There is an established literature on the symptoms and complications of COVID‐19 but the after‐effects of COVID‐19 are not well understood with few studies reporting persistent symptoms and quality ...of life. We aim to evaluate the pooled prevalence of poor quality of life in post‐acute COVID‐19 syndrome (PCS) and conducted meta‐regression to evaluate the effects of persistent symptoms and intensive care unit (ICU) admission on the poor quality of life. We extracted data from observational studies describing persistent symptoms and quality of life in post‐COVID‐19 patients from March 10, 2020, to March 10, 2021, following PRISMA guidelines with a consensus of two independent reviewers. We calculated the pooled prevalence with 95% confidence interval (CI) and created forest plots using random‐effects models. A total of 12 studies with 4828 PCS patients were included. We found that amongst PCS patients, the pooled prevalence of poor quality of life (EQ‐VAS) was (59%; 95% CI: 42%–75%). Based on individual factors in the EQ‐5D‐5L questionnaire, the prevalence of mobility was (36, 10–67), personal care (8, 1–21), usual quality (28, 2–65), pain/discomfort (42, 28–55), and anxiety/depression (38, 19–58). The prevalence of persistent symptoms was fatigue (64, 54–73), dyspnea (39.5, 20–60), anosmia (20, 15–24), arthralgia (24.3, 14–36), headache (21, 3–47), sleep disturbances (47, 7–89), and mental health (14.5, 4–29). Meta‐regression analysis showed the poor quality of life was significantly higher among post‐COVID‐19 patients with ICU admission (p = 0.004) and fatigue (p = 0.0015). Our study concludes that PCS is associated with poor quality of life, persistent symptoms including fatigue, dyspnea, anosmia, sleep disturbances, and worse mental health. This suggests that we need more research on PCS patients to understand the risk factors causing it and eventually leading to poor quality of life.
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COVID‐19 and Older Adults: What We Know Shahid, Zainab; Kalayanamitra, Ricci; McClafferty, Brendan ...
Journal of the American Geriatrics Society,
20/May , Volume:
68, Issue:
5
Journal Article
Peer reviewed
Open access
Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), a novel virus that causes COVID‐19 infection, has recently emerged and caused a deadly pandemic. Studies have shown that this virus ...causes worse outcomes and a higher mortality rate in older adults and those with comorbidities such as hypertension, cardiovascular disease, diabetes, chronic respiratory disease, and chronic kidney disease (CKD). A significant percentage of older American adults have these diseases, putting them at a higher risk of infection. Additionally, many adults with hypertension, diabetes, and CKD are placed on angiotensin‐converting enzyme (ACE) inhibitors and angiotensin II receptor blockers. Studies have shown that these medications upregulate the ACE‐2 receptor, the very receptor that the SARS‐CoV‐2 virus uses to enter host cells. Although it has been hypothesized that this may cause a further increased risk of infection, more studies on the role of these medications in COVID‐19 infections are necessary. In this review, we discuss the transmission, symptomatology, and mortality of COVID‐19 as they relate to older adults, and possible treatments that are currently under investigation. J Am Geriatr Soc 68:926–929, 2020
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BACKGROUND/OBJECTIVES
The 2019 coronavirus disease (COVID‐19) has been documented in a large share of nursing homes throughout the United States, leading to high rates of mortality for residents. To ...understand how to prevent and mitigate future outbreaks, it is imperative that we understand which nursing homes are more likely to experience COVID‐19 cases. Our aim was to examine the characteristics of nursing homes with documented COVID‐19 cases in the 30 states reporting the individual facilities affected.
DESIGN
We constructed a database of nursing homes with verified COVID‐19 cases as of May 11, 2020, via correspondence with and publicly available reports from state departments of health. We linked this information to nursing home characteristics and used regression analysis to examine the association between these characteristics and the likelihood of having a documented COVID‐19 case.
SETTING
All nursing homes from 30 states that reported COVID‐19 cases at the facility‐level.
PARTICIPANTS
Nursing home residents in states reporting data.
MEASUREMENTS
Whether a nursing home had a reported COVID‐19 case (yes/no), and conditional on having a case, the number of cases at a nursing home.
RESULTS
Of 9,395 nursing homes in our sample, 2,949 (31.4%) had a documented COVID‐19 case. Larger facility size, urban location, greater percentage of African American residents, non‐chain status, and state were significantly (P < .05) related to the increased probability of having a COVID‐19 case. Five‐star rating, prior infection violation, Medicaid dependency, and ownership were not significantly related.
CONCLUSION
COVID‐19 cases in nursing homes are related to facility location and size and not traditional quality metrics such as star rating and prior infection control citations. J Am Geriatr Soc 68:1653‐1656, 2020.
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BACKGROUND/OBJECTIVES
Previous studies have reported that older patients may experience worse outcome(s) after infection with severe acute respiratory syndrome coronavirus‐2 than younger individuals. ...This study aimed to identify potential risk factors for mortality in older patients with coronavirus disease 2019 (COVID‐19) on admission, which may help identify those with poor prognosis at an early stage.
DESIGN
Retrospective case‐control.
SETTING
Fever ward of Sino‐French New City Branch of Tongji Hospital, Wuhan, China.
PARTICIPANTS
Patients aged 60 years or older with COVID‐19 (n = 244) were included, of whom 123 were discharged and 121 died in hospital.
MEASUREMENTS
Data retrieved from electronic medical records regarding symptoms, signs, and laboratory findings on admission, and final outcomes of all older patients with COVID‐19, were retrospectively reviewed. Univariate and multivariate logistic regression analyses were used to explore risk factors for death.
RESULTS
Univariate analysis revealed that several clinical characteristics and laboratory variables were significantly different (ie, P < .05) between discharged and deceased patients. Multivariable logistic regression analysis revealed that lymphocyte (LYM) count (odds ratio OR = 0.009; 95% confidence interval CI = 0.001‐0.138; P = .001) and older age (OR = 1.122; 95% CI = 1.007‐1.249; P = .037) were independently associated with hospital mortality. White blood cell count was also an important risk factor (P = .052). The area under the receiver operating characteristic curve in the logistic regression model was 0.913. Risk factors for in‐hospital death were similar between older men and women.
CONCLUSION
Older age and lower LYM count on admission were associated with death in hospitalized COVID‐19 patients. Stringent monitoring and early intervention are needed to reduce mortality in these patients. J Am Geriatr Soc 68:E19–E23, 2020.
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Background
Presently a median of 37.5% of the U.S. skilled nursing facility (SNF) workforce has been vaccinated for COVID‐19. It is essential to understand vaccine hesitancy among SNF workers to ...inform vaccine campaigns going forward.
Objective
To describe the concerns raised among healthcare workers and staff from SNFs during town hall meetings.
Design
Sixty‐three SNFs from four corporations were invited to send Opinion Leaders, outspoken staff from nursing, nurse aid, dietary, housekeeping or recreational therapy, to attend a 1‐h virtual town hall meeting. Meetings used a similar format where the moderator solicited concerns that the attendees themselves had or had heard from others in the facility about the COVID‐19 vaccine. Physicians and moderators used personal stories to address concerns and reaffirmed positive emotions.
Setting
Twenty‐six video town hall meetings with SNF staff.
Participants
Healthcare workers and staff, with physicians serving as content experts.
Measurement
Questions and comments about the COVID‐19 vaccines noted by physicians.
Results
One hundred and ninety three staff from 50 facilities participated in 26 meetings between December 30, 2020 and January 15, 2021. Most staff reported getting information about the vaccine from friends or social media. Concerns about how rapidly the vaccines were developed and side effects, including infertility or pregnancy related concerns, were frequently raised. There were no differences in concerns raised by discipline. Questions about returning to prior activities after being vaccinated were common and offered the opportunity to build on positive emotions to reduce vaccine hesitancy.
Conclusions
Misinformation about the COVID‐19 vaccine was widespread among SNF staff. Sharing positive emotions and stories may be more effective than sharing data when attempting to reduce vaccine hesitancy in SNF staff.
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Aims
Coronavirus disease 2019 (COVID‐19) is a still growing pandemic, causing many deaths and socio‐economic damage. Elevated expression of the severe acute respiratory syndrome coronavirus 2 ...(SARS‐CoV‐2) entry receptor angiotensin‐converting enzyme 2 on cardiac cells of patients with heart diseases may be related to cardiovascular burden. We have thus analysed cardiovascular and inflammatory microRNAs (miRs), sensitive markers of cardiovascular damage, in critically ill, ventilated patients with COVID‐19 or influenza‐associated acute respiratory distress syndrome (Influenza‐ARDS) admitted to the intensive care unit and healthy controls.
Methods and results
Circulating miRs (miR‐21, miR‐126, miR‐155, miR‐208a, and miR‐499) were analysed in a discovery cohort consisting of patients with mechanically‐ventilated COVID‐19 (n = 18) and healthy controls (n = 15). A validation study was performed in an independent cohort of mechanically‐ventilated COVID‐19 patients (n = 20), Influenza‐ARDS patients (n = 13) and healthy controls (n = 32). In both cohorts, RNA was isolated from serum and cardiovascular disease/inflammatory‐relevant miR concentrations were measured by miR‐specific TaqMan PCR analyses. In both the discovery and the validation cohort, serum concentration of miR‐21, miR‐155, miR‐208a and miR‐499 were significantly increased in COVID‐19 patients compared to healthy controls. Calculating the area under the curve using receiver operating characteristic analysis miR‐155, miR‐208a and miR‐499 showed a clear distinction between COVID‐19 and Influenza‐ARDS patients.
Conclusion
In this exploratory study, inflammation and cardiac myocyte‐specific miRs were upregulated in critically ill COVID‐19 patients. Importantly, miR profiles were able to differentiate between severely ill, mechanically‐ventilated Influenza‐ARDS and COVID‐19 patients, indicating a rather specific response and cardiac involvement of COVID‐19.
Circulating levels of inflammation and cardiac myocyte‐specific miRs are dysregulated in the blood of critically ill COVID‐19 patients compared to healthy individuals and also severely ill Influenza‐ARDS patients.
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The worldwide coronavirus (COVID‐19) has had profound effects on all aspects of life: physical health, the ability to travel locally or to more distant destinations, material and financial resources, ...and psychosocial wellbeing. Couples, families, and communities and individual persons in those relationships have struggled to cope with emerging depression, anxiety, and trauma, and the rise of relational conflict. In this article, we suggest that the existential nature of the pandemic’s challenges requires more than just the usual psychosocial interventions. We propose a taxonomy of responses to foster coping and resilience—“Reaching Up, Down, In, and Around.” “Reaching Up” includes accessing spiritual, religious, and ethical values. “Reaching Down” includes ideas and practices that foster a revised relationship with the Earth and its resources, and that engage families to participate in activities that aid the Earth’s recovery from decades of human‐caused damage. “Reaching In” represents a turn towards experiences available in the mind and in shared minds in relationships that provide pleasure, excitement, joy, and peace, given that external sources of these emotions are of limited availability due to quarantine. “Reaching Around” involves reframing the mandate for “social distancing” as fostering social connection and support while maintaining physical distancing. The challenges for family therapists, whose practices are confined largely to online therapy, and who are struggling with the same fears and constraints as those persons they are attempting to help, are also discussed.
RESUMEN
El coronavirus (la COVID‐19) mundial ha tenido efectos profundos en todos los aspectos de la vida: en la salud física, en la posibilidad de viajar a nivel local o a destinos más distantes, en los recursos materiales y económicos y en el bienestar psicosocial. Las parejas, las familias, las comunidades y las personas individuales de esas relaciones se han esforzado para hacer frente a la depresión, la ansiedad y el trauma emergentes, y al aumento del conflicto relacional. En este artículo, sugerimos que la índole existencial de las dificultades de la pandemia necesita más que solo las intervenciones psicosociales habituales. Proponemos una taxonomía de respuestas para fomentar el afrontamiento y la resiliencia: “Llegar arriba, abajo, adentro y alrededor”. “Llegar arriba” implica acceder a valores espirituales, religiosos y éticos. “Llegar abajo” implica ideas y prácticas que fomenten una relación revisada con la Tierra y sus recursos, y que capten la atención de las familias para participar en actividades que ayuden a la recuperación de la Tierra de décadas de daño causado por los humanos. “Llegar adentro” representa un giro hacia experiencias que hay en la mente y entre mentes por relaciones que brindan placer, entusiasmo, alegría y paz, dado que la disponibilidad de las fuentes externas de estas emociones es limitada debido a la cuarentena. “Llegar alrededor” implica replantear la orden de “distanciamiento social” como fomento de la conexión social y el apoyo mientras se mantiene la distancia física. También se explican las dificultades para los terapeutas familiares, cuyas prácticas están limitadas en gran medida a la terapia en línea, y quienes están luchando contra los mismos miedos y limitaciones que esas personas a quienes intentan ayudar.
摘要
全球范围内冠状病毒(COVID‐19)对生活的所有方面都产生了深远影响：身体健康、当地的旅行或去往更遥远目的地的旅行能力、物质和财政资源以及心理社会方面的福祉。夫妻、家庭、社区和个人等各种关系中的人们都在努力应对较之以前有所增加的新出现的抑郁、焦虑、创伤和关系冲突。在这篇文章中，我们提出与大流行病随之而来的挑战其存在的本质要求的不再仅仅是平常的心理社会干预。我们提出了一种培养应对能力和复原力的分类应对措施——“向上、向下、向内和向周围求助”。“向上”包括获得精神、宗教和伦理价值。“向下”包括促进与地球及其资源的一种新型关系的思想和实践，以及让家庭参与帮助地球从几十年人为破坏中恢复的活动中来。“向内”代表着一种转向，转向在内心上和在人际关系中给大家提供快乐、兴奋、快乐和平静的经验，因为这些情绪其外部来源由于隔离变得有限。“向周围求助”包括重新定义“社会距离”的禁足令，即在保持身体距离的同时，培养社会联系和支持。家庭治疗师的实践大多局限于在线治疗，他们与那些他们试图帮助的人一样，也在与同样的恐惧和约束作斗争，本文也讨论了他们面临的挑战。
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Summary
Many people report suffering from post‐acute sequelae of COVID‐19 or “long‐COVID”, but there are still open questions on what actually constitutes long‐COVID and how prevalent it is. The ...current definition of post‐acute sequelae of COVID‐19 is based on voting using the Delphi‐method by the WHO post‐COVID‐19 working group. It emphasizes long‐lasting fatigue, shortness of breath and cognitive dysfunction as the core symptoms of post‐acute sequelae of COVID‐19. In this international survey study consisting of 13,628 subjects aged 18–99 years from 16 countries of Asia, Europe, North America and South America (May–Dec 2021), we show that post‐acute sequelae of COVID‐19 symptoms were more prevalent amongst the more severe COVID‐19 cases, i.e. those requiring hospitalisation for COVID‐19. We also found that long‐lasting sleep symptoms are at the core of post‐acute sequelae of COVID‐19 and associate with the COVID‐19 severity when COVID‐19 cases are compared with COVID‐negative cases. Specifically, fatigue (61.3%), insomnia symptoms (49.6%) and excessive daytime sleepiness (35.8%) were highly prevalent amongst respondents reporting long‐lasting symptoms after hospitalisation for COVID‐19. Understanding the importance of sleep‐related symptoms in post‐acute sequelae of COVID‐19 has a clinical relevance when diagnosing and treating long‐COVID.
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