期刊,Journal of the American Geriatrics Society 2022年70卷7期_国家学术搜索

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期刊信息/Journal information

Journal of the American Geriatrics Society

Williams and Wilkins [etc.]

主办单位：Williams and Wilkins [etc.]

国际刊号：0002-8614

Journal of the American Geriatrics Society/Journal Journal of the American Geriatrics SocietySCIAHCIISSHPISTP

正式出版

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Issue Information

7页

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NSTL

Factors associated with hospital admission and severe outcomes for older patients with COVID‐19

Jiyu KimCaroline BlaumRosie FerrisMauricio Arcila‐Mesa...

12页

查看更多>>摘要：Abstract Background Morbidity and death due to coronavirus disease 2019 (COVID‐19) experienced by older adults in nursing homes have been well described, but COVID‐19's impact on community‐living older adults is less studied. Similarly, the previous ambulatory care experience of such patients has rarely been considered in studies of COVID‐19 risks and outcomes. Methods To investigate the relationship of advanced age (65+), on risk factors associated with COVID‐19 outcomes in community‐living elders, we identified an electronic health records cohort of older patients aged 65+ with laboratory‐confirmed COVID‐19 with and without an ambulatory care visit in the past 24?months (n?=?47,219) in the New York City (NYC) academic medical institutions and the NYC public hospital system from January 2020 to February 2021. The main outcomes are COVID‐19 hospitalization; severe outcomes/Intensive care unit (ICU), intubation, dialysis, stroke, in‐hospital death), and in‐hospital death. The exposures include demographic characteristics, and those with ambulatory records, comorbidities, frailty, and laboratory results. Results The 31,770 patients with an ambulatory history had a median age of 74?years; were 47.4% male, 24.3% non‐Hispanic white, 23.3% non‐Hispanic black, and 18.4% Hispanic. With increasing age, the odds ratios and attributable fractions of sex, race–ethnicity, comorbidities, and biomarkers decreased except for dementia and frailty (Hospital Frailty Risk Score). Patients without ambulatory care histories, compared to those with, had significantly higher adjusted rates of COVID‐19 hospitalization and severe outcomes, with strongest effect in the oldest group. Conclusions In this cohort of community‐dwelling older adults, we provided evidence of age‐specific risk factors for COVID‐19 hospitalization and severe outcomes. Future research should explore the impact of frailty and dementia in severe COVID‐19 outcomes in community‐living older adults, and the role of engagement in ambulatory care in mitigating severe disease.

原文链接:

NSTL
Wiley

Age‐related differences in symptoms in older emergency department patients with COVID‐19: Prevalence and outcomes in a multicenter cohort

Elizabeth M. GoldbergLauren T. SoutherlandJustine PagenhardtRyan Hoopes...

13页

查看更多>>摘要：Abstract Background Older adults represent a disproportionate share of severe COVID‐19 presentations and fatalities, but we have limited understanding of the differences in presentation by age and the association between less typical emergency department (ED) presentations and clinical outcomes. Methods This retrospective cohort study used the RECOVER Network registry, a research collaboration of 86 EDs in 27 U.S. states. We focused on encounters with a positive nasopharyngeal swab for SARS‐CoV‐2, and described their demographics, clinical presentation, and outcomes. Sequential multivariable logistic regressions examined the strength of association between age cohort and outcomes. Results Of 4536 encounters, median patient age was 55?years, 49% were women, and 34% were non‐Hispanic Black persons. Cough was the most common presenting complaint across age groups (18–64, 65–74, and 75+): 71%, 67%, and 59%, respectively (p?<?0.001). Neurological symptoms, particularly altered mental status, were more common in older adults (2%, 11%, 26%; p?<?0.001). Patients 75+ had the greatest odds of ED index visit admission of all age groups (adjusted odds ratio [aOR] 6.66; 95% CI 5.23–8.56), 30‐day hospitalization (aOR 7.44; 95% CI 5.63–9.99), and severe COVID‐19 (aOR 4.26; 95% CI 3.45–5.27). Compared to individuals with alternate presentations and adjusting for age, patients with typical symptoms (fever, cough and/or shortness of breath) had similar odds of ED index visit admission (aOR 1.01; 95% CI 0.81–1.24), potentially higher odds of 30‐day hospitalization (aOR 1.23; 95% CI 1.00–1.53), and greater odds of severe COVID‐19 (aOR 1.46; 95% CI 1.12–1.90). Conclusions Older patients with COVID‐19 are more likely to have presentations without the most common symptoms. However, alternate presentations of COVID‐19 in older ED patients are not associated with greater odds of mechanical ventilation and/or death. Our data highlights the importance of a liberal COVID‐19 testing strategy among older ED patients to facilitate accurate diagnoses and timely treatment and prophylaxis.

原文链接:

NSTL
Wiley

Worsening sleep predicts lower life space mobility during the onset of the COVID‐19 pandemic

Emily J. SmailChristopher N. KaufmannKira E. RiehmMamoun T. Mardini...

8页

查看更多>>摘要：Abstract Background Poor sleep health is an understudied yet potentially modifiable risk factor for reduced life space mobility (LSM), defined as one's habitual movement throughout a community. The objective of this study was to determine whether recalled changes in sleep traits (e.g., sleep quality, refreshing sleep, sleep problems, and difficulty falling asleep) because of the COVID‐19 pandemic were associated with LSM in older adults. Methods Data were obtained from a University of Florida‐administered study conducted in May and June of 2020 (n?=?923). Linear regression models were used to assess the impact of COVID‐related change in sleep traits with summary scores from the Life Space Assessment. Analyses were adjusted for demographic, mental, and physical health characteristics, COVID‐related avoidant behaviors, and pre‐COVID sleep ratings. Results In unadjusted models, reporting that any sleep trait got “a lot worse” or “a little worse” was associated with a decrease in LSM (all p?<?0.05). Results were attenuated when accounting for demographic, mental, and physical health characteristics. In fully adjusted models, reporting that problems with sleep got “a lot worse” or that refreshing sleep got “a little worse” was associated with a lower standardized LSM score (β?=??0.38, 95% CI: ?0.74, ?0.01, and β?=??0.19, 95% CI: ?0.37, ?0.00, respectively). Conclusions While additional research is needed in diverse people and environments, the results demonstrate an association between sleep traits that worsen in response to a health threat and reduced LSM. This finding suggests that interventions that focus on maintaining sleep health in times of heightened stress could preserve LSM.

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