects of adopting such a breakfast strategy in older adults at high risk of energy and protein malnutrition warrants exploration. Full article

The LuBAIR™ Paradigm is a novel approach to ascribe meaning to behavioral expressions in advanced neurocognitive disorders when the reliability of a clinical assessment is limited. The meaning ascribed to each behavioral category was used to identify those which are likely to respond to the use of atypical antipsychotics, in their management. De-prescribing was attempted on patients who qualified to enter this retrospective study. De-prescribing was defined as successful if individuals were completely withdrawn from AAP and remained off them for 60 days, without the re-emergence of behaviors. The LuBAIR™ Inventory was filled on two occasions. The data collected on the second occasion, in the successful and failed de-prescribed groups, were compared in this retrospective study. MANOVA, Chi-Square paired t-test statistical analyses were used to detect the differences in the behavioral categories between the two cohorts. Cohen d was used to measure effect size. Patients who did not have Mis-Identification and Goal-Directed Expressions were more likely to successfully de-prescribe: X2 (1, N = 40) = 29.119 p < 0.0001 and X2 (1, N = 40) = 32.374, p < 0.0001, respectively. Alternatively, the same behavioral categories were more likely to be present in patients who failed de-prescribing: MANOVA and paired t-test (p < 0.0001). Atypical antipsychotics, in their role as an antipsychotic and mood stabilizer, may be used to manage Mis-Identification and Goal-Directed Expressions, respectively. Full article

The aim of this single-center, open-label, randomized controlled study was to evaluate which formulation of vitamin D—between cholecalciferol and calcifediol—is most effective in the treatment of hypovitaminosis D in older adults. Demographic characteristics, clinical history, and comprehensive geriatric assessment were recorded at admission. Eligible patients were randomly assigned an equivalent vitamin D supplement, either with cholecalciferol or calcifediol, from the time of hospital admission to three months after discharge. Among the 140 older patients included (mean age 83 ± 6.6 years, 57.8% females), 69 received cholecalciferol and 71 received calcifediol. The mean plasma values of 25-hydroxyvitamin D3 (25OH-vitamin D3) found at the time of enrollment were 16.8 ± 9.9 ng/mL in patients receiving cholecalciferol and 18.8 ± 13.3 ng/mL in those treated with calcifediol (p = 0.31). At the three month follow-up, the mean concentration of 25OH-vitamin D3 was significantly higher in patients treated with calcifediol than in those receiving cholecalciferol (30.7 ± 8.4 vs. 45.4 ± 9.8 ng/mL, respectively; p < 0.001). Supplementation with either cholecalciferol or calcifediol effectively results in reaching the optimal circulating values of 25OH-vitamin D3 in older patients suffering from hypovitaminosis D. However, supplementation with calcifediol led to average circulating values of 25OH-vitamin D3 that were significantly higher (over 50%) than those obtained with cholecalciferol. Full article

Increasing evidence has shown an association between periodontitis and cognitive impairment. Subgingival microbiota play a great role in periodontitis pathogenesis. However, the correlation between the subgingival microbiome and cognitive impairment remains unclear. This study aimed to evaluate the red and orange complex subgingival microbiome of cognitively impaired and cognitively normal elderly Indonesian subjects with periodontitis. Twenty-eight elderly subjects diagnosed with periodontitis underwent two cognitive examinations using the Hopkins Verbal Learning Test and the Mini-Mental State Examination. Gingival crevicular fluid taken from the periodontal pocket, at a depth between 5 and 7 mm, using a paper point was used as the subgingival samples. The subgingival microbiome in the cognitive impairment group (n = 14) and cognitively normal group (n = 14) was compared using the 16S rRNA Metagenomic iSeq™ 100 Sequencing System. There was β-diversity in the subgingival microbiota between the cognitively impaired and cognitively normal subjects. The metagenomic analysis showed a higher abundance of Porphyromonas and Treponema bacteria in the cognitive impairment group than in the normal cognitive group (p < 0.05). The abundance of Porphyromonas gingivalis and Treponema denticola was higher in the cognitively impaired elderly subjects. The role of P. gingivalis and T. denticola in the pathogenesis of cognitive impairment needs further investigation. Full article

(1) Background: An aging society is frequently affected by multimorbidity and polypharmacy, which, in turn, leads to an increased risk for drug interaction. The aim of this study was to evaluate the influence of drug interactions on the length of stay (LOS) in hospitals. (2) Methods: This retrospective, single-centre study is based on patients treated for community-acquired pneumonia in the hospital. Negative binomial regression was used to analyse the association between drug interactions and the LOS in the hospital. (3) Results: The total cohort contained 503 patients, yet 46 inpatients (9%) that died were not included in the analyses. The mean age was 74 (±15.3) years, 35% of patients older than 65 years were found to have more than two drug interactions, and 55% had a moderate, severe, or contraindicated adverse drug reaction. The regression model revealed a significant association between the number of drug interactions (rate ratio (RR) 1.02; 95%-CI 1.01–1.04) and the severity of drug interactions (RR 1.22; 95%-CI 1.09–1.37) on the LOS for the overall cohort as well as for the subgroup of patients aged 80 years and older. (4) Conclusion: Drug interactions are an independent risk factor for prolonged hospitalisation. Standardised assessment tools to avoid drug interactions should be implemented in clinical routines. Full article

Background: Ageing in women is associated with chronic degenerative pain leading to a functional decrease and therefore increase fall risk. It is therefore essential to detect early functional decreases in the presence of pain related to osteoarthritis. Objective: This cross-sectional study aimed to assess the impact of pain on functionality, postural control and fall risk in women aged between 45 to 64 years old. Methods: Twenty-one (21) women aged 45 to 64 were evaluated by clinical and functional measures such as a pain questionnaire (Lequesne Index), functional tests (Stair Step Test, 5 times sit-to-stand, 6MWD, Timed-up and Go) and postural performance (under force platform). Women were classified into 2 groups from the Lequesne Pain Index (PI): low pain (score ≤ 9) and strong pain (score ≥ 10) for subsequent comparisons on functionality (physical and postural control performance). Results: A significant impact was observed between the pain index (strong PI) and 3 of the 4 functional tests carried out including Stair Step Test (p = 0.001; g = 1.44), walking distance (p = 0.003; g = 1.31) and Timed-up and Go (p = 0.04; g = −0.93). The group with a strong PI score reported further poor postural control under force platform compared to the weak pain group. Conclusion: Pain and severity based on the PI index negatively modulate physical and postural control performance in women aged 45 to 64 years old. Full article

Malnutrition–sarcopenia syndrome (MSS) might put older adults at higher risk for disability, frailty, and mortality. This study examined the prevalence and association of the self-management-process factors (i.e., self-efficacy and aging expectations) and behaviors (protein and caloric intake and sedentary and physical-activity behaviors) to MSS among older adults living in continuing care retirement communities (CCRCs). Using a cross-sectional correlational design, data of 96 CCRC residents (82.4 ± 7.4 years) were analyzed. Muscle mass, strength, function, nutritional status, sedentary time, physical activity levels, protein and caloric intake, self-efficacy for physical activity, aging expectations, and physical and mental health-related quality of life were measured. Results show that 36 (37.5%) had sarcopenia, 21 (21.9%) had malnutrition risk, 13 (13.4%) had malnutrition, and 12 (12.5%) had MSS. We also found that high time spent in sedentary behaviors (OR = 1.041; 95% CI: 1.011–1.071) was associated with higher odds of having MSS and high expectations regarding aging (OR = 0.896; 95% CI: 0.806–0.997) were associated with less likelihood of having MSS. Findings suggest that CCRC residents should be screened for MSS. Self-management interventions that consider the self-management-process factors are needed to prevent MSS and mitigate its negative outcomes among CRCC residents. Full article

Background: Dementia care programs have become more common due to a growing number of persons living with dementia and lack of substantial benefit from pharmacologic therapies. Cultural and language differences may present barriers to access and efficacy of these programs. In this article, we aimed to systematically review the current literature regarding outcomes of dementia care programs that included multicultural and non-English speaking populations. Methods: A systematic review was conducted using four scientific search engines. All studies included in the review are English language, randomized control trials evaluating various care coordination models. The initial search strategy focusing on studies specifically targeting multicultural and non-English speaking populations resulted in too few articles. We expanded our search to articles that included these populations although these populations may not have been the focus of the study. Results: Seven articles met inclusion criteria for final review. Measured outcomes included emergency room use, hospitalizations, provider visits, quality of life indicators, depression scores, and caregiver burden. Conclusions: Dementia care programs demonstrate significant ability to provide support and improve outcomes for those living with dementia and their caregivers. There is limited research in this field and thus opportunity for further study in underserved and safety net populations including more high-quality randomized controlled trials with larger sample sizes. Full article

The association between body mass index (BMI) and frailty in elderly patients with disabilities is unclear. We aimed to investigate the association between BMI and frailty in the elderly with disabilities according to sex. This cross-sectional study included 280 elderly patients with disabilities from an elderly daycare center. BMI classification for the Asian population was used to categorize the patients into four groups: underweight, normal, overweight, and obese. Frailty score was based on the phenotypic definition of frailty and consisted of five criteria derived from the revised Japanese version of the Cardiovascular Health Study. Those who had three or more criteria were considered frail. Logistic regression models were constructed to investigate the associations between frailty and BMI in each group (males and females). In females, being underweight was significantly associated with frailty after adjusting for confounders (age and Mini-Mental State Examination score); after adding medical history as a confounder, the aforementioned association was not significant. In males, BMI was not significantly associated with frailty. The association between BMI and frailty differed according to sex among the elderly with disabilities. This finding provides important information regarding frailty risk to workers in daycare facilities. Full article

Background: Little documentation exists on relationships between long-term residential care facilities (LTRCFs), staff working conditions and residents’ quality of care (QoC). Supporting evidence is weak because most studies examining this employ cross-sectional designs. Methods: Systematic searches of twelve bibliographic databases sought experimental and longitudinal studies, published up to May 2021, focusing on LTRCF nursing staff’s working conditions and the QoC they provided to older adults. Results: Of the 3577 articles identified, 159 were read entirely, and 11 were retained for inclusion. Higher nursing staff hours worked per resident per day (HPRD) were associated with significant reductions in pressure sores and urinary tract infections. Overall staff qualification levels and numbers of RNs had significant positive influences on QoC. Conclusions: To the best of our knowledge, this systematic review is the first to combine cohort studies with a quasi-experimental study to explore associations between LTRCF nursing staff’s working conditions and older adult residents’ QoC. Human factors (including HPRD, staff turnover, skill mix, staff ratios) and the specific working contribution of RNs had overwhelmingly significant influences on QoC. It seems essential that LTRCF supervisory and decision-making bodies should promote optimal working conditions for nursing staff because these have such a direct impact on residents’ QoC. Full article

Depression is one of the most prevalent pathologies in older adults. Its diagnosis and treatment are complex due to different factors that intervene in its development and progression, including intercurrent organic diseases, perceptual deficits, use of drugs, and psycho-social conditions associated with the aging process. We present the case of a 75-year-old woman (who lives in the community) with a diagnosis of major depression with more than 10 years of history, analyzing her evolution and therapeutic approach. Full article

Elderly people are at high risk for pneumococcal infections. However, older age is not an eligibility factor for pneumococcal vaccination in France. Adults with certain co-morbidities or immunocompromised states are eligible for vaccination, which leaves adults aged ≥65 years without comorbidities at-risk for pneumococcal infections. The objective of the study was to evaluate the acceptability to healthcare professionals (HCPs) of extending pneumococcal vaccination to all individuals ≥65 years. Based on themes identified in semi-structured interviews with 24 HCPs, a representative sample of 500 general practitioners and pharmacists were surveyed about their knowledge, attitudes and beliefs with respect to pneumococcal vaccination for individuals ≥65 years. Current recommendations for pneumococcal vaccination are poorly understood by participants (mean score: 5.8/10). Respondents were generally supportive of inclusion of age in vaccination recommendations (7.5/10), with 58% being very supportive. For 72% of HCPs, this would contribute to improved vaccination coverage. The strategy could be facilitated by associating pneumococcal vaccination with the influenza vaccination campaign (8.3/10). Pharmacists were favourable to participating in pneumococcal vaccination (8.5/10). In conclusion, extension of pneumococcal vaccination to all people aged ≥65 years would be welcomed by HCPs, simplifying identification of patients to be vaccinated and potentially improving vaccination coverage. Full article

(1) Background: Evaluation of the quality and reliability of the frailty syndrome videos available on YouTube platform was the aim of this study. (2) Methods: The observational study included 75 videos retrieved by searching seven terms related to frailty syndrome on YouTube. The quality and reliability of the videos were measured using three different tools: quality criteria for consumer health information (DISCERN), the Global Quality Score (GQS), and the Journal of American Medical Association (JAMA). The video content was categorized according to the following characteristics: video provider, duration, view count, average daily views of the video, average daily views of a channel, channel subscribers, number of days since upload date, likes, dislikes, comments, the external webpages linked to the videos. (3) Results: The videos had a mean duration of 375 s and an average number of views of 1114. The quality of 17 videos assessed in the study was found to be high, 48—intermediate, and 10—low. The high-quality videos had the longest duration, the highest number of views, and points for the DISCERN score. The physician uploaders had the highest mean DISCERN and mean GQS scores, the highest number of views, and the longest duration but the hospital channels had the highest JAMA score. (4) Conclusions: YouTube can be a valuable source of medical information for patients and caregivers. The quality of videos mostly depends on the authorship and the source of video providers—physicians, academic, and health care-related organizations provide the best quality content based on professional medical knowledge. Full article

The burden of oral health care increases among older people, with a profound challenge in utilising dental services in primary dental care settings. This study aimed to analyse two decades of nationwide hospital separation patterns due to oral health-related conditions among older people. Ageing population data were obtained from the Australian Bureau of Statistics, including people aged 65 years and older. All principal diagnoses of oral health conditions (ICD-10-AM) were analysed in this study. The hospitalisation data included all separations of older people for the financial years 1998–1999 to 2018–2019. A total of 205,461 hospital separations were recorded for older people over a period of twenty-one years. More than 60% of these separations were collectively attributed to dental caries, disorders of teeth and supporting structures, diseases of the jaws, diseases of the pulp and periapical tissues. However, the average rate of separations per 10,000 people due to dental caries was the highest among the dental conditions (8.68). Furthermore, the remaining oral health-related conditions predict an annual percentage increase in the rate that would compromise their oral health quality of life. Dental caries and its sequela seem to be the leading cause for oral health-related hospital admissions in Australia for people aged 65 and older. This could be an indicator of the inadequacy of disease management in the primary dental care setting. Full article

During the COVID-19 pandemic, long-term care (LTC) centers have adopted a series of measures that have affected the physical and cognitive health of patients. The routines of the patients, as well as the interventions of professionals, have been altered. In the case presented here, our aim was to explain the effect that the strong confinement due to the spread of the first COVID-19 wave in Spain had on a 75-year-old resident in an LTC center, with cognitive and behavioral symptomatology compatible with a diagnosis of mixed dementia, as well as the measures that the center adopted to manage the lockdown situation in the best possible way, including personalized attention protocols and a video call program. Different nosological hypotheses are also raised using a semiological analysis, including the analysis of the initial and continuation diagnostic protocols, as well as the therapeutic options. Full article