Due to the pandemic of corona virus disease 2019 (COVID-19), the stroke medical care system is unavoidably undergoing major changes such as a decrease in the number of stroke patients receiving consultation, delay in consultation, and a decrease in the number of intravenous thrombolysis and mechanical thrombectomy procedures. Stroke incidence in COVID-19 patients is approximately 1.1%. The features of stroke with COVID-19 have been elucidated: higher incidence in ischemic stroke than hemorrhagic...
Vitamin D deficiency, which impedes good immune function, is common during winter and spring in regions of high latitude. There is good evidence that vitamin D deficiency contributes to the seasonal increase of virus infections of the respiratory tract, from the common cold to influenza, and now possibly also COVID-19. This communication explores key factors that make it more likely, particularly in combination, that individuals are vitamin D deficient. These factors include old age, obesity,...
CONCLUSION: Patients with COVID-19 and CAD have an exceedingly higher risk of mortality, which is mainly attributable to the burden of comorbidities rather than to a direct effect of CAD per se.
The Coronavirus disease 2019 (COVID-19) has emerged as a new global health threat. By increasing the risk of isolation, fear, stigma, abuse and economic fallout, COVID-19 has led to increase in risk of psychiatric disorders, chronic trauma and stress, which eventually increase suicidality and suicidal behavior. There is limited data on association of pandemics and suicides. Cases of suicides have been rising since COVID-19 first emerged in China. The association between suicides and pandemics...
CONCLUSION: Respondents had generally good foundational knowledge of federal health programs and public health functions, although some gaps were identified. Inclusion of health policy and public health topics in continuing medical education would be well received by clinicians. To improve collaboration between public health and medicine, public health should personally engage clinicians more and explain how they can work together to improve population health.
CONCLUSION: COVID-19 demonstrated severe morbidity and mortality in critically ill patients. Modifications in care delivery outside the ICU allowed the hospital to effectively care for a surge of critically ill and severely hypoxic patients.
CONCLUSIONS: Our study revealed that cardiac injury was an important predictor for patients having a severe or fatal outcome. Patients with pre-existing hypertension and higher SOFA scores upon admission were more likely to develop cardiac injury. Nevertheless, pulmonary ventilation dysfunction and oxygen inhalation insufficiency were not the main causes of cardiac injury in patients with COVID-19.
STUDY QUESTION: Can we use prediction modelling to estimate the impact of coronavirus disease 2019 (COVID 19) related delay in starting IVF or ICSI in different groups of women?
CONCLUSION: Mortality of patients with COVID-19 requiring invasive mechanical ventilation is high, with particularly daunting mortality seen in patients of advanced age, even in a well-resourced health care system. A substantial proportion of patients requiring invasive mechanical ventilation were not of advanced age, and this group had a reasonable chance for recovery.
Introduction: The identification of modifiable health span-promoting factors is a public health priority. Objective: To explore the socio-environmental, lifestyle, behavioural, and psychological determinants of a clinical phenotypic measure of biological ageing in the Singapore Longitudinal Ageing Study (SLAS) cohort. Methods: Using cross-sectional data on 2,844 SLAS-2 adults with a chronological age (CA) ≥55 years, we estimated biological age (BA) using a validated panel of clinical, biochemical, physiological, and functional indicators (8 in men and 10 in women) and calculated the difference between BA and CA (BA – CA in years). Potential determinants included education, housing status, loss of a spouse, living alone, lifestyle and health activity, smoking, alcohol consumption, nutritional risks, consumption of milk, soy, fruit, vegetables, coffee and tea, sleep parameters, and life satisfaction. Results: The mean CA was 67.0 (standard deviation [SD] 7.9; range 55–94) years. The estimated BA varied more widely (SD 8.9 years; range 47.5–119.9 years), and BA – CA ranged from –11.3 to 30.0 years. In stepwise selection regression analyses, multiple significant independent determinants in a final model were larger for private housing, being single/divorced/widowed, productivity, cognitive and leisure time activity scores, 10 h/week of moderate-to-vigorous physical activity, unintended loss of weight, life satisfaction, and daily consumption of fruits 1–2 or ≥3 servings and Chinese tea 1–2 or ≥3 cups daily, together explaining 16% of BA – CA variance in men and 14% in women. Associated BA – CA estimates were highest in men with high-end housing status (–1.8 years, effect size 0.015) and unintended weight loss (1.5 years, effect size 0.017). Conclusion: We identified determinants of biological ageing which can promote health span.
Posted: November 16, 2020, 1:19 pm
Background: Comprehensive geriatric care (CGC) for older adults during hospitalization for hip fracture can improve mobility, but it is unclear whether CGC delivered after a return to community living improves mobility compared with usual post-discharge care. Objective: To determine if an outpatient clinic-based CGC regime in the first year after hip fracture improved mobility performance at 12 months. Methods: A two-arm, 1:1 parallel group, pragmatic, single-blind, single-center, randomized controlled trial at 3 hospitals in Vancouver, BC, Canada. Participants were community-dwelling adults, aged ≥65 years, with a hip fracture in the previous 3–12 months, who had no dementia and walked ≥10 m before the fracture occurred. Target enrollment was 130 participants. Clinic-based CGC was delivered by a geriatrician, physiotherapist, and occupational therapist. Primary outcome was the Short Physical Performance Battery (SPPB; 0–12) at 12 months. Results: We randomized 53/313 eligible participants with a mean (SD) age of 79.7 (7.9) years to intervention (n = 26) and usual care (UC, n = 27), and 49/53 (92%) completed the study. Mean 12-month (SD) SPPB scores in the intervention and UC groups were 9.08 (3.03) and 8.24 (2.44). The between-group difference was 0.9 (95% CI –0.3 to 2.0, p = 0.13). Adverse events were similar in the 2 groups. Conclusion: The small sample size of less than half our recruitment target precludes definitive conclusions about the effect of our intervention. However, our results are consistent with similar studies on this population and intervention.
Posted: November 11, 2020, 7:17 am
Background: Altered plasma activity of β-1,4-galactosyltransferases (B4GALTs) is a novel candidate biomarker of human aging. B4GALT1 is assumed to be largely responsible for this activity increase, but how it modulates the aging process is unclear at present. Objectives: To determine how expression of B4GALT1 and other B4GALT enzymes changes during aging of an experimentally tractable model organism, Caenorhabditis elegans. Methods: Targeted analysis of mRNA levels of all 3 C. elegans B4GALT family members was performed by qPCR in wild-type and in long-lived daf-2 (insulin/IGF1-like receptor)-deficient or germline-deficient animals. Results: bre-4 (B4GALT1/2/3/4) is the only B4GALT whose expression increases during aging in wild-type worms. In addition, bre-4 levels also rise during aging in long-lived daf-2-deficient worms, but not in animals that are long-lived due to the lack of germline stem cells. On the other hand, expression of sqv-3 (B4GALT7) and of W02B12.11 (B4GALT5/6) appears decreased or constant, respectively, in all backgrounds during aging. Conclusions: The age-dependent bre-4 mRNA increase in C. elegans parallels the age-dependent B4GALT activity increase in humans and is consistent with C. elegans being a suitable experimental organism to define potentially conserved roles of B4GALT1 during aging.
Posted: November 10, 2020, 7:29 am
Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a recent outbreak of coronavirus disease (COVID-19). In Cuba, the first case of COVID-19 was reported on March 11, 2020. Elderly individuals with multiple comorbidities are particularly susceptible to adverse clinical outcomes in the course of SARS-CoV-2 infection. During the outbreak, a local transmission event took place in a nursing home in Villa Clara province, Cuba, in which 19 elderly residents tested positive for SARS-CoV-2. Methods: Based on the increased susceptibility to cytokine release syndrome, inducing respiratory and systemic complications in this population, 19 patients were included in an expanded access clinical trial to receive itolizumab, an anti-CD6 monoclonal antibody. Results: All patients had underlying medical conditions. The product was well tolerated. After the first dose, the course of the disease was favorable, and 18 of the 19 patients (94.7%) were discharged clinically recovered with negative real-time reverse transcription polymerase chain reaction test results at 13 days. After one dose of itolizumab, circulating IL-6 decreased within the first 24–48 h in patients with high baseline values, whereas in patients with low levels, this concentration remained over low values. To preliminarily assess the effect of itolizumab, a control group was selected among the Cuban COVID-19 patients that did not receive immunomodulatory therapy. The control subjects were well matched regarding age, comorbidities, and severity of the disease. The percentage of itolizumab-treated, moderately ill patients who needed to be admitted to the intensive care unit was only one-third of that of the control group not treated with itolizumab. Additionally, treatment with itolizumab reduced the risk of death 10 times as compared with the control group. Conclusion: This study corroborates that the timely use of itolizumab in combination with other antivirals reduces COVID-19 disease worsening and mortality. The humanized antibody itolizumab emerges as a therapeutic alternative for patients with COVID-19. Our results suggest the possible use of itolizumab in patients with cytokine release syndrome from other pathologies.
Posted: October 26, 2020, 5:46 am
Background: Swallowing disorders are a serious health concern among older adults. Previous studies reported that sarcopenia may affect swallowing disorders; however, whether sarcopenia is related to the capacity to swallow (measured according to swallowing speed) in community-dwelling older adults is unclear. Objectives: The aim of this study was to investigate the relationship between sarcopenia and swallowing capacity in community-dwelling older women. Methods: This cross-sectional observational study was conducted among community-dwelling older women in Japan. The inclusion criteria were as follows: women aged ≥65 years, with the ability to walk independently, and without dysphagia. The exclusion criterion was a history of stroke or Parkinson’s disease that directly caused dysphagia. The participants were divided into a sarcopenia and a healthy group based on the criteria of the Asian Working Group for Sarcopenia 2019. We measured swallowing speed (mL/s) as the swallowing capacity by conducting a 100-mL water-swallowing test. To assess the relationship between sarcopenia and swallowing capacity, we performed a multiple regression analysis. Results: Two-hundred and sixty participants were enrolled in the study. Their mean age was 82.3 ± 6.9 years, and 61 (23.5%) of them displayed sarcopenia. The mean swallowing speed was 11.5 ± 4.9 mL/s, and 17 women (6.5%) exhibited choking or a wet-hoarse voice. Multiple regression analysis revealed that sarcopenia was related to the swallowing capacity after adjusting for age, the Mini-Mental State Examination, and the number of comorbidities (β = –0.20, 95% CI –3.78 to –0.86, p = 0.002). Conclusions: We found that sarcopenia was related to the swallowing capacity in older women in this study. Future research should clarify whether a similar relationship exists in older men as well as the effect of sarcopenia on the swallowing capacity in older adults over a period of time.
Posted: October 19, 2020, 12:23 pm
Introduction: Age-related functional decline elevates the risk of car accidents. Whether specific cognitive impairments and physical frailty increase the risk of car accidents is still unclarified. Objective: This study examines the association between car accidents, frailty, and cognitive function, owing to an increase in car accidents related to older adults. Methods: Data were collected from 12,013 older adults (45.4% women, mean age: 71.7 years [min: 60, max: 96]) enrolled in the National Center for Geriatrics and Gerontology (NCGG) – Study of Geriatric Syndromes. A 2-year self-reported history of car accidents was assessed. The Japanese cardiovascular health study index was used as the criterion and included the following components of frailty: shrinking, weakness, exhaustion, low activity, and slowness. “Frailty” was assigned a value of 1 or more based on these components. Cognitive function was assessed using the NCGG Functional Assessment Tool, and cognitive impairment was assessed using a standardized value. Results: Of the participants, 1,117 (9.3%) had a car accident history. The proportions of the frailty components’ applicability were observed in the car accidents group compared to the non-car accidents group: shrinking (p = 0.006), exhaustion (p = 0.031), low activity (p = 0.034), and slowness (p = 0.030), but not weakness (p = 0.452). The proportion of cognitive impairment in executive function was also higher in the car accidents group (p = 0.011). A logistic regression analysis showed that both frailty (OR 1.26, 95% CI 1.11–1.43; p #x3c; 0.001) and cognitive impairment (OR 1.26, 95% CI 1.11–1.43, p #x3c; 0.001) are associated with car accidents. Discussion: This study’s findings contribute to enhancing the utility of risk assessments for older drivers. Further study is required to clarify the risk of car accidents.
Posted: October 19, 2020, 8:00 am
Introduction: Being elderly is a well-known risk factor for candidemia, but few data are available on the prognostic impact of candidemia in the very old (VO) subjects, as defined as people aged ≥75 years. Objective: The aim of this study was to assess risk factors for nosocomial candidemia in two groups of candidemia patients, consisting of VO patients (≥75 years) and adult and old (AO) patients (18–74 years). In addition, risk factors for death (30-day mortality) were analysed separately in the two groups. Methods: We included all consecutive candidemia episodes from January 2011 to December 2013 occurring in six referral hospitals in north-eastern Italy. Results: A total of 683 nosocomial candidemia episodes occurred. Of those, 293 (42.9%) episodes were in VO and 390 (57.1%) in AO patients. Hospitalization in medical wards, chronic renal failure, urinary catheter, and peripheral parenteral nutrition (PPN) were more common in VO than in AO patients. In the former patient group, adequate antifungal therapy (73.2%) and central venous catheter (CVC) removal (67.6%) occurred less frequently than in AO patients (82.5 and 80%, p #x3c; 0.002 and p #x3c; 0.004, respectively). Thirty-day mortality was higher in VO compared to AO patients (47.8 vs. 23.6%, p #x3c; 0.0001). In AO patients, independent risk factors for death were age (OR 1.04, 95% CI 1.00–1.09, p = 0.038), recent history of chemotherapy (OR 22.01, 95% CI 3.12–155.20, p = 0.002), and severity of sepsis (OR 40.68, 95% CI 7.42–223.10, p #x3c; 0.001); CVC removal was associated with higher probability of survival (OR 0.10, 95% CI 0.03–0.33, p #x3c; 0.001). In VO patients, independent risk factors for death were PPN (OR 3.5, 95% CI 1.17–10.47, p = 0.025) and hospitalization in medical wards (OR 2.58, 95% CI 1.02–6.53, p = 0.046), while CVC removal was associated with improved survival (OR 0.40, 95% CI 0.16–1.00, p = 0.050). Conclusion: Thirty-day mortality was high among VO patients and was associated with inadequate management of candidemia, especially in medical wards.
Posted: October 16, 2020, 8:15 am
Introduction: Previous studies have demonstrated the relationship between cognitive frailty and falls among older adults. Activity engagement (AE) is known to be related to falls in older adults but the subject has been limited to empirical study. This study aimed to explore the mediating role of AE between cognitive frailty and falls among older adults in rural Shandong, China. Methods: A total of 3,242 rural seniors (age ≥60 years; 63.6% women) were included in this cross-sectional study. Regression and bootstrap analyses were performed to explore the mediating role of AE between cognitive frailty and falls. Results: The prevalence of falls was 13.1% and the prevalence of cognitive frailty was 6.6% among the participants. AE mediated the association between cognitive frailty and falls (95% CI 0.077–0.223). However, the direct effect was no longer significant after being adjusted for AE (95% CI –0.037 to 0.684; p = 0.078). Conclusion: Cognitive frailty was found to be associated with falls among rural older adults, and AE mediated this association. More attention should be paid to promote AE among Chinese rural older adults with cognitive frailty.
Posted: October 12, 2020, 12:53 pm
Introduction: Falls are currently the top safety problem in long-term care facilities (LTCFs) in China. Due to the increasing number of residents living in LTCFs, more evidence is needed to give a foundation for fall prevention. Objective: This study aimed to explore the epidemiological characteristics of falls in LTCFs in central Shanghai. Methods: The study was conducted in 21 LTCFs in a central district in Shanghai, with a capacity of 3,065 residents. A two-stage sampling method was applied in participant recruitment. Falls were recorded by LTCF staff over a 12-month period. Details of falls were obtained by face-to-face interviews. The χ2 test was used in data analyses. Results: The incidence of falls was 13.5%; 64.0% falls resulted in injuries, with 32.0% involving fractures. Women had a significantly higher incidence of injurious falls than men (χ2 = 4.066, p = 0.044). Residents aged 80–89 years or in level 1 care had the highest incidence of falls with severe consequences. The incidence of falls was significantly higher at small- or medium-sized LTCFs, public LTCFs, and LTCFs with higher environmental risk levels compared to their counterparts. Most falls occurred when walking on a flat floor (28.9%) and rising up or sitting down (24.0%); 40.9% occurred during the night. Of those injured, 54.8% were treated in hospitals, and only 53.7% completely recovered. Conclusions: Though the average incidence of falls in LTCFs in Shanghai was relatively low, great variation was observed between LTCFs, and severe consequences occurred frequently. Fall prevention programmes should be evidence-based with applicable devices and individualized care services and supports. The roles of personal and institutional factors on falls warrant further study.
Posted: October 6, 2020, 9:10 am
Background: Functional and physiological adaptations induced by resistance training have been extensively studied in older adults. However, microRNA (miRNA) as the novel regulator in protective effects remains poorly understood. Objective: The purpose of an exploratory study was to analyze the response of a panel of circulating miRNAs to adaptations mediated by resistance training. Methods: Ten healthy older adults (age: 67.6 ± 2.2 years, 7 women and 3 men) without previous experience in resistance training were recruited. Blood samples were collected at baseline and after a 12-week resistance training. Next-generation sequencing was used to determine circulating miRNA responses to chronic resistance training. Results: After the 12-week training, physical functions including grip strength, lower body strength and endurance, and walking capacity were improved in the older adults, while the serum levels of leptin (from 18.1 ± 20.0 to 14.9 ± 17.6 ng/mL, p = 0.029) and tumor necrosis factor alpha (TNFα; from 4.4 ± 0.6 to 4.0 ± 0.6 pg/mL, p #x3c; 0.001) were significantly decreased. In addition, adipogenesis-related miRNAs (miR-103a-3p, -103b, -143-5p, -146b-3p, -146b-5p, -17-5p, -181a-2-3p, -181b-5p, -199a-5p, -204-3p, and -378c), anti-adipogenesis-related miRNAs (miR-155-3p, -448, and -363-3p), myogenesis-related miRNAs (miR-125b-1-3p, -128-3p, -133a-3p, 155-3p, -181a-2-3p, -181b-5p, -199a-5p, -223-3p, and -499a-5p), and inflammation-related miRNAs (miR-146b-3p, -146b-5p, -155-3p, -181a-2-3p, and -181b-5p) were changed significantly in the older adults after training (fold change #x3e;2, p #x3c; 0.05). The log2 fold change of miRNA-125-1-3p was inversely correlated with delta walking time (R = –0.685, p = 0.029) and change in insulin-like growth factor 1 (R = –0.644, p = 0.044). Conclusions: Our results can help explain the link between specific circulating miRNAs and beneficial effects of resistance training on functional and physiological adaptations in older adults.
Posted: October 6, 2020, 8:50 am