Journal of the American Geriatrics Society

BackgroundFrailty is a geriatric syndrome characterized by an increased vulnerability to stressors and increased risk of adverse clinical outcomes. While older patients with acute stroke are routinely screened for prestroke disability using the modified Rankin Scale (mRS), because of its known association with stroke outcomes, prestroke frailty is still rarely assessed. The Clinical Frailty Scale (CFS) is a popoular tool for retrospective frailty assessment in the acute setting. The study hypothesis was that prestroke frailty measured with CFS was associated with stroke outcome of older patients independent of prestroke disability assessed with mRS. MethodsWe recruited 4086 individuals aged [≥]65 years consecutively admitted with acute stroke to an Italian hospital. Prestroke disability (mRS [≥]3) was assessed at admission. Prestroke CFS was retrospectively assessed using information from the medical records. Logistic models determined the association of CFS with poor functional outcome, prolonged discharge, unfavorable discharge setting, and poor rehabilitation potential. Cox models determined the association of CFS with 30-day and 1-month mortality. All models were adjusted for prestroke disability and other major confounders. ResultsParticipants were median age 81 years (25th-75th percentile, 75-87 years), 55.0% female, 82.6% with ischemic stroke, and 26.3% with prestroke disability. Overall prevalence of prestroke frailty (CFS [≥]4) was 41.6%. Multivariable-adjusted logistic models showed that CFS was associated with increasing risk of all outcomes except prologed discharge. In severe frailty (CFS 7-8), OR (95%CI) was 3.44 (2.33-5.07) for poor functional outcome, 0.53 (0.38-0.75) for prolonged discharge, 1.89 (0.36-263) for unfavourable discharge, and 6.24 (3.80-10.26) for poor rehabilitation potential (reference CFS 1-3). In multivariable adjusted-Cox models, CFS was unrelated to 30-day mortality but HR (95%CI) of 1-year mortality was significant for both CFS 4-6 (1.70, 1.36-2.11) and CFS 7-8 (1.69, 1.25-2.30). ConclusionsPrestroke frailty measured with CFS was associated with higher risk of several adverse outcomes even after adjustment for prestroke disability and other major confounders.

BackgroundPre-injury frailty among older trauma patients is a predictor of increased morbidity and mortality. We sought to determine the relationship between frailty status and the care trajectories of older adult patients who underwent frailty screening in the emergency department (ED). MethodsUsing a retrospective cohort design of a single institutional trauma database, we pooled data on trauma patients, 65 years and older, who had frailty screening at ED presentation (N=987). The predictor variable was frailty status, measured as either robust, pre-frail, or frail. The outcome variables were measures of clinical care trajectory: inpatient admission, length of hospital stay, home discharge, and discharge to rehabilitation. We controlled for age, sex, race/ethnicity, body mass index, Charlson Comorbidity Index, injury type and severity, and Glasgow Coma Scale score. We performed multivariable logistic and quantile regressions to measure the influence of frailty on post-trauma care trajectories. ResultsThe mean (SD) age of the study population was 81 (9.0) years and the population was predominantly female (66%) and non-Hispanic White (64%). Compared to older adult trauma patients classified as robust, those categorized as frail had 2.8 (95% CI: 1.75 - 4.40), 0.4 (95% CI: 0.27 - 0.63), and 2.1 (95% CI: 1.38 - 3.27) times the adjusted odds of hospital admission, home discharge, and discharge to rehabilitation, respectively. Those classified as pre-frail (Adjusted MD: 1.0; 95% CI: 0.46 - 1.54) and frail (Adjusted MD: 2.0; 95% CI: 1.35 - 2.65) had longer lengths of hospital stay compared to those classified as robust. ConclusionPre-injury frailty is a predictor of care trajectories for older-adult trauma patients.

BackgroundLong COVID is characterized by persistent symptoms affecting one or more organ systems for at least 3 months following a SARS-CoV-2 infection. The pathophysiologic mechanisms of this complex disease are poorly understood. Beyond the described symptoms of fatigue, dyspnea, myalgias, among others, Long COVID can affect the patients ability to work and function in society compared to their baseline. Frailty is defined as the decline of physiologic reserve that leads to increased vulnerability to stressors and poor health outcomes. Our study aimed to examine the characteristics of frailty seen in patients with Long COVID compared to the frailty seen in aging patients with multimorbidity. MethodsThis is a retrospective cohort study conducted in the Miami Veterans Affairs Medical Center (VAMC). The data used to calculate the Fried phenotype through the Johns Hopkins frailty calculator was collected from two separate clinics, a Long COVID clinic and a Geriatric Frailty clinic. We obtained the VA Frailty Index from VA CDW (Corporate Data Warehouse). ResultsWe included 106 patients from the Long COVID clinic and 97 from the frailty clinic. Patients from the Long COVID clinic were significantly younger than those from the frailty clinic (60{+/-}12.6 vs.. 79.8{+/-}5.8, p<0.01). In the standard frailty group, weakness and slowness were the predominant features present in both the frail and pre-frail groups, with increasing exhaustion and lower activity in the frail group. Patients with frailty in the Long COVID group experienced exhaustion and low activity at a higher rate than those in the Geriatric frailty clinic. ConclusionsLong COVID may predispose patients to develop a subtype of frailty ("post-viral frailty") that presents with a higher frequency of exhaustion and low activity. This frailty appears phenotypically different from the frailty encountered in geriatric patients with multimorbidity, which presents more often with slowness and weakness as the initial drivers.

ObjectiveIdentify subgroups of postoperative older adults using electronic health record data. Summary of Background DataPostoperative older adults represent a vulnerable population who may benefit from tailored postoperative care pathways. Identifying clinical subgroups can inform the development of these pathways. MethodsRetrospective cohort study of postoperative adults >65 years (N=2,036) from a single healthcare system. Latent class analysis was used to identify patient subgroups based on measures of frailty, mobility, activities of daily living, and general health status. Hospital outcomes were described among each subgroup, including extended lengths of stay (LOS) (>0.5 SD beyond mean LOS by surgical category), discharge disposition (i.e., home versus non-home discharge), and utilization (weekly visit frequency) of physical therapy (PT) and occupational therapy (OT). ResultsWe identified 3 subgroups that we labeled Low Frailty-High Mobility (LF-HM), High Frailty-Low Mobility (HF-LM), and Low Frailty-Low Mobility (LF-LM), representing 15.3%, 27.6%, and 57.1% of the cohort, respectively. Discharge to home was highest among the LF-HM group (99%), followed by LF-LM (96%), and HF-LM (77%). Extended LOS was most common among the HF-LM group (27%), followed by LF-LM (18%), and LF-HM (6%). PT and OT visit frequencies were highest in the HF-LM group followed by the LF-LM and LF-HM groups. ConclusionsThis study identified 3 subgroups of postoperative older adults using routinely collected patient data. These groups may help to identify patients with increased odds of non-home discharge, extended LOS, and higher utilization of PT and OT and may inform the development of tailored postoperative care pathways for older adults.

Background/ObjectivesCoronavirus disease 2019 (COVID-19) is associated with a hypercoagulable state and increased thrombotic risk in infected individuals. Several complex and varied coagulation abnormalities were proposed for this association1. Acetylsalicylic acid(ASA, aspirin) is known to have inflammatory, antithrombotic properties and its use was reported as having potency to reduce RNA synthesis and replication of some types of coronaviruses including human coronavirus-299E (CoV-229E) and Middle East Respiratory Syndrome (MERS)-CoV 2,3. We hypothesized that chronic low dose aspirin use may decrease COVID-19 mortality relative to ASA non-users. MethodsThis is a retrospective, observational cohort analysis of residents residing at Veterans Affairs Community Living Centers from December 13, 2020, to September 18, 2021, with a positive SARS-CoV-2 PCR test. Low dose aspirin users had low dose (81mg) therapy (10 of 14 days) prior to the positive COVID date and were compared to aspirin non-users (no ASA in prior 14 days). The primary outcome was mortality at 30 and 56 days post positive test and hospitalization. ResultsWe identified 1.823 residents who had SARS-CoV-2 infection and 1,687 residents were eligible for the study. Aspirin use was independently associated with a reduced risk of 30 days of mortality (adjusted HR, 0.60, 95% CI, 0.40-0.90) and 56 days of mortality (adjusted HR, 0.67, 95% CI, 0.47-0.95) ConclusionChronic low dose aspirin use for primary or secondary prevention of cardiovascular events is associated with lower COVID-19 mortality. Although additional randomized controlled trials are required to understand these associations and the potential implications more fully for improving care, aspirin remains a medication with known side effects and clinical practice should not change based on these findings.

PurposeTo ascertain delirium prevalence and outcomes in COVID-19. MethodsWe conducted a point-prevalence study in a cohort of COVID-19 inpatients at University College Hospital. Delirium was defined by DSM-IV criteria. The primary outcome was all-cause mortality at 4 weeks; secondary outcomes were physical and cognitive function. ResultsIn 71 patients, 31 (42%) had delirium, of which only 19 had been recognised by the clinical team. At 4 weeks, 20 (28%) had died, 26 (36%) were interviewed by telephone and 21 (30%) remained as inpatients. Physical function was substantially worse in people after delirium (-39 points on functional scale/166, 95% CI -92 to -21, p=0.01) (Table 2). Mean cognitive scores at follow-up were similar and delirium was not associated with mortality in this sample. O_TBL View this table: org.highwire.dtl.DTLVardef@1062c36org.highwire.dtl.DTLVardef@40a765org.highwire.dtl.DTLVardef@ae062dorg.highwire.dtl.DTLVardef@1179aa8org.highwire.dtl.DTLVardef@aac078_HPS_FORMAT_FIGEXP M_TBL O_FLOATNOTable 2.C_FLOATNO O_TABLECAPTIONUnivariable and multivariable models estimating the associations with physical function at 4 weeks on a combined Barthel (100 points) and Nottingham Extended Activities of Daily Living score (66 points). C_TABLECAPTION C_TBL ConclusionsOur findings indicate that delirium is common, yet under-recognised. Delirium is associated with functional impairments in the medium-term. Key summary points AimTo investigate functional and cognitive outcomes among patients with delirium in COVID-19. FindingsDelirium in COVID-19 was prevalent (42%) but only a minority had been recognised by the clinical team. At 4-week follow-up, delirium was significantly associated with worse functional outcomes, independent of pre-morbid frailty. Cognitive outcomes were not appreciably worse. MessageThe presence of delirium is a significant factor in predicting worse functional outcomes in patients with COVID-19.

BackgroundPost-stroke delirium (PSD) is a critical neuropsychiatric condition affecting up to 50% of elderly patients during hospitalization, often leading to poorer outcomes. Despite its prevalence, PSD remains underrecognized in clinical practice, and national-level studies exploring its risk factors are limited. ObjectiveThis study aimed to examine the incidence and risk factors associated with PSD in elderly individuals ([&ge;]65 years) using a large, nationally representative dataset. MethodsData from the Healthcare Cost and Utilization Project National Inpatient Sample (2010-2019) were analyzed. Elderly patients with a primary diagnosis of stroke were selected, and PSD was defined using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and ICD-10-CM codes. To determine independent risk factors for PSD, multivariate logistic regression was applied, adjusting for demographic, clinical, and hospital-related variables. ResultsAmong 1,644,773 elderly stroke patients, the incidence of PSD was 19.5%. Patients with PSD were significantly older, with a median age of 79 years, compared to 78 years in those without PSD (p < 0.001). They also experienced prolonged hospital stays (5 days vs. 4 days, p < 0.001), incurred greater hospitalization costs ($44,863 vs. $35,787, p < 0.001), and exhibited a higher risk of in-hospital mortality (12.6% vs. 7.0%, p < 0.001). Significant independent risk factors for PSD included advanced age ([&ge;]80 years, odds ratio [OR] = 1.237), three or more comorbidities (OR = 2.049), Black race (OR = 1.113), Asian/Pacific Islander race (OR = 1.060), fluid/electrolyte disorders (OR = 1.902), psychoses (OR = 1.765), sepsis (OR = 2.364), and dysphagia (OR = 1.315). ConclusionsPSD is frequently observed in elderly stroke patients and is associated with adverse clinical outcomes. Advanced age, comorbidities, and stroke-related complications are significant risk factors. These results underscore the importance of developing focused prevention and intervention strategies to enhance outcomes for this high-risk population.

BackgroundDelirium affects a quarter of patients after acute stroke and predicts poorer outcomes. Our aim was to determine whether either qualitative assessment or quantitative assessments of the regional atrophy obtained from routinely performed computed tomography (CT) brain imaging could identify those most at risk of developing delirium. MethodsWe recruited 95 patients with acute stroke (age [&ge;]65) over one year. Follow-up for delirium and cognition was performed at 1, 3, 5, 7, 14, 21, 28 days, 4 months and 12 months. All participants underwent routine CT brain (Toshiba 64-slice or 128-slice scanner). White matter disease and atrophy were rated qualitatively (mild, moderate, severe). Atrophy in multiple specific areas was measured quantitatively. ResultsTwenty-six (27%) developed delirium during the 12 months of follow-up. On univariable analysis, delirium was associated with increasing age, being female, less independent in pre-stroke activities of daily living, pre-existing cognitive impairment, increasing stroke severity, having had a total anterior circulation stroke and global cerebral atrophy on brain CT. Multivariable analysis demonstrated that only global cerebral atrophy, being female and having a more severe stroke predicted delirium. This model accounted for between 38% and 55% of the variance in delirium. For quantitative CT analysis, on univariable analysis, delirium was associated with atrophy in several specific brain areas. On multivariable analysis, only NIHSS (for every one point increase OR 1.23, 95% CI 1.06-1.43; p=0.006)) and cistern ambiens ratio (OR 1.41, 95% CI 1.48-4.96; p=0.028) were significantly associated. This model accounted for between 35.1% and 51.2% of delirium variance. ConclusionClinical variables together with either qualitative atrophy assessment or cistern ambiens ratio on routine CT brain could identify stroke patients most at risk of delirium and to stratify patients in clinical trials of delirium prevention and treatment.

ImportanceAs the population of the United States (US) ages, there is considerable interest in ensuring safe and high-quality surgical care for older persons. Yet, valid, generalizable data on the occurrence of major surgery in the geriatric population are sparse. ObjectiveTo estimate the incidence and cumulative risk of major surgery in older persons over a 5-year period and evaluate how these estimates differ according to demographic and geriatric characteristics. DesignProspective longitudinal study. SettingContinental US from 2011 to 2016. Participants5,571 community-living fee-for-service Medicare beneficiaries, aged 65+, from the National Health and Aging Trends Study (NHATS). Main Outcomes and MeasuresMajor surgeries were identified through linkages with data from the Centers for Medicare & Medicaid Services. Data on frailty and dementia were obtained from the baseline NHATS assessment. ResultsThe nationally-representative incidence of major surgery per 100 person-years was 8.8 (95% confidence interval [CI], 8.2-9.5), with estimates of 5.2 (95% CI, 4.7-5.7) and 3.7 (95% CI, 3.3-4.1) for elective and non-elective surgeries. The adjusted incidence of major surgery peaked at 10.8 (95% CI, 9.4-12.4) in persons 75-79 years, increased from 6.6 (95% CI, 5.8-7.5) in the non-frail group to 10.3 (95% CI, 8.9-11.9) in the frail group, and was similar by sex (males 8.6 [95% CI, 7.7-9.6]; females 8.3 [95% CI, 7.5-9.1]) and dementia (no 8.6 [95% CI, 7.9-9.3]; possible 7.8 [95% CI, 6.3-9.6]; probable 8.1 [95% CI, 6.7-9.9]). The 5-year cumulative risk of major surgery was 13.8% (95% CI, 12.2%-15.5%), representing nearly 5 million unique older persons (4,958,048 [95% CI, 4,345,342-5,570,755]), including 12.1% (95% CI, 9.5%-14.6%) in persons 85-89 years, 9.1% (95% CI, 7.2%-11.0%) in those [&ge;]90 years, 12.1% (95% CI, 9.9%-14.4%) in those with frailty, and 12.4% (95% CI, 9.8%-15.0%) in those with probable dementia. Conclusions and RelevanceMajor surgery is a common event in the lives of community-living older persons, including high-risk vulnerable subgroups such as the oldest old, those with frailty or dementia, and those undergoing non-elective surgery. The burden of major surgery in older Americans will add to the challenges ahead for the US health care system in our aging society. KEY POINTSO_ST_ABSQuestionC_ST_ABSWhat is the incidence and cumulative risk of major surgery in older persons in the United States? FindingsIn this prospective longitudinal study, data from 5,571 community-living fee-for-service Medicare beneficiaries were used to calculate nationally-representative estimates for the incidence and cumulative risk of major surgery over a 5-year period. Nearly 9 major surgeries were performed annually for every 100 older persons, and more than 1 in 7 Medicare beneficiaries underwent a major surgery over 5 years, representing nearly 5 million unique older persons. MeaningMajor surgery is a common event in the lives of community-living older persons.

ObjectivesEvaluate neurocognitive health and its response to interventions in older, obese patients with heart failure with preserved ejection fraction (HFpEF). BackgroundNeurocognitive dysfunction may be an underrecognized feature of HFpEF that responds to weight-loss interventions. MethodsWe first compared detailed baseline cognitive testing (Uniform Data Set version 3 and Rey Auditory Verbal Learning Test [RAVLT]), and brain volumes and cerebral blood flow (CBF) from 3T magnetic resonance imaging between older patients with HFpEF (n=46) and healthy age-matched controls (HC; n=22). The HFpEF patients were then randomized to a 20-week caloric restriction (CR) intervention with either aerobic-only (CR+AT; n=23) or aerobic+resistance exercise training (CR+AT+RT; n=23), and repeated cognitive testing and neuroimaging post-intervention. Cognitive scores were normalized to national data and transformed to z-scores for global, memory, attention, executive function, visuospatial, and language fluency domains. ResultsCompared to HC, participants with HFpEF had significantly lower baseline global cognitive performance, and lower global, visuospatial processing and language fluency domain z-scores than normative means. Following the diet and exercise intervention, there were significant improvements in global (+0.6 [95% CI: 0.3, 0.8]) and category fluency (+0.2 [95% CI: -0.004, 0.3]) z-scores, and in RAVLT immediate (+0.6 [95% CI: 0.1, 1.0] points) and delayed (0.9 [95% CI: 0.2, 1.6] points) recall. Only CR+AT+RT was associated with improved phonemic fluency z-score (+0.4 [95% CI: 0.1, 0.7]). There were no significant intervention effects on brain volumes or CBF. ConclusionsOlder, obese patients with chronic HFpEF have significant cognitive deficits that are ameliorated by diet and exercise interventions.

BackgroundLimitations in activities of daily living have widespread implications for the well-being of older adults. However, the relation between performance-based physical function and self-reported functional impairment is inconsistent. MethodsThe cohort included 6,282 White women and 310 Black women aged 65 and older participating in the Study of Osteoporotic Fractures (SOF) from 1986 to 2010 who reported no limitations in any Instrumental Activities of Daily Living (IADL) at baseline. Approximately every two to six years, participants self-reported their physical limitations and trained interviewers assessed common measures of physical performance (i.e., usual gait speed, grip strength, and chair stand time). We used Cox proportional hazards models using age as the time scale to calculate hazard ratios between individual and summary measures of physical performance and incident IADL limitations. ResultsOver follow-up, 4,193 White women and 118 Black women developed IADL impairment (IR = 451.34 and 361.52 per 10,000 person-years, respectfully). Usual gait speed was associated with IADL limitations in both race cohorts (slowest gait vs. fastest gait HR: 3.83, 95% CI: 3.41 - 4.31; HR: 2.59, 95% CI: 1.42 - 4.73). For every one-point increase in summary performance score, rate of IADL limitations was lower for both White women and Black women (HR: 0.79, 95% CI: 0.78-0.80; HR: 0.87, 95% CI: 0.81 - 0.94). ConclusionIn this longitudinal study, women with poorer performance in individual and summary measures of physical function had an increased rate of incident IADL limitations over follow-up compared to women with the best performance. These findings confirm previous research using cross-sectional data.

We describe six-month functional status, hospitalization, and mortality among 23,632 cases of Long Covid in skilled nursing facilities (SNFs) in the US, primarily experienced by adults over 65 years old. We describe outcomes across seven medications used to treat Covid-19 including functional status (ADLs).

Importance and ObjectiveCOVID-19 has a high mortality rate amongst nursing home populations (26.4% nationally and 28.3% in New Jersey). Identification of factors influencing mortality in COVID-19 positive nursing home populations may help direct physicians towards appropriate glycemic, blood pressure, weight, kidney function, lipid, thyroid, and hematologic management to reduce COVID-19 mortality. Design, Setting, and ParticipantsRetrospective cross-sectional study of patients in two nursing home facilities (one urban, one suburban) from 3/16/2020 to 7/13/2020 with positive COVID-19 PCR assays. Age, race, sex, lipids, hematologic parameters, body mass index, blood pressure, thyroid function, albumin, blood urea nitrogen, creatinine, and hemoglobin A1c were correlated with COVID-19 mortality by chi-squared analysis. Main Outcome and Results56 patients met the inclusion criteria for the study. Mortality was 14.3% while the New Jersey nursing home average mortality rate was 28.3% as of August 2020. Our patient cohort had a 49.5% reduction in mortality compared to the state average. In our overall cohort, none of the clinical parameters correlated with COVID-19 mortality using chi-squared analysis. In the 56 patient cohort, average clinical and laboratory findings were 74.0 years, 62.5% female, 28.5% uncontrolled hypertension, BMI 25.6, hemoglobin A1c 6.4, TSH 2.4, vitamin B12 568.3, folate 12.4, iron 47.8, total iron binding capacity 271.8, hemoglobin 11.6, albumin 3.5, triglycerides 100.3, total cholesterol 133.5, HDL 40.9, and BUN to Creatinine ratio 22.2:1. Logistic multivariate regression analyses failed to demonstrate clinically significant correlation with COVID-19 mortality. In the urban nursing home, BUN to creatinine ratio exceeding 20:1 was the only factor that showed statistical significance to COVID-19 mortality (p = 0.03). In the suburban nursing home, age over 80 was the only clinical factor demonstrating statistical significance to COVID-19 mortality (p = 0.003). Conclusions and RelevanceIn our COVID-19 positive nursing home patients, no one parameter was clinically significant in the overall 56-patient cohort; however, mortality in our population was 14.3% compared to New Jerseys 28.3%, a 49.5% reduction in mortality. Rigorous control of the aforementioned clinical parameters may have contributed to this reduction in mortality. Further research requires analysis of more nursing home patients to determine whether rigorous control of clinical parameters decreases mortality from COVID-19. Key PointsO_ST_ABSQuestionC_ST_ABSWhat clinical parameters lead to a lower mortality rate in nursing home patients with COVID-19? FindingsIn this cross-sectional analysis of 56 SARS-CoV-2 positive New Jersey nursing home residents from March to July 2020, controlling hemoglobin A1c, blood pressure, hematologic and lipid panels to recommended levels yielded a mortality rate of 14.3%, a 49.5% reduction from the 28.3% mortality rate of COVID-19 in New Jersey nursing homes. MeaningMaintaining rigorous control of clinical parameters in nursing home populations may account for a decreased mortality rate of COVID-19.

BackgroundPhysical performance tests are predictive of mortality and have been proposed for screening for certain health conditions (e.g., sarcopenia); however, the diagnostic screening and prognostic value of physical performance tests has primarily been studied in age-limited or disease-specific cohorts. In this study, we sought to identify the most salient characteristics associated with three lower quarter balance and strength tests in a deeply phenotyped cohort of community-dwelling adults. MethodsWe applied a stacked elastic net approach on detailed data on sociodemographic, health and health-related behaviors, and biomarker data from the first visit of the Project Baseline Health Study (N=2502) to determine which variables were most associated with three physical performance measures: single-legged balance test (SLBT), sitting-rising test (SRT), and 30-second chair-stand test (30CST). Analyses were stratified by age (<65 and [&ge;]65). ResultsFemale sex, Black or African American race, lower educational attainment, and health conditions such as non-alcoholic fatty liver disease and cardiovascular conditions (e.g., hypertension) were consistently associated with worse performance across all three tests. Several other health conditions were associated with either better or worse test performance, depending on age group and test. C-reactive protein was the only laboratory value associated with performance across age and test groups with some consistency. ConclusionsOur results highlighted previously identified and several novel salient factors associated with performance on the SLBT, SRT, and 30CST. Future research should discern and validate the value of these tests as affordable, noninvasive biomarkers of prevalent and/or future disease in the community.

BackgroundThe COVID-19 pandemic has greatly affected nursing home residents (NHRs), a vulnerable group with high rates of illness and death. While vaccination is essential for reducing infections and severe outcomes in the short term, it is important to understand how long antibody levels and neutralizing activity last. This understanding will help us create effective public health strategies for the long term. According to current CDC guidelines, individuals over the age of 65 should receive a booster dose six months after their previous vaccination. MethodsThis observational retrospective cohort study analyzed post-vaccination serum from samples with up to 400 days of follow-up from 697 NHRs and 127 healthcare workers (HCWs) across Northeast Ohio and Rhode Island. Analyses were conducted to model decay rates of both neutralizing and binding antibody titers and the impact of previous exposures to SARS-CoV-2 on these decay rates. ResultsResults indicate that NHRs show Wuhan and Omicron BA.4/5 neutralizing and binding antibody titers diminish significantly from 2 weeks to 12 months post-vaccination. NHRs with prior infection show higher peak antibody titers and slower decay than those naive to infection. Antibody levels after vaccination for infection-naive NHR residents lagged HCW and NHR with prior infection, but then decayed at a similar rate. ConclusionThe immunologic findings in this cohort of NHR are in line with the existing real-world clinical effectiveness data in older individuals and support the CDC recommendation of a bi-annual vaccination to reduce severe COVID-19 outcomes in persons age 65 and older.

ObjectiveTo investigate the differential effects of frailty on biventricular function in senile patients and analyse the prognosis of different combinations of clinical status. Methods and ResultsPatients aged [&ge;]80 years with at least one basic disease causing heart failure were included and divided into three groups according to frailty score. Basic data, ultrasound data, and follow-up data were collected and analyses of differences between groups and survival were performed. The proportion of patients with right heart failure in the frailty group was significantly higher than that in the others. A total of 33 (15.1%) patients died within a year, 162 (74%) were readmitted within 1 year, and 84 (38.4%) were admitted for heart failure within 1 year. The frailty group with right heart failure had the highest rate of all cause and heart failure-related readmission. Frailty significantly increased the risk of 1-year all-cause mortality, all-cause readmission, and heart failure-related readmission. Right heart failure significantly increased the 1-year all-cause readmission and heart failure-related readmission rates. After adjusting for the interaction of factors, only frailty had a significant effect on the three prognostic events. ConclusionsRight heart failure is more likely to be associated with frailty in senile patients. One-year all-cause mortality, all-cause readmission, and heart failure-related readmission rates were significantly increased in frail patients with right heart failure. Frailty was a significant predictor of all-cause death, all-cause readmission, and heart failure-related readmission.

BackgroundFrailty and multimorbidity are common in older adults and contribute substantially to prolonged hospitalizations, readmissions, and mortality. Yet, existing prediction models often fail to integrate frailty-specific biomarkers and lack interpretability for routine clinical use. ObjectivesTo develop and internally validate an interpretable, machine learning-enhanced logistic regression model to predict prolonged hospital length of stay (LOS) among frail older adults with multimorbidity, and to identify key predictors to guide individualized inpatient care. MethodsWe conducted a retrospective study of 440 hospitalized adults aged [&ge;]65 years with multimorbidity ([&ge;]2 chronic conditions) and frailty (Frailty Index [&ge;]0.25) at a tertiary geriatric department between January 2022 and December 2023. Fourteen demographic, clinical, and biochemical variables were analysed. Feature selection employed Elastic Net regularization, Extreme Gradient Boosting with SHAP value analysis, and the Boruta algorithm to ensure robust predictor identification. A multivariable logistic regression model was trained and internally validated using stratified 10-fold cross-validation and 1,000 bootstrap iterations. Discrimination (AUC-ROC), calibration, and clinical utility (decision curve analysis) were assessed. ResultsEight predictors age, diabetes, hypertension, prior stroke, serum albumin, HDL cholesterol, systolic blood pressure, and neutrophil-to-lymphocyte ratio--were retained in the final model. The model achieved good discrimination (AUC = 0.770, 95% CI 0.688-0.853) and acceptable calibration (Hosmer-Lemeshow {chi}{superscript 2} = 14.86, p = 0.062). Cross-validation (mean AUC 0.687 {+/-} 0.072) and bootstrap correction (AUC 0.672) confirmed internal stability. Serum albumin was the strongest protective factor, while elevated neutrophil-to-lymphocyte ratio and prior stroke were significant risk factors. ConclusionsThis interpretable model accurately predicts prolonged hospital stay in frail older adults with multimorbidity using routinely available clinical data. Its transparent design supports integration into electronic health records for real-time risk stratification, facilitating targeted discharge planning and personalized geriatric care.

BackgroundThe one-year SINEMA trial demonstrated improved blood pressure (BP) control and reduced mortality up to 72 months after the intervention. This article aims to assess between-arm differences in mean annual cumulative BP and to explore whether the associations between cumulative BP and biofunctional outcomes differed by trial arm. MethodsPost-hoc secondary analysis of the SINEMA cluster-randomized trial, which recruited 1299 adults with stroke from 50 rural villages in Hebei, China, between 2017 and 2018. The 12-month intervention was followed by observational assessments at 72 and 84 months post-baseline. BP was measured during each face-to-face follow-up, assessed by blinded assessors at baseline, 12, 72, and 84 months. Mean annual cumulative systolic BP (SBP), diastolic BP (DBP), mean arterial pressure (MAP), and pulse pressure (PP) were calculated. Biofunctional outcomes included health-related quality of life, modified Rankin Scale, activities of daily living, physical function, and cognition function. ResultsAmong 897 participants (mean age 62.7 years; 40.8% female) with complete data across all assessment, the intervention arm demonstrated significantly lower mean annual cumulative SBP (-2.2 mm Hg; 95% CI, -3.9 to -0.6), DBP (-1.6 mm Hg; 95% CI, -2.4 to -0.7), and MAP (-1.8 mm Hg; 95% CI, -2.8 to -0.8), not PP, compared with usual care. Significant associations between cumulative BP and biofunctional outcomes were observed in the control arm while not in the intervention arm. Interaction effects between trial arm and cumulative BP were significant for multiple outcomes, most prominently for cumulative SBP. ConclusionsThe one-year SINEMA intervention was associated with lower cumulative BP burden over 72-84 months but did not improve overall biofunctional outcomes. Secondary analyses revealed that the association between cumulative BP burden and biofunctional decline differed by intervention arm, suggesting cumulative BP exposure may be an important long-term risk indicator and the intervention may modify BP-outcome relationships through mechanisms requiring further investigation.

BackgroundOlder adults with coronavirus disease 2019 (COVID-19) face an increased risk of adverse health outcomes including mortality. Ethical guidelines consider allocation of limited resources based on likelihood of survival, frilty, co-morbidities and age. However, the association of frailty with clinical outcomes in older COVID-19 patients remains unclear. ObjectivesTo determine the association between frailty and short-term mortality in older adults hospitalized for COVID-19. DesignRetrospective single-center observational study. Setting and participantsN = 81 patients with COVID-19 confirmed by reverse-transcriptase polymerase chain reaction (RT-PCR), at the Geriatrics department of Imelda general hospital, Belgium. MeasurementsFrailty was graded according to the Rockwood Clinical Frailty Scale (CFS). Demographic, biochemical and radiological variables, co-morbidities, symptoms and treatment were extracted from electronic medical records. ResultsParticipants (N = 48 women, 59%) had a median age of 85 years (range 65-97 years), median CFS score of 7 (range 2 - 9), and 42 (52%) were long-term care residents. Within six weeks, eighteen patients died. Mortality was significantly but weakly associated with age (Spearman r = 0.241, P = 0.03) and CFS score (r = 0.282, P = 0.011), baseline lactate dehydrogenase (LDH) (r = 0.301, P = 0.009), lymphocyte count (r = -0.262, P = 0.02) and RT-PCR Ct value (r = -0.285, P = 0.015). Mortality was not associated with long-term care residence, dementia, delirium or polypharmacy. In multivariable logistic regression analyses, CFS, LDH and RT-PCR Ct values (but not age) remained independently associated with mortality. Both age and frailty had poor specificity to predict survival. A multivariable model combining age, CFS, LDH and viral load significantly predicted survival. Conclusions and implicationsAlthough their prognosis is worse, even the oldest and most severely frail patients may benefit from hospitalization for COVID-19, if sufficient resources are available. BRIEF SUMMARYOutcomes of frail older adults hospitalized for COVID-19, particularly long-term care residents, remain unclear. In this retrospective cohort, frailty predicted mortality independently of age or established biomarkers.

Older adults are at elevated risk for morbidity and mortality caused by influenza. Vaccination is the primary means of prophylaxis, but protection is often compromised in older adults. As acute eccentric resistance exercise mobilizes immune cells into muscle, it may enhance vaccination response. PURPOSE: Compare antibody responses to influenza vaccination in older adults who performed resistance exercise prior to vaccination to those who did not exercise. METHODS: 29 resistance training-naive older adults (20 women, 73.9 {+/-} 5.3 years) were randomized to 1 of 3 groups: vaccination in the same arm that exercised (Ex-S), vaccination in the opposite arm that exercised (Ex-OP), and seated rest (No-Ex). Exercise was unilateral and consisted of 10 sets of 5 eccentric repetitions at 80% of the pre-determined concentric one repetition maximum. Lateral raises were alternated with bicep curls. No-Ex sat quietly for 25 min. Following exercise or rest, all subjects received the 2018 quadrivalent influenza vaccine (Seqirus Afluria) in the non-dominant deltoid. Antibody titers against the four influenza vaccine strains were determined by hemagglutinin inhibition assays at baseline, 6-, and 24-weeks post-vaccination. Group differences in antibody titers by time were assessed by restricted maximum likelihood mixed models. Fold-changes in antibody titers 6- and 24-weeks from baseline were compared between groups by Kruskal-Wallis tests. RESULTS: No significant group x time effects were found for any strain. Groups did not differ in fold-increase of antibody titers 6- and 24-weeks post-vaccination. Although seroconversion rates remained low, only one subject (Ex-S) reported flu-like symptoms 18 weeks post-vaccination. CONCLUSION: Acute arm eccentric exercise did not influence antibody titers to the influenza vaccine delivered post-exercise in older adults. More strenuous exercise may be required for exercise to act as an adjuvant. http://ClinicalTrials.gov Identifier: NCT03736759 U.S. NIH Grant/Contract: R03AG052778