We performed three experiments to investigate whether adjectives can modulate the sensorimotor activation elicited by nouns. In Experiment 1, nouns of graspable objects were used as stimuli. ...Participants had to decide if each noun referred to a natural or artifact, by performing either a precision or a power reach‐to‐grasp movement. Response grasp could be compatible or incompatible with the grasp typically used to manipulate the objects to which the nouns referred. The results revealed faster reaction times (RTs) in compatible than in incompatible trials. In Experiment 2, the nouns were combined with adjectives expressing either disadvantageous information about object graspability (e.g., sharp) or information about object color (e.g., reddish). No difference in RTs between compatible and incompatible conditions was found when disadvantageous adjectives were used. Conversely, a compatibility effect occurred when color adjectives were combined with nouns referring to natural objects. Finally, in Experiment 3 the nouns were combined with adjectives expressing tactile or shape proprieties of the objects (e.g., long or smooth). Results revealed faster RTs in compatible than in incompatible condition for both noun categories. Taken together, our findings suggest that adjectives can shape the sensorimotor activation elicited by nouns of graspable objects, highlighting that language simulation goes beyond the single‐word level.
Prevalence of sarcopenia is substantial in most geriatrics settings, but estimates vary greatly across studies because of difference in population characteristics, diagnostic criteria, and methods ...used to assess muscle mass, muscle strength, and physical performance. We investigated the feasibility of the European Working Group on Sarcopenia in Older People (EWGSOP) algorithm assessment in hospitalized older adults and analyzed prevalence and clinical correlates of sarcopenia.
Cross-sectional analysis of 655 participants enrolled in a multicenter observational study of older adults admitted to 12 acute hospital wards in Italy. Sarcopenia was assessed as low skeletal mass index (kg/m2) plus either low handgrip strength or low walking speed (EWGSOP criteria). Skeletal muscle mass was estimated using bioimpedance analysis.
Of the 655 patients (age 81.0 ± 6.8 years; women 51.9%) enrolled in the study, 275 (40.2%) were not able to perform the 4-m walking test because of medical problems. The overall prevalence of sarcopenia on hospital admission was 34.7% (95% confidence interval 28-37) and it steeply increased with aging (p < .001). In multivariable analysis, patients with sarcopenia on hospital admission were older and were more likely to be male and to have congestive heart failure, cerebrovascular disease, and severe basic activities of daily living disability. The prevalence of sarcopenia was inversely correlated with body mass index.
Based on EWGSOP criteria, prevalence of sarcopenia is extremely high among older adults on admission to acute hospital wards. Older age, male gender, congestive heart failure, cerebrovascular disease, severe activities of daily living disability, and body mass index were the clinical variables significantly associated with the presence of sarcopenia.
Background
New evidence is emerging on the importance of lean body mass during periods of illness and recovery. The preservation of lean body mass during such periods of intense stress impacts both ...patient and treatment outcomes. However, data concerning the incidence of sarcopenia among older people during hospitalization are scarce. The objective of this study was to evaluate the development of sarcopenia in a sample of hospitalized older subjects.
Methods
We used data of 394 participants from the multicentre Italian Study conducted by the Gruppo Lavoro Italiano Sarcopenia—Trattamento e Nutrizione (GLISTEN) in 12 Acute Care Wards (Internal Medicine and Geriatrics) of University Hospitals across Italy. This study was designed to determine the prevalence of sarcopenia at hospital admission and the change in muscle mass and strength during hospitalization. Sarcopenia was defined as low skeletal mass index (kg/m2) along with either low handgrip strength or slow walking speed European Working Groups on Sarcopenia in Older People (EWGSOP) criteria. Estimation of skeletal muscle mass was performed by bioelectrical impedance analysis (BIA).
Results
The mean age of the 394 enrolled patients (including 211 females who accounted for 53% of the sample) was 79.6 ± 6.4 years. Among those without sarcopenia at hospital admission, 14.7% of the study sample met the EWGSOP sarcopenia diagnostic criteria at discharge. The incidence of sarcopenia during hospitalization was significantly associated with the number of days spent in bed but was not correlated with the total length of hospital stay. In particular, patients who developed sarcopenia spent an average of 5.1 days in bed compared with 3.2 days for those with no sarcopenia at discharge (P = 0.02). Patients with sarcopenia showed a significantly lower body mass index compared with non‐sarcopenic peers (25.0 ± 3.8 kg/m2 vs. 27.6 ± 4.9 kg/m2, respectively; P < 0.001). Similarly, the skeletal mass index at admission was significantly lower among patients who developed sarcopenia during hospital stay.
Conclusions
Incident sarcopenia during hospital stay is relatively common and is associated with nutritional status and the number of days of bed rest.
In older and multimorbid patients, chronic conditions may affect the prognostic validity of computed tomography (CT) findings in COVID-19. This study aims at assessing to which extent CT findings ...have prognostic implications in COVID-19 older patients.
Hospitalized COVID-19 patients aged 60 years or more enrolled in the multicenter, observational and longitudinal GeroCovid study who underwent chest CT were included. Patients were stratified by tertiles of age and pneumonia severity to compare CT findings. Hierarchical clustering based on CT findings was performed to identify CT-related classificatory constructs, if any. The hazard ratio (HR) of mortality was calculated for individual CT findings and for clusters, after adjusting for potential confounders.
380 hospitalized COVID-19 patients, with a mean age of 78 (SD:9) years, underwent chest CT scan. Ground glass opacity (GGO), consolidation, and pleural effusion were the three most common CT findings, with GGO prevalence decreasing from younger to older patients and pleural effusion increasing. More severe the pneumonia more prevalent were GGO, consolidation and pleural effusion. HR of mortality was 1.94 (95%CI 1.24-3.06) for pleural effusion and 13 (95%CI 6.41-27) for cluster with a low prevalence of GGO and a high prevalence of pleural effusion ("LH"), respectively. Out of the three CT based clusters, "LH" was the only independent predictor in the multivariable model.
Pleural effusion qualifies as a distinctive prognostic marker in older COVID-19 patients. Research is needed to verify whether pleural effusion reflects COVID-19 severity or a coexisting chronic condition making the patient at special risk of death.
ClinicalTrials.gov: NCT04379440.
Abstract Pneumonia is one of the main causes of morbidity and mortality in the elderly. The elderly population has exponentially increased in the last decades and the current epidemiological trends ...indicate that it is expected to further increase. Therefore, recognizing the special needs of older people is of paramount importance. In this review we address the main differences between elderly and adult patients with pneumonia. We focus on several aspects, including the atypical clinical presentation of pneumonia in the elderly, the methods to assess severity of illness, the appropriate setting of care, and the management of comorbidities. We also discuss how to approach the common complications of severe pneumonia, including acute respiratory failure and severe sepsis. Moreover, we debate whether or not elderly patients are at higher risk of infection due to multi-drug resistant pathogens and which risk factors should be considered when choosing the antibiotic therapy. We highlight the differences in the definition of clinical stability and treatment failure between adults and elderly patients. Finally, we review the main outcomes, preventive and supportive measures to be considered in elderly patients with pneumonia.
Atrial fibrillation (AF), the most frequent arrhythmia of older patients, associates with serious thromboembolic complications and high mortality. Coronavirus disease 2019 (COVID-19) severely affects ...aged subjects, determining an important prothrombotic status. The aim of this study was to evaluate mortality-related factors in older AF patients with COVID-19.
Between March and June 2020, we enrolled ≥60 year-old in-hospital COVID-19 patients (
806) in GeroCovid, a multicenter observational study promoted by the Italian Society of Gerontology and Geriatric Medicine.
The prevalence of AF was 21.8%. In-hospital mortality was higher in the AF group (36.9 vs. 27.5%,
= 0.015). At admission, 51.7, 10.2, and 38.1% of AF cases were taking, respectively, oral anticoagulants (OACs), antiplatelet agents, and no antithrombotic therapy. During hospitalization, 51% patients switched to low-molecular-weight heparins. AF patients who survived were younger (81 ± 8 vs. 84 ± 7 years;
= 0.002) and had a lower CHA
DS
-VASc score (3.9 ± 1.6 vs. 4.4 ± 1.3;
= 0.02) than those who died. OAC use before (63.1 vs. 32.3%;
< 0.001) and during hospitalization (34.0 vs. 12.7%;
= 0.002) was higher among survivors. At multivariable analysis, lower age, higher self-sufficiency, less severe initial COVID-19 presentation, and the use of vitamin K antagonists (odds ratio OR = 0.16, 95% confidence interval CI: 0.03-0.84) or direct OACs (OR = 0.22, 95% CI: 0.08-0.56) at admission, or the persistence of OAC during hospitalization (OR = 0.05, 95% CI: 0.01-0.24), were associated with a lower chance of in-hospital death.
AF is a prevalent and severe condition in older COVID-19 patients. Advanced age, dependency, and relevant clinical manifestations of disease characterized a worse prognosis. Preadmission and in-hospital anticoagulant therapies were positively associated with survival.
Background and aims
Atrial fibrillation (AF) is often complicated by disabling conditions in the elderly. COVID-19 has high mortality in older people. This study aimed at evaluating the relationship ...of pre-infection AF with characteristics and survival of older COVID-19 patients.
Methods
We retrospectively analyzed inpatients aged ≥ 60 years enrolled in GeroCovid Observational, a multicenter registry endorsed by the Italian and the Norwegian Societies of Gerontology and Geriatrics. Pre-COVID-19 sociodemographic, functional, and medical data were systematically collected, as well as in-hospital mortality.
Results
Between March and June 2020, 808 COVID-19 subjects were enrolled (age 79 ± 9 years; men 51.7%). The prevalence of AF was 21.8%. AF patients were older (82 ± 8 vs. 77 ± 9 years,
p
< 0.001), had a higher CHA
2
DS
2
-VASc score (4.1 ± 1.5 vs. 3.2 ± 1.5,
p
< 0.001) and were more likely to present almost all comorbidities. At multivariable analysis, advanced age, white blood cell count, the presence of heart and peripheral artery diseases were significantly associated with the presence of AF. In-hospital mortality was higher in AF patients (36.9 vs. 27.5%; OR = 1.55, 95% CI = 1.09–2.20;
p
= 0.015). A decision tree analysis showed that, in AF subjects, preserved functional status at admission was the most important factor associated with survival. In patients without AF, baseline COVID-19 severity was the most relevant variable related to clinical prognosis.
Conclusions
AF is frequent in older patients with COVID-19, in whom it associates with clinical complexity and high mortality. Pre-infection disability shapes the prognosis of this extremely vulnerable segment of hospitalized subjects.
Clinical trial registration
GeroCovid Observational was registered at
www.clinicaltrials.gov
(NCT04379440).
We present a case report of an older patient with aortic stenosis who was managed before and after transcatheter aortic valve implantation by a team of cardiologists but without the support of a ...geriatrician. We first describe the patient's post-interventional complications from a geriatric perspective and afterwards, discuss the unique approach that the geriatrician would have provided. This case report was written by a group of geriatricians working in an acute hospital, along with a clinical cardiologist who is an expert in aortic stenosis. We discuss the implications for modifying conventional practice in tandem with existing literature.
...the pharmaceutical industry and upstream regulatory agencies should support and pursue a real-life validation of vaccines against COVID-19 in the most at-risk population. ...some multicentre ...initiatives, such as GeroCovid Vax 13, are monitoring vaccinated nursing home residents over time and will provide reliable information on shorter and longer-term safety and efficacy of COVID-19 vaccines in such vulnerable population.Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.Acknowledgements We are thankful to the colleagues of the GeroCovid Working Group who are collaborating in data collection for their valuable contribution, and to all the study participants.Authors’ contribution All authors attest they meet the ICMJE criteria for authorship.Funding source None.Appendix A Supplementary material Supplementary data to this article can be found online at https://doi.org/10.1016/j.vaccine.2021.03.066.Appendix A Supplementary material The following are the Supplementary data to this article: Supplementary data 1 Pfizer/BionTech 4 Moderna 5 Oxford-AstraZeneca 7 Age classes 42.2% with age > 55 years 24.8% with age ≥65 years 15.9% with age >55 year (10.9% from 56 to 70 years, and 5% >70 years) Inclusion criteria - Healthy participants who, through medical history, physical examination, and clinical judgment of the investigator are eligible for inclusion in the study. -
Background
Delirium is an acute neuropsychiatric condition associated with unfavourable outcomes, frequent in older hospitalized people. In the context of the SARS-CoV-2 pandemic, few studies have ...specifically focused on the inflammatory status of older, frail patients with hyperactive delirium (HD) hospitalized for COVID-19.
Aim
To identify biological correlates of HD at hospital admission and to assess the independent effect of delirium and physical frailty on in-hospital mortality.
Methods
Data were retrospectively extracted by the multicenter registry GeroCovid Observational Study. Individuals aged ≥ 60 years were included if the information on the presence of HD, frailty based on the modified Fried criteria and inflammatory status had been collected. The risk of mortality was evaluated using a Kaplan–Meier estimator, according to frailty and delirium. Logistic and restricted cubic-spline regressions were employed to assess the relationship between inflammatory markers and HD.
Results
Three-hundred-thirty-seven older adults were included in the analysis mean age (SD) 77.1 (9.5) years, 50.1% females, and 11.5% presented with HD. A significant association of both PaO
2
/FiO
2
ratio (
p
= 0.015) and serum lactate dehydrogenase (
p
= 0.04) with delirium was observed. By Cox multivariable regression, frail and non-frail patients with HD had a 4.42 and 2.85 higher mortality risk compared with non-frail, non-delirious patients.
Conclusions
Hyperactive delirium at hospital admission is related with markers of lung failure among older adults, especially when physical frailty coexists. Delirium is associated with increased in-hospital mortality risk, which is doubled by the coexistence of physical frailty.
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